Annotated Bibliography
Updated December 2008
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Articles
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Baker DW, Wolf MS, Feinglass J, Thompson J, Gazmararian JA, Huang J. “Health literacy and mortality among elderly persons.” Archives of Internal Medicine. 2007 Jul 23;167(14):1503-9A.
The authors wanted to determine “whether low health literacy levels independently predict overall and cause-specific mortality.” Understanding that those with low health literacy have low health knowledge, self-management of chronic disease, and use of preventive services, the authors discovered that reading fluency “independently predicts all-cause mortality and cardiovascular death among community-dwelling elderly persons” (article abstract).
Health Literacy Innovations: National Survey of Medicaid Guidelines for Health Literacy http://www.healthliteracyinnovations.com/information/HLI_Medicaid_Survey.pdf
Houts PS, Doak CC, Doak LG, Loscalzo MJ. “The role of pictures in improving health communication: a review of research on attention, comprehension, recall, and adherence." Patient Education and Counseling. 2006 May; 61(2):173-90.
The goal of this article was to assess the effects of pictures on health communications. The authors found that “pictures closely linked to written or spoken text can, when compared to text alone, markedly increase attention to and recall of health education information. All patients can benefit, but patients with low literacy skills are especially likely to gain. Patients with very low literacy skills can be helped by spoken directions plus pictures to take home as reminders, or by pictures plus very simply worded captions” (article abstract).
Osborne, Helen. A compilation of health literacy articles. Health Literacy Consulting: Articles. http://www.healthliteracy.com/articles.asp
Safeer, Richard S. and Jann Keenan. “Health Literacy: The Gap Between Physicians and Patients.” American Family Physician. 2005 Aug 1; 72(3): 463-468. http://www.aafp.org/afp/20050801/463.pdf
Arguing that inadequate health literacy can result in “difficulty accessing health care, following instructions from a physician, and taking medication properly,” this article offers suggestions to health professionals on how to help patients who struggle with low literacy (article abstract).
Vernon, John A (lead author). Low Health Literacy Implication for National Health Policy http://www.gwumc.edu/sphhs/departments/healthpolicy/chsrp/downloads/LowHealthLiteracyReport10_4_07.pdf
Booklets and Brochures Available on the Web
- American Medical Association. Health Literacy
and patient safety: Help patients understand. 2nd edition.
May 2007. http://www.ama-assn.org/ama1/pub/upload/mm/367/healthlitclinicians.pdf
This booklet “reviews the problem of health literacy, its consequences for the health care system, and the likelihood that a clinician’s practice includes patients with limited literacy” (p. 7). The booklet also offers practical suggestions to clinicians and concludes with case discussions.
Berkman ND, DeWalt DA, Pignone MP, Sheridan SL, Lohr KN, Lux L, Sutton SF, Swinson T, Bonito AJ. Literacy and Health Outcomes. Evidence Report/Technology Assessment No. 87. Rockville, MD: Agency for Healthcare Research and Quality. January 2004. http://www.ahrq.gov/downloads/pub/evidence/pdf/literacy/literacy.pdf
This report on literacy and health outcomes was requested by the American Medical Association and funded by the AHRQ. The report addresses two key questions:
1: Are literacy skills related to: (a) Use of health care services? (b) Health outcomes? (c) Costs of health care? (d) Disparities in health outcomes or health care service use according to race, ethnicity, culture, or age?
2: For individuals with low literacy skills, what are effective interventions to: (a) Improve use of health care services? (b) Improve health outcomes? (c) Affect the costs of health care? (d) Improve health outcomes and/or health care service use among different racial, ethnic, cultural, or age groups? (p. 5)Center for Health Care Strategies, Inc. Health Literacy Fact Sheets, 1-9. http://www.chcs.org/usr_doc/Health_Literacy_Fact_Sheets.pdf
This series of nine fact sheets was created for those who are designing patient education materials for consumers with low health literacy skills. The sheets define health literacy, describe its impact on health outcomes, provide strategies to prepare appropriate educational materials to assist low-literate consumers, and provide resources for additional health literacy information and publications.
Crea, Kathleen. Health Literacy Sources: A Guide for Health Professionals. Jan. 2006. http://library.uchc.edu/eduoff/healthliteracy.pdf
Kathleen Crea compiled a list of websites of health literacy resources for health professionals and patients and families.
