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Research and Evaluate

Overview and Methods for Measuring Health Literacy


Research and evaluation are essential pieces of the health literacy improvement process and effective public health practice. The only way we will know if the changes and interventions we implement are having the intended effect is when we conduct an evaluation. Evaluation occurs during the planning, implementation and outcome phases in the form of formative, process and outcome evaluations. The tools and resources below will help you think about what and how to research and evaluate.

Methods for Measuring Health Literacy

Survey Research

  • National Assessment of Adult Literacy (NAAL) – The NAAL is a nationally representative assessment of English literacy among America adults age 16 and older. Sponsored by the National Center for Education Statistics (NCES), the NAAL is the Nation's most comprehensive measure of adult literacy. The Health Literacy Component of the NAAL introduces the first-ever national assessment of adults' ability to use literacy skills with health-related materials and forms.
  • The National Center for Education Statistics (NCES) created state and county literacy estimates based on national data.
  • The National Assessment of Educational Progress (NAEP) is the largest nationally representative and continuing assessment of what America's students know and can do in various subject areas, including reading, math and science. Although these data are not specific to health literacy, the results provide reliable assessments of the underlying skills for health literacy in the school-aged population.
  • Health Literacy Skills Instrument: A survey research project led by Dr. Lauren McCormack at RTI International and funded by the NIH National Cancer Institute. The abstract describes the project as follows. "The specific aims of this study are to (1) develop a pool of survey items that reflect an operational definition and conceptual framework for health literacy using an expert consensus process, (2) ensure the functionality of the items by pretesting them using cognitive appraisal methodology, (3) pilot test the items with individuals at a variety of reading and educational levels, and (4) assess the psychometric properties of the health literacy items and examine their relationship with selected health outcomes including utilization of health care services."
    A summary of the project as of 2010 is available in the following journal article: McCormack L, et al. Measuring Health Literacy: A Pilot Study of a New Skills-based Instrument. Journal of Health Communication, 15: 51-71, 2010.
  • Consumer Assessment of Healthcare Providers and Systems (CAHPS) Questionnaire
    The CAHPS Consortium has developed a supplemental set for the CAHPS Clinician & Group Survey that focuses on assessing providers' activities to foster and improve the health literacy of patients. While health literacy depends in part on individuals' skills, it also depends on the complexity of health information and how it is communicated. The primary goal of the CAHPS Item Set for Addressing Health Literacy is to measure, from the patients' perspective, how well health information is communicated to them by health care professionals.
  • Research Underway in Health Literacy Supported by NIH (NIH 2010)
    NIH has funded the development of some health literacy research tools including surveys.

Organizational Assessment Tools

  • Pharmacy Audit Tool - This pharmacy health literacy tool was designed to capture perspectives of three critical audiences-objective auditors, pharmacy staff, and patients. The three parts of the assessment are complementary and designed to form a comprehensive assessment. Although the assessment was designed to be used in outpatient pharmacies of large, urban, public hospitals that primarily serve a minority population, it can be adapted for use in other pharmacy and non-pharmacy environments.
  • Universal Precautions Toolkit - The Agency for Healthcare Research and Quality commissioned the University of North Carolina at Chapel Hill to develop and test this Health Literacy Universal Precautions Toolkit. The toolkit offers primary care practices a way to assess their services for health literacy considerations, raise awareness of the entire staff, and work on specific areas.
  • The updated Evidence Report on Health Literacy Interventions and Outcomes from the Agency for Healthcare Research and Quality provides a brief discussion of instruments used in clinical research to measure health literacy. The authors conclude the instruments measure reading and to some extent numeracy skills rather than the broader concept of health literacy.
    • TOFHLA (S-TOFHLA) – A modified Cloze method to assess reading and numerical comprehension
    • REALM – Brief word recognition test
    • Newest Vital Sign – A 3 minute screening tool for use in clinical settings
  • The National Standards on Culturally and Linguistically Appropriate Services are directed at healthcare organizations to help make their healthcare services more culturally and linguistically accessible.
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  • Page last reviewed: August 5, 2011
  • Page last updated: February 12, 2014 The U.S. Government's Official Web PortalDepartment of Health and Human Services
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