MEASURES OF HEALTH LITERACY
WORKSHOP SUMMARY
Lyla M. Hernandez, Rapporteur
THE NATIONAL ACADEMIES PRESS
Washington, D.C.
www.nap.edu
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NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.
This study was supported by contracts between the National Academy of Sciences and the Academy for Educational Development (Unnumbered Award); Affinity Health Plan (Unnumbered Award); American Academy of Family Physicians (Unnumbered Award); Johnson & Johnson (Unnumbered Award); Kaiser Permanente (Unnumbered Award); Merck & Co., Inc. (Unnumbered Award); Missouri Foundation for Health (08-048-HL-8); and U.S. Department of Health and Human Services (N01-OD-4-2139, TO#148). Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project.
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Suggested citation: IOM (Institute of Medicine). 2009. Measures of Health Literacy: Workshop Summary. Washington, DC: The National Academies Press.
THE NATIONAL ACADEMIES
Advisers to the Nation on Science, Engineering, and Medicine
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The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine.
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MEMBERS OF THE PLANNING GROUP FOR THE WORKSHOP ON MEASURES OF HEALTH LITERACY
CINDY BRACH, Senior Health Policy Researcher,
Center for Delivery, Organization, and Markets, Agency for Healthcare Research and Quality
CAROLYN COCOTAS, Senior Vice President,
Quality and Corporate Compliance, F.E.G.S. Health and Human Services System
DEBBIE FRITZ, Director,
Policy and Standards, Health Management Innovations Division, GlaxoSmithKline
RUTH PARKER, Professor of Medicine,
Emory University School of Medicine
TERRI TYE, Director of Public Affairs,
The Joint Commission
IOM planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published workshop summary rests with the workshop rapporteur and the institution.
ROUNDTABLE ON HEALTH LITERACY
GEORGE ISHAM (Chair), Medical Director and Chief Health Officer,
HealthPartners
SHARON E. BARRETT, Health Literacy Staff Consultant,
Association of Clinicians for the Underserved
CINDY BRACH, Senior Health Policy Researcher,
Center for Delivery, Organization, and Markets, Agency for Healthcare Research and Quality
CAROLYN COCOTAS, Senior Vice President,
Quality and Corporate Compliance, F.E.G.S. Health and Human Services System
MICHAEL L. DAVIS, Senior Vice President,
Human Resources, General Mills, Inc.
BENARD P. DREYER, Professor of Pediatrics,
New York University School of Medicine, and
Chair,
American Academy of Pediatrics Health Literacy Program Advisory Committee
DEBBIE FRITZ, Director,
Policy and Standards, Health Management Innovations Division, GlaxoSmithKline
MELODY GOLLER, Health Education Manager,
Scientific Activities Division, American Academy of Family Physicians Foundation
MARTHA GRAGG, Vice President of Program,
Missouri Foundation for Health
LINDA HARRIS, Team Leader,
Health Communication and eHealth Team, Office of Disease Prevention and Health Promotion, U.S. Department of Health and Human Services
BETSY L. HUMPHREYS, Deputy Director,
National Library of Medicine, National Institutes of Health
TERRIS KING, Deputy Director,
Office of Clinical Standards and Quality, Centers for Medicare & Medicaid Services
JEAN KRAUSE, Executive Vice President and CEO,
American College of Physicians Foundation
MARGARET LOVELAND,
Global Medical Affairs, Merck & Co., Inc.
DENNIS MILNE, Vice President of American Stroke Association and Patient Education,
American Heart Association
RUTH PARKER, Professor of Medicine,
Emory University School of Medicine
YOLANDA PARTIDA, Director,
National Program Office, Hablamos Juntos, University of California, San Francisco, Fresno Center for Medical Education & Research
IOM forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published workshop summary rests with the workshop rapporteur and the institution.