Federal Drug Administration (FDA): Quick Information for Your Health. http://www.fda.gov/opacom/lowlit/7lowlit.html
The FDA provides easy-to-read health brochures in English and Spanish. Brochures are available in both HTML and PDF formats and topics include keeping food safe, diabetes, losing weight safely, giving medication, etc.
Jacobson KL, Gazmararian JA, Kripalani S, McMorris KJ, Blake SC, Brach C. Is Our Pharmacy Meeting Patients’ Needs? A Pharmacy Health Literacy Assessment Tool User’s Guide. (Prepared under contract No. 290-00-0011 T07.) AHRQ Publication No.07-0051. Rockville, MD: Agency for Healthcare Research and Quality. October 2007. http://www.ahrq.gov/QUAL/pharmlit/pharmlit.pdf
This assessment tool was designed for use in a specific environment—the outpatient pharmacies of large, urban, public hospitals that primarily serve a minority population with a high incidence of chronic disease and limited health literacy skills. Users wishing to assess a different type of organization or pharmacy environment may use this assessment tool as a template and add, omit, and adapt items as appropriate.
The Joint Commission. “What did the Doctor say?:” Improving health literacy to protect patient safety. 2007. http://www.jointcommission.org/NR/rdonlyres/D5248B2E-E7E6-4121-8874-99C7B4888301/0/improving_health_literacy.pdf
This booklet is the culmination of a roundtable discussion addressing health literacy. Believing that many people play a role in improving health literacy, the roundtable discussion offers methods for tackling the underlying problems of health literacy, the impact of low health literacy and patient safety, and the current state of health care communication.
MAXIMUS and CFK National Program Office. The Health Literacy Style Manual: covering kids and families. 2005. http://coveringkidsandfamilies.org/resources/docs/stylemanual.pdf
This booklet has suggestions for developing and improving print materials related to government programs. Strategies include writing and formatting specifically for clients, many of whom have limited literacy skills.
Medical Library Association. Deciphering Medspeak Brochures. July 2007. http://www.mlanet.org/resources/medspeak/index.html. Brochures.
These brochures help consumers translate "medspeak," the specialized language of health professionals. Written in English and Spanish, these brochures address HIV/AIDS, stroke, eye disease, heart disease, diabetes, and breast cancer.
U.S. Department of Health and Human Services Office of Disease Prevention and Health Promotion. Quick Guide to Health Literacy. http://www.health.gov/communication/literacy/quickguide/Quickguide.pdf
This guide contains a basic overview of key health literacy concepts and techniques for improving health literacy through communication, navigation, knowledge-building, and advocacy. It provides the information needed to become an effective advocate for improved health literacy.
Books
Committee on Health Literacy Board on Neuroscience and Behavioral Health. Health Literacy: A Prescription to End Confusion. Washington, D.C.: The National Academies Press, 2004. http://www.iom.edu/?id=19723&redirect=0
Taking social, cultural, and educational issues into consideration, the Committee on Health Literacy demonstrates the problems of health literacy, its origins, consequences, and solutions. The report defines health literacy as “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions” (p. 2). The committee also suggests a strategy to improve health literacy in the United States.
Osborne, Helen. Health Literacy from A to Z: Practical Ways to Communicate Your Health Message. Sudbury, Massachusetts: Jones and Bartlett Publishers, 2005.
Osborne argues that health providers face two problems: “recognizing when patients do not understand written words . . . [and] knowing how to communicate through words, pictures, computers screens, and other visual media” (p. xiii). She focuses on helping solve these two issues and providing practical suggestions to health providers and others who communicate health information. Designed as a “tool of action,” Osborne, in each of her chapters, provides the reader with starting points, strategies, ideas, solutions, and sources to learn more about health literacy. Chapters, which are in alphabetical order, include consumer health libraries, hearing and communicating with people who are deaf and hard of hearing, language and culture, pictographs, plain language, signs, stories, website design, and word choice.
Zarcadoolas, Christina, Andrew F. Pleasant, and David S. Greer. Advancing Health Literacy: A Framework for Understanding and Action. San Francisco, California: Jossey-Bass, 2006.
Acknowledging the consequences of low health literacy and the complexity of medicine and health, the goal of this book is to answer the following question: “How can this model of health literacy and the literacy principles it outlines improve the daily performance of health professionals and health programs in their efforts to advance individual and public health literacy?” (p. xvi). The authors define health literacy as “the ability to understand, evaluate, and act on spoken, written, and visual health information to reduce risk and live a healthier life” (p. xvi).
