the basics - World Health Communication Associates

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