Conclusions
Health literacy is a complicated construct that depends on individual capacity to communicate and the demands posed by society and the health care system. More comprehensive tests are needed to understand the gap between capacities and current demands to help guide efforts to educate children and adults about health issues and to develop health-related information that more of the general public can understand. For research, new instruments are needed that will measure individuals reading fluency more precisely without posing an undue response burden. Computer-assisted testing, which selects items from a bank of possible items according to a baseline-predicted reading ability and responses to previous questions, should allow more accurate measurement of indiidual capacity without increasing the time required to complete testing. It remains unclear whether it is possible to develop an accurate, practical “screening” test to identify individuals with limited health literacy. Even if this goal is achieved, it remains unclear whether it is better to screen patients or to adopt “universal precautions” to avoid miscommunication by using plain language in all oral and written communication and confirming understanding with all patients by having them repeat back their understanding of their diagnosis and treatment plan. George Bernard Shaw said, “The main problem with communication is the assumption that it has occurred.” This is a universal truth that transcends reading ability.
Similar content being viewed by others
References
Communicating with patients who have limited literacy skills. Report of the National Work Group on Literacy and Health. J Fam Pract. 1998;46:168–76.
Ad Hoc Committee on Health Literacy. Health literacy: report of the council on scientific affairs. JAMA. 1999;281:552–7.
Institute of Medicine. Health Literacy: A Prescription to End Confusion. Washington, DC: National Academies Press; 2004.
Berkman ND, DeWalt DA, Pignone MP, et al. Literacy and Health Outcomes. Evidence Report/Technology Assessment No. 87. Rockville, MD: Agency for Healthcare Research and Quality; 2004.
U.S. Department of Health and Human Services. Health People 2010: Understanding and Improving Health. Chapter 11. 2nd edn. Washington, DC: U.S. Government Printing Office; 2000.
Baker DW, Gazmararian JA, Sudano J, Patterson M. The association between age and health literacy among elderly persons. J Gerontol B Psychol Sci Soc Sci. 2000;55:S368–74.
American College of Physicians. Downloadable Patient Health Care Information. Available at: http://www.doctorsforadults.com/download.htm?dfa. Accessed April 1, 2006.
Kirsch I, Jungeblut A, Jenkins L, Kolstad A. Adult Literacy in America: A First Look at the Results of the National Adult Literacy Survey. Washington, DC: National Center for Education, U.S. Department of Education; 1993.
Schwartz LM, Woloshin S, Black WC, Welch HG. The role of numeracy in understanding the benefit of screening mammography. Ann Intern Med. 1997;127:966–72.
Lipkus IM, Samsa G, Rimer BK. General performance on a numeracy scale among highly educated samples. Med Decis Making. 2001;21:37–44.
Adelsward V, Sachs L. The meaning of 6.8: numeracy and normality in health information talks. Soc Sci Med. 1996;43:1179–87.
Baker DW, Williams MV, Parker RM, Gazmararian JA, Nurss J. Development of a brief test to measure functional health literacy. Patient Educ Couns. 1999;38:33–42.
Parker RM, Baker DW, Williams MV, Nurss JR. The Test of Functional Health Literacy in Adults (TOFHLA): a new instrument for measuring patient’s literacy skills. J Gen Intern Med. 1995;10:537–42.
Davis TC, Long SW, Jackson RH, et al. Rapid estimate of adult literacy in medicine: a shortened screening instrument. Fam Med. 1993;25:391–5.
Fisher LD, van Belle G. Biostatistics: A Methodology for the Health Sciences. New York, NY: John Wiley and Sons; 1993.
Jastak S, Wilkinson GS. WRAT-R, Wide Range Achievement Test, Administration Manual, Revised Edition. Wilmington, DE: Jastak Assessment Systems; 1984.
Miller JD. The measurement of scientific literacy. Public Understand Sci. 1998;7:203–23.
Williams MV, Baker DW, Honig EG, Lee ML, Nowlan A. Inadequate literacy is a barrier to asthma knowledge and self-care. Chest. 1998;114:1008–15.
Williams MV, Baker DW, Parker RM, Nurss JR. Relationship of functional health literacy to patients’ knowledge of their chronic disease. A study of patients with hypertension and diabetes. Arch Intern Med. 1998;158:166–72.
Gazmararian JA, Williams MV, Peel J, Baker DW. Health literacy and knowledge of chronic disease. Patient Educ Couns. 2003;51:267–75.
Baker DW, Brown J, Chan KS, Dracup KA, Keeler EB. A telephone survey to measure communication, education, self-management, and health status for patients with heart failure: the Improving Chronic Illness Care Evaluation (ICICE). J Card Fail. 2005;11:36–42.
Educational Testing Service. Test content for health activities literacy tests. Available at: http://www.ets.org/etsliteracy/. Accessed April 1, 2006.
Wolf MS, Gazmararian JA, Baker DW. Health literacy and functional health status among older adults. Arch Intern Med. 2005;165:1946–52.
Baker DW, Gazmararian JA, Williams MV, et al. Health literacy and use of outpatient physician services by medicare managed care enrollees. J Gen Intern Med. 2004;19:215–20.
Wolf MS, Davis TC, Arozullah A, et al. Relation between literacy and HIV treatment knowledge among patients on HAART regimens. AIDS Care. 2005;17:863–73.
Dolan NC, Ferreira MR, Fitzgibbon ML, et al. Colorectal cancer screening among African-American and white male veterans. Am J Prev Med. 2005;28:479–82.
Wolf MS, Davis TC, Cross JT, Marin E, Green K, Bennett CL. Health literacy and patient knowledge in a Southern US HIV clinic. Int J STD AIDS. 2004;15:747–52.
Dolan NC, Ferreira MR, Davis TC, et al. Colorectal cancer screening knowledge, attitudes, and beliefs among veterans: does literacy make a difference? J Clin Oncol. 2004;22:2617–22.
Seligman HK, Wang FF, Palacios JL, et al. Physician notification of their diabetes patients’ limited health literacy. A randomized, controlled trial. J Gen Intern Med. 2005;20:1001–7.
Bass PF III, Wilson JF, Griffith CH. A shortened instrument for literacy screening. J Gen Intern Med. 2003;18:1036–8.
Weiss BD, Mays MZ, Martz W, et al. Quick assessment of literacy in primary care: the newest vital sign. Ann Fam Med. 2005;3:514–22.
Williams MV, Parker RM, Baker DW, et al. Inadequate functional health literacy among patients at two public hospitals. JAMA. 1995;274:1677–82.
Chew LD, Bradley KA, Boyko EJ. Brief questions to identify patients with inadequate health literacy. Fam Med. 2004;36:588–94.
Wallace LS, Rogers ES, Roskos SE, Holiday DB, Weiss BD. Screening items to identify patients with limited health literacy skills. J Gen Intern Med. 2006;21:874–7.
Gazmararian JA, Baker DW, Williams MV, et al. Health literacy among medicare enrollees in a managed care organization. JAMA. 1999;281:545–51.
Folstein MF, Folstein SE, McHugh PR. “Mini-mental State.” A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12:189–98.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Baker, D.W. The meaning and the measure of health literacy. J GEN INTERN MED 21, 878–883 (2006). https://doi.org/10.1111/j.1525-1497.2006.00540.x
Issue Date:
DOI: https://doi.org/10.1111/j.1525-1497.2006.00540.x