Culture, Diversity, Language, and working with minority communities
- Association of Asian Pacific Community Health Organization:
http://www.aapcho.org/site/aapcho/section.php?id=11295CBPR Toolkit for Health Centers: Community-Based Participatory Research: A Health Center Toolkit with Asian Americans, Native Hawaiians, and Pacific Islanders.
Be a Superhero (Spanish):
http://www.ahrq.gov/news/press/pr2008/superheropr.htm and http://www.ahrq.gov/superheroes/AHRQ presents a Spanish-language national public service campaign designed to encourage Hispanics to become more involved in their health care. The campaign urges Hispanics to stay healthy for their loved ones by visiting their doctor for regular screenings.
Culturally Competent Practice with Latino Families Developed for the Georgia Division of Family and Children’s Services (DHR): http://www.dfcs.dhr.georgia.gov/DHR-DFCS/DHR_DFCS-Edu/Files/Latino%20Module%201%20participant%20guide%204-25-07.pdf
Demographics and Health Care Access and Utilization of Limited-English-Proficient and English-Proficient Hispanics: http://www.meps.ahrq.gov/mepsweb/data_stats/Pub_ProdResults_Details.jsp?pt=Research%20Findings&opt=2&id=85
The Healthy Aboriginal Network: http://www.thehealthyaboriginal.net/
The Healthy Aboriginal Network is a non-profit promotion of health, literacy & wellness for aboriginal youth. Topics include: diabetes prevention, suicide prevention, gambling addiction, and staying in school.
Healthy Roads Media: http://www.healthyroadsmedia.org/ipodvideos.htm
Health information access is a basic healthcare need. Literacy, health-literacy, illness, aging, disability and language are all issues that can pose barriers to obtaining basic health information. This site contains free health education materials in a number of languages and a variety of formats.
Hospital, Language, and Culture: http://www.jointcommission.org/PatientSafety/HLC/
This webpage has research concerning meeting diverse patient needs.
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HRSA Free Online Training: http://www.hrsa.gov/healthliteracy/training.htm/ Unified Health Communication 101: Addressing Health Literacy, Cultural Competency, and Limited English Proficiency
Strategies to improve health literacy for diverse populations should address literacy, language, and cultural barriers
http://www.ahrq.gov/research/oct07/1007RA6.htmUnequal Treatment: Confronting Racial and Ethnic Disparities in Health Care (Fri, 25 Jan 2008 15:13:31 -0500)
http://media.nap.edu/podcasts/nax50unequaltre.mp3Racial and ethnic disparities in health care are known to reflect access to care and other issues that arise from differing socioeconomic conditions. The podcast provides a brief glimpse at how disparities in treatment may arise in health care systems and looks at aspects of the clinical encounter that may contribute to such disparities.
Presentations
Agency for Healthcare and Research Quality (AHRQ) Quick Tips—When Talking with Your Doctor
http://www.ahrq.gov/consumer/quicktips/doctalk.htm and Research has shown that patients who have good relationships with their doctors tend to be more satisfied with their care—and to have better results. The above sites discuss tips to help consumers and their doctor become partners in improving health care. The Video on Communicating with Your Doctor can be found at http://www.ahrq.gov/consumer/commdrvid.htm.Health Literacy Podcasts: http://www.healthliteracyoutloud.com/
This site contains podcast interviews with those in-the-know about health literacy. Examples include health literacy and chronic disease, hospital interest in health literacy, and use humor and graphics in conveying health information.
McCormick, Don. Plain & Simple: Health Communication Workshop. Iowa Department of Public Health.
http://www.idph.state.ia.us/health_literacy/common/pdf/psworkshop.pdfThe objectives of this presentation include learning about health literacy, plain language, and suggestions for improving sample documents.
National Institute of Literacy. National Assessment of Adult Literacy. http://www.nifl.gov/nifl/NAAL2003.html
Sponsored by the National Center for Education Statistics, the 2003 National Assessment of Adult Literacy (NAAL) is a nationally representative assessment of English literacy among American adults age 16 and older. Webcasts are available on such topics as addressing low literacy and defining the goals and research behind the National Assessment of Adult Literacy.
Proceedings of the Surgeon General's Workshop on Improving Health Literacy. September 7, 2006, National Institutes of Health, Bethesda, MD
http://www.surgeongeneral.gov/topics/healthliteracy/toc.htmlOn September 7, 2006, Acting Surgeon General Kenneth Moritsugu held a Surgeon General's Workshop on Improving Health Literacy. The goal of the workshop was to present the state of the science in the field of health literacy from a variety of perspectives, including those of health care organizations and providers, the research community, and educators. During the course of the one-day workshop, participants identified the public health consequences of limited health literacy and established an evidence base for taking action.