SCOTT C. RATZAN, Vice President,
Global Health, Johnson & Johnson
KYU BAK LOUIS RHEE, Director,
Office of Innovation and Program Coordination, National Center on Minority Health and Health Disparities, National Institutes of Health
WILL ROSS, Associate Dean for Diversity, Associate Professor of Medicine,
Washington University School of Medicine
WILLIAM SMITH, Senior Scientist and Director,
Academy for Educational Development
AMY WILSON-STRONKS, Project Director,
Division of Standards and Survey Methods, and
Principal Investigator,
Hospitals, Language, and Culture Study, The Joint Commission
WINSTON F. WONG, Medical Director,
Community Benefit, Disparities Improvement and Quality Initiatives, Kaiser Permanente
SABRA WOOLLEY, Program Director,
Health Communication and Informatics Branch, National Cancer Institute
Study Staff
LYLA M. HERNANDEZ, Senior Program Officer
ERIN HAMMERS, Research Associate
ERIN RUSCH, Research Assistant
ROSE MARIE MARTINEZ, Director,
Board on Population Health and Public Health Practice
Reviewers
This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report:
Benard Dreyer, New York University School of Medicine
Crystal Duran, Cultural & Linguistics Unit, CIGNA
Jean Krause, American College of Physicians Foundation
Rima Rudd, Harvard School of Public Health
Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the final draft of the report before its release. The review of this report was overseen by Harold J. Fallon, School of Medicine, University of Alabama at Birmingham. Appointed by the Institute of Medicine, he was responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the author and the institution.
in memoriam
This workshop summary is dedicated to Dr. Sabra Woolley, an accomplished researcher and advocate in the field of health communication, health literacy, and health disparities, a valued sponsor and founding member of the Roundtable on Health Literacy, and an irreplaceable colleague and friend.
Acknowledgments
The sponsors of the Institute of Medicine Roundtable on Health Literacy made it possible to plan and conduct the workshop, Measures of Health Literacy. Sponsors from the U.S. Department of Health and Human Services are the Health Resources and Services Administration, the Office of Disease Prevention and Health Promotion, and the National Cancer Institute. Non-federal sponsorship was provided by the Academy for Educational Development, Affinity Health Plan, American Academy of Family Physicians, Johnson & Johnson, Kaiser Permanente, Merck & Co., Inc., and the Missouri Foundation for Health.
The Roundtable wishes to express its appreciation to the expert speakers whose presentations illuminated the ongoing work in developing measures of health literacy. These speakers were Marin Allen, Lisa Chew, Carolyn Clancy, John DuMoulin, Julie Gazmararian, Elizabeth Hahn, Amresh Hanchate, Nicole Lurie, Kathleen Mazor, Lauren McCormack, Ruth Parker, Andrew Pleasant, Sandra Smith, Beverly Weidmer Ocampo, Barry Weiss, and Amy Wilson-Stronks.
The Roundtable also wishes to thank the planning committee members for their work in developing an excellent workshop agenda. Members of the planning committee were Cindy Brach, Carolyn Cocotas, Debbie Fritz, Ruth Parker, and Terri Tye. Thanks also go to Cindy Brach, Carolyn Cocotas, and George Isham for moderating the workshop.
FIGURES
2-1 |
Causal pathways between limited health literacy and health outcomes, |
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2-2 |
Conceptual model of the relationship among individual capacities, health-related print and oral literacy, and health outcomes, |
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2-3 |
Health care system and patients/public, |
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3-1 |
Conceptual framework for individual health literacy, |
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3-2 |
Signs of a stroke, |
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3-3 |
Caution symbols on medication bottles, |
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3-4 |
Item response theory, |
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3-5 |
Prose item, |
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3-6 |
Medications for Mr. Beta, |
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3-7 |
Sample body mass index chart, |
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3-8 |
Receiver Operating Characteristic curves for detecting limited health literacy, |
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3-9 |
Functional Healthcare Literacy Scale, |
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3-10 |
Functional Selfcare Literacy Scale, |
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3-11 |
Home visitation promotes parental functional health literacy, |
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4-1 |
Results: Comparison of S-TOFHLA and DAHL scores, |
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4-2 |
Mean health literacy by Public Use Microdata Area (PUMA) for Missouri, |
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4-3 |
Model and single variable estimates produce different area-level estimates, |
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5-1 |
Operating funds allocated to cultural and linguistic services, |
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6-1 |
Health literacy framework, |