the basics - World Health Communication Associates

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• Written communication regarding medications and tests;• Techniques utilized by health providers to ensure patient comprehension ofhealth information (commonly referred to as “teach back methods”); and• Patient-provider relationship.For more information see https://www.cahps.ahrq.gov/default.asp3.1 CURRENT MEASUREMENT TOOLS—INDIVIDUAL SKILLS ANDABILITIESREALMThe Rapid Estimate of Adult Literacy in Medicine (REALM) is a word recognitiontest. Patients are asked to read a list of 66 increasingly difficult medical terms. Thenumber of correctly pronounced words is subsequently related to approximate gradelevels of reading (0-18: third grade and below; 19-44: fourth to sixth grade; 45-60:seventh and eighth grade; 61-66: ninth grade and above). REALM is simple, brief(administered in two to three minutes) and useful for profiling patients’ reading skills.TOFHLA and S-TOFHLAComprehension tests—such as the Test of Functional Health Literacy in Adults(TOFHLA) and the Short Test of Functional Health Literacy in Adults (S-TOFHLA)—were designed to provide a broader assessment of functional health literacy. Theytake into account reading comprehension and quantitative literacy (numeracy).TOFHLA uses three passages of prose to assess reading comprehension. Theseare: (1) instructions for the preparation for an upper gastrointestinal tract x-ray, (2)the patient rights and responsibilities section of a selected application form, and(3) a standard hospital consent form. Each of these passages has about every fifthword eliminated and the respondent is asked to choose the most appropriate word tocomplete the sentence.S-TOFHLA uses only the first two passages. For both the TOFHLA and theS-TOFHLA, hospital forms and prescription bottles are also used to assess a patient’snumeracy skills, such as instructions for taking medication, appointment schedules,blood pressure and glucose monitoring, and obtaining financial assistance for bothof these tests.24SECTION 3: HOW IS HEALTH LITERACY MEASURED?
The number and type of quantitative tasks vary according to the version ofthe TOFHLA used. TOFHLA and S-TOFHLA have been shown to be reliable and validmeasures of functional health literacy. Although TOFHLA and S-TOFHLA are theprimary instruments by which reading comprehension and numeracy skills aremeasured, the time—22 minutes for the TOFHLA and 12 minutes for the S-TOFHLA—and complexity have limited their use to research within health care environments.NVSThe Newest Vital Sign (NVS) test is a health literacy screening tool administered inthree minutes. It requires users to read a standard nutrition label from a carton of icecream and answer a series of six questions. The concept implies that health literacy isa vital sign, just as heart rate and blood pressure are. As with the TOFHLA, there areEnglish and Spanish versions of the NVS. Currently, there is limited experience withthe NVS in the published literature.One-Item Screening MeasuresWhile researchers may choose to use one of the above tools, it may be necessaryfor practitioners in a busy health care environment to simplify the measurement ofhealth literacy. Because of the shame associated with limited health literacy, effortshave been made to identify simple screening questions that avoid the perception ofliteracy testing.One study evaluated a series of questions as potential predictors of healthliteracy as measured by the S-TOFHLA. Three questions emerged from the analysis asbest single-item screening measures:• How often do you have problems learning about your medical condition becauseof difficulty understanding written information?• How confident are you filling out medical forms by yourself?• How often do you have someone help you read hospital materials?In a follow-up study of the three questions, “How confident are you fillingout medical forms by yourself?” was identified as the best predictor of limitedhealth literacy skills when validated against REALM. Using a one-item screeningquestion during individual encounters is simple, less intrusive, and may be a practicalalternative to more complex measures.SECTION 3: HOW IS HEALTH LITERACY MEASURED? 25
Page 2 and 3: 2 FOREWORD
Page 6: SECTION 5: MESSAGES TO KEY STAKEHOL
Page 9 and 10: The guide has been developed throug
Page 11 and 12: WHO IS THIS GUIDE FOR?SUMMARYHealth
Page 13 and 14: Section 5: How can we advocate for
Page 15 and 16: systems and settings are ones which
Page 17 and 18: companies—which glamorise and pro
Page 19: Health literacy is best viewed as a
Page 22 and 23: 3. POOR HEALTH LITERACY IS ASSOCIAT
Page 24 and 25: Percent Alive50 60 70 80 90 100Adeq
Page 28 and 29: 3.2 MEASURING THE DEMAND AND COMPLE
Page 30 and 31: 3.3 SCORECARDSThe WHCA Action Guide
Page 32 and 33: 3.4 A PUBLIC HEALTH LITERACY KNOWLE
Page 34 and 35: Social CapitalLinks have also been
Page 36 and 37: They also have to move from communi
Page 38 and 39: Use active voiceAvoid unnecessaryja
Page 40 and 41: epidemic outbreak tracking (providi
Page 42 and 43: may also include direct instruction
Page 46 and 47: For example, children and young peo
Page 48 and 49: Initiatives which have been shown t
Page 50 and 51: · understanding of bias and levels
Page 52 and 53: 4.4 HOME AND COMMUNITY SETTINGSPeop
Page 54 and 55: 4.5 WORKPLACE SETTINGSThe workplace
Page 56: 4.6 POLICY-MAKING ARENASPolicies at
Page 61 and 62: SECTION 6: BUILDING NATIONAL AND LO
Page 63 and 64: REFERENCESAllen CE. 2001. 2000 pres
Page 65 and 66: Figueroa ME, Kincaid DL, Rani M & L
Page 67 and 68: Kickbusch I & Maag D. 2008. Health
Page 69 and 70: Parker RM, Ratzan, SC & Lurie N. 20
Page 71: Sudore RL, Yaffe K, Satterfield S,
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the basics - World Health Communication Associates

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