Stableford, Sue. Write It Easy to Read: Vibrant Plain Language for Clear Health Communication. Biddleford, Maine: AHEC Health Literacy Center, 2004. Presentation. http://www.clearlanguagegroup.com
Stableford focuses on the need for “plain language” and defines “limited health literacy” and “easy-to-read.” She argues that health literacy is critical to lowering health disparities and to increasing safety and quality care, chronic disease prevention, and bioterrorism preparedness. Using real world examples, she helps the student understand the importance of writing clearly, using “plain language,” and utilizing layout and design for reading ease. To contact Sue Stableford, email sstableford@une.edu or call 207-283-0170 ext 2205.
Wescott, Beth. Easy-to-Read Health and Wellness Material for Consumers: recognizing it, finding it, writing it, rewriting it.National Networks of Libraries of Medicine. August 2007. http://nnlm.gov/sea/training/easytoread.html. CD.
The CD aids the user to critique, rewrite and create materials that get health and wellness information across quickly and clearly. This CD reviews the disconnect between information providers and information seekers, the process of educating adults, the success of "plain language" initiatives and the importance of text, type, graphics, space and layout. The user is provided with brochure examples, SMOG and REALM tests, a webliography and links to other training. Clear health communication is the goal, regardless of the medium. To contact Beth Wescott, email bwescott@hshsl.umaryland.edu or call 1-800-338-7657.
World Education. Health Literacy: New Field, New Opportunities. http://www.healthliteracy.worlded.org/docs/tutorial/SWF/flashcheck/main.htm
This online tutorial is designed for health and literacy educators interested in getting more involved in health literacy work. Users learn about the challenges associated with low health literacy, meet some of the new health literacy practitioners in the field, hear about successful strategies and practices, and apply what they have learned to a challenging health literacy scenario. The tutorial was developed by World Education and funded by the National Network of Libraries of Medicine New England Region (NN/NL NER).
Toolkits
American Medical Association. Health Literacy Kit. Chicago: AMA Foundation, 2007. Manual, DVD, and VHS. http://www.ama-assn.org/ama/pub/category/9913.html
Using a multimedia approach focused on health professionals, the American Medical Association (AMA) uses real-life scenarios and statistics to address the problems of health literacy. They define health literacy as “the ability to read, understand, and act on medical information” (DVD). Understanding the need for more research on health literacy, the AMA gives several ideas to enable health professionals to help their patients understand the health information given. These suggestions include offering an open and shame free environment, an attitude of helpfulness, and a place where patients feel safe. The AMA Foundation Health Literacy Kit costs $35 and includes a manual, Continuing Medical Education credit, and two videos/DVDs, Low Health Literacy: You Can't Tell By Looking and Health Literacy: Help Your Patients Understand. Both videos can be viewed free of charge from http://www.ama-assn.org/ama/pub/category/8035.html
Children’s Hospital & Regional Medical Center. Patient & Family Education Materials Development Kit. July 2005. http://www.cshcn.org/forms/matdevkit05.pdf
This kit provides steps to writing a handout that is easy to read and understand. The information is based on readability research about word use, font styles and layout. The kit also helps the reader with the process of planning and evaluating resources for his/her own program on a broader scale.
Medical Library Association. Health Information Literacy. Nov. 2006. http://www.mlanet.org/resources/healthlit/index.html. CD and Website.
This site offers a plethora of resources for health professionals and consumers and includes links and information to fact sheets, brochures, toolkits, and project ideas for health literacy. A corresponding CD version available from the Medical Library Association (MLA) also explains the resources from MLA and outside sources. Members of MLA can read more about the Health Information Literacy Research Project at http://www.mlanet.org/members/mla_news/2007/apr_07/literacy.html
National Maternal and Child Oral Health Resource Center: Bright Futures Toolbox
http://www.mchoralhealth.org/Toolbox/index.htmlThis toolbox highlights materials that advance the Bright Futures philosophy of promoting and improving the oral health of infants, children, and adolescents. The toolkit is for Health Professionals and Families concerning Oral Health.
