By: Taylor Eisenstein
Health literacy skills can vary. The highest skill level is proficient, followed by intermediate, basic, and below basic. In the United States, according to results from the 2003 National Assessment of Adult Literacy, 53% of participants had intermediate health literacy. However, only 12% of adults possessed proficient health literacy. Many adults had lower skill levels of health literacy; 22% possessed basic health literacy and 14% of participants had below basic health literacy. Adults ages 65 and older had poorer average health literacy than younger adults.
Many literacy tests can assess health literacy through a variety of means. The Rapid Estimate of Adult Literacy in Medicine (REALM) assesses individuals on reading and pronunciation of various words, but it does not test comprehension. In contrast, the Test of Functional Health Literacy in Adults (TOFHLA) further assesses comprehension. For instance, it might ask individuals to interpret certain medical instructions. However, many individuals with low literacy may feel ashamed or embarrassed when their literacy status is disclosed through these tests.
Inadequate health literacy can have disastrous consequences for patients. The National Action Plan to Improve Health Literacy was introduced in May 2010 by the U.S. Department of Health and Human Services as a united effort to combat health literacy struggles. The plan consists of seven goals that culminate in the plan’s primary vision, which aims to create a society that “provides everyone access to accurate, actionable health information; delivers person-centered health information and services; and supports life-long learning and skills to promote good health.” Similarly, the Plain Writing Act of 2010, practiced by the CDC, was established to ensure that federal agencies communicate using language that is understandable to the general public. Further plans or potential screening strategies must be implemented to identify, educate, and assist patients with low health literacy, so that adverse outcomes can be prevented.
1. Kutner, M., Greenburg, E., Jin, Y., & Paulsen, C. (2006). The Health Literacy of America's Adults: Results from the 2003 National Assessment of Adult Literacy. NCES 2006-483. National Center for Education Statistics.
2. Williams, M. V., Baker, D. W., Honig, E. G., Lee, T. M., & Nowlan, A. (1998).
Inadequate literacy is a barrier to asthma knowledge and self-care. Chest, 114(4), 1008-1015.
3. Williams, M. V., Baker, D. W., Parker, R. M., & Nurss, J. R. (1998b).
Relationship of functional health literacy to patients' knowledge of their chronic disease: a study of patients with hypertension and diabetes. Archives of internal medicine, 158(2), 166-172.
4. Baker, D. W., Parker, R. M., Williams, M. V., Clark, W. S., & Nurss, J. (1997). The relationship of patient reading ability to self-reported health and use of health services. American journal of public health, 87(6), 1027-1030.