Public Health Information Partners. Health Literacy: Tools for Improving Health Communications. 2007. http://library.nymc.edu/PHInformatics/hltoolkit.cfm
Beginning 2004, the New York Medical College, School of Public Health and Health Sciences Library created Public Health Information Partners, an academic/local partnership with health professionals in the seven counties comprising the Hudson Valley Region of New York State. This toolkit is from a conference held May 30, 2007 at New York Medical College, Valhalla, NY. The conference goal was to provide health professionals and hospital staff with an educational opportunity to develop awareness of health literacy issues and improve communication skills with individuals throughout the Hudson Valley Region of New York. This toolkit offers links to websites that promote health literacy skills.
Singleton, Kate. Virginia Adult Education Health Literacy Toolkit. 2003. http://www.aelweb.vcu.edu/publications/healthlit/index.shtml
Answering questions such as what is health literacy and what resources are available, this Toolkit is a resource to help adult education instructors and administrators better understand the problem of health literacy as it affects their learners. It is designed to support creative approaches to help learners increase health literacy as they engage in sound, productive adult literacy instruction. Information and resources are provided to educate the educator about health care in the United States and cultural issues relating to health, and to simplify creation of health lessons and curricula for teachers and programs. Many online and print resources are available.
Websites
Agency for Health Care Research and Quality: Health Literacy and Cultural Competency. http://www.ahrq.gov/browse/hlitix.htm
Online resources and pathfinders relating to health literacy, consumer decision aids, clinical information, and improving healthcare delivery.
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Ask Me 3. http://www.npsf.org/askme3/
This website helps consumers and providers learn how to communicate effectively with each other, address the problem of health literacy, and provide a solution to end health literacy. Ask Me 3 helps consumers ask three questions to their provider about their health: 1) What is my main problem? 2) What do I need to do? 3) Why is this important for me? This website, with printable materials, helps consumers.
Harvard School of Public Health. Health Literacy Studies. June 2007. http://www.hsph.harvard.edu/healthliteracy/index.html
Harvard School of Public Health’s Health Literacy Studies focuses on communication and literacy skills and are interested in exploring the pathways from education to health outcomes. Resources include a slide presentation, video, a chart about health literacy, literature, and how to create and access print materials.
Health & Literacy Special Collection. http://healthliteracy.worlded.org/
The Health & Literacy Special Collection is created, compiled, and updated by World Education with support from the National Institute for Literacy (NIFL) and their LINCS Project. Information includes health lessons, easy-to-read material, multilingual health information, and health literacy research.
Health Literacy Consulting. http://www.healthliteracy.com/default.asp
Helen Osborne, the developer of this website, directs health care professionals and consumers to a variety of health literacy resources. Osborne also offers ideas on how to celebrate health literacy month.
Health Literacy – National Network of Libraries of Medicine. http://nnlm.gov/outreach/consumer/hlthlit.html
Funded by the National Library of Medicine, this website defines health literacy and lists health literacy organizations and websites.
MedlinePlus Easy-to-Read. http://www.nlm.nih.gov/medlineplus/easytoread/easytoread_a.html
Developed by the National Institutes of Health and National Library of Medicine, MedlinePlus helps consumers find up-to-date, quality information about health topics, herbs and drugs. Information is available in English, Spanish, and Easy-to-Read versions. Also see health topic, “Talking to your doctor.”
The Newest Vital Sign: A Health Literacy Assessment Tool. http://www.clearhealthcommunication.com/physicians-providers/newest-vital-sign.html
The Newest Vital Sign is a bilingual (English and Spanish) screening tool that identifies patients at risk for low health literacy.
NIH Senior Health
http://nihseniorhealth.gov/This website from the National Institute on Aging and National Library of Medicine has easy-to-read health information and videos for senior citizens.
The Partnership for Clear Health Communication (PCHC).
http://www.npsf.org/pchc/The Partnership for Clear Health Communication (PCHC) is a national, non-profit coalition of organizations working to build awareness and advance solutions to improve health literacy and positively impact health outcomes.
Popular topics: Improving Health Literacy
http://www.plainlanguage.gov/populartopics/health_literacy/index.cfmPLAIN, the Plain Language Action and Information Network, sponsors this site and its goal is to promote the use of “plain language” for all government communications. Plain language (also called Plain English) is communication an audience can understand the first time they read or hear it.
Useful Examples
Baby and Me. READ Saskatoon. 2nd edition.
http://www.nald.ca/readsask/pubs/babyme/babyme.pdfDeveloped by READ Saskatoon, this easy-to-read book divides pregnancy into 3 trimesters. Each section explains what to expect for the mother and her growing baby.
Diabetes Easy-to-Read. National Diabetes Information Clearinghouse.
http://diabetes.niddk.nih.gov/dm/ez.aspThese easy-to-read materials are written in English and Spanish and are available from the National Institute of Diabetes and Digestive and Kidney Diseases. Topics include information about diabetes and how it relates to medication, physical activity, and nutrition.
Hands on Health South Carolina
http://www.handsonhealth-sc.org/The purpose of Hands on Health South Carolina is to give South Carolinians a place to go to learn about health and wellness in an easy-to-read format. Health problems addressed include diabetes, heart disease, cancer, asthma, stroke, and suicide.
My Guide to Sugar Diabetes
http://etl2.library.musc.edu/reach/materials/booklet.pdfDeveloped by South Carolina Diabetes Prevention and Control Program Diabetes Initiative of South Carolina Enterprise/MUSC Neighborhood Health Program, this guide has easy-to-read information about Sugar Diabetes.
National Institutes on Aging. Understanding Alzheimer’s Disease. 2006. http://www.nia.nih.gov/NR/rdonlyres/F463CE6C-B0A7-47F4-882A-8EA143020193/0/understandingalzheimers.pdf
Developed by Alzheimer’s Disease Education and Referral Center (ADEAR), this booklet offers easy-to-read information about Alzheimer’s Disease. ADEAR also offers an easy-to-read booklet on Understanding Memory Loss.
Tools to Help you build a Healthy life: http://www.4women.gov/Tools/
From womenshealth.gov and available for women, girls, and moms-to-be in English and Spanish, this page offers health tools such as calculators, charts, checklists, and quizzes.
Tests to Assess Health Literacy
Rapid Estimate of Adult Literacy in Medicine (REALM). Columbia University School of Nursing. http://www.nursing.columbia.edu/informatics/HealthLitRes/assessTool.html
The REALM is a medical-word recognition and pronunciation test comprising 66 medical terms, arranged in order of complexity by the number of syllables and pronunciation difficulty, starting with simple one-syllable words (e.g., pill, eye) and ending with multi-syllable words (e.g., antibiotics, potassium). Patients read down the list, pronouncing aloud as many words as they can while the examiner scores the number of words pronounced correctly using standard dictionary pronunciation as the scoring standard. Scores on the REALM vary from 0 (no words pronounced correctly) to 66 (all words pronounced correctly.) The score assigns health literacy skills into 4 categories of grade-equivalent reading level: 0–18 (3rd grade), 19–44 (4th to 6th grade), 45–60 (7th to 8th grade) and 61–66 (9th grade). It can be administered and scored in under 2 minutes by personnel with minimal training, making it easy to use in clinical settings (Adapted from Measurement Excellence and Training Resource Information Center.) A sample sheet can be found at http://www.nursing.columbia.edu/informatics/HealthLitRes/pdf/REALM_1.pdf
Test of Functional Health Literacy in Adults (TOFHLA). Columbia University School of Nursing. http://www.nursing.columbia.edu/informatics/HealthLitRes/assessTool.html
The TOFHLA measures the functional literacy level of patients, using real-to-life health care materials. These materials include patient education information, prescription bottle labels, registration forms, and instructions for diagnostic tests. The TOFHLA assesses two main constructs, numeric and reading comprehension; it has a total of 67 items. The numeric scale, used to measure the ability to read and understand numbers, includes 17 items; the reading comprehension scale, used to measure the patient’s ability to read and understand health care-related passages, contains 50 items. There is also a Spanish version called TOFHLA-S. A sample sheet in English can be found at http://www.peppercornbooks.com/catalog/pdf/tofhla_eng_12pt_websmpl.pdf
Wide Range Achievement Test-Revised (WRAT-R). United States Department of Veterans Affairs. http://www.hsrd.research.va.gov/for_researchers/measurement/instrument/overviews/is_literacy.cfm
The WRAT-R is an individual achievement test that assesses skills in reading, spelling, and arithmetic. It is commonly used in educational settings, but the reading subscale has been used in the medical field to measure health literacy. The test assesses word recognition by having the person read aloud from a list of words. When 10 consecutive words are mispronounced, the test concludes and a score is derived. The WRAT-R is appropriate for people aged 5 to adults. It takes approximately 15 to 30 minutes to complete. A raw score is computed for each scale by summing the number of correct answers, and then the raw score may be converted to a grade equivalent score and a standard score. Standard scores have a mean of 100 and standard deviation of 16.
