Health Literacy

The National Assessment of Adult Literacy: Health Literacy Results

September 7, 2006

Grover J. (Russ Whitehurst)
Director
Institute of Education Series
 

Discussion Topics

• Measuring health literacy
• Comparing health literacy with other types of literacy
• Reporting the results
• Describing adults with Below Basic and Basic Health Literacy

National Assessment of Adult Literacy

• Assessment of the English literacy of U.S. adults
  • Prose, Document, Quantitative Scales
• Conducted in 1992 and 2003
• Nationally representative sample of more than 19,000 adults age 16 and older
• One-on-one administration in households and prisons

Descriptions of Literacy Levels

Nonliterate in English—unable to complete a minimum number of screening tasks or could not be tested because did not speak English or Spanish.
 

Measuring Health Literacy

• The health literacy tasks encompassed three domains of information: clinical, prevention, and navigation of the health care system
• The health literacy scale did not measure the ability to obtain information from nonprint sources

Health Literacy & Literacy Are Closely Related

• Similarities:
  • Both involve the ability to recognize and understand words, search text, and make text-based inferences
• Differences:
  • The health literacy scale required some information about health and the U.S. health system, including:
    • common health-related vocabulary
    • typical structure of written health materials
    • workings of the health care system

Vaccination Schedule

Question: Refer to the chart to answer the following question.  How many polio vaccinations should children have received by the time they are 7 years old.

Narrative:  This is an example of a preventive health literacy task.  Adults were shown a vaccination schedule and asked: "How many polio vaccinations should children receive by the time they are 7 years old?"  To perform the task, respondents had to search for multiple pieces of information within a vaccination table.  Overall, 90 million adults would not be able to respond correctly.
 

X-ray Instructions

Question: Refer to the X-ray instructions below to answer the following question.  What can you drink the morning of your X-ray?

Narrative:  This is an example of a clinical health literacy task.  Adults were shown a short set of medical instructions and asked: "What can you drink the morning of your X-ray?"  Overall, 32 million adults would not be able to perform this task.
 

Sample Task From the Alternative Assessment

Question:  What does the label say a person would do in case of an overdose?

Narrative:  This task was specifically designed as part of the alternative assessment to provide useful information about adults at the lowest end of the literacy scale.  In this task, adults were shown an over-the-counter box of cough syrup.  Adults did not have to scan the label to locate the appropriate information because interviewers were instructed to point to relevant paragraph.  Adults were asked what the label directed them to do in case of an overdose.  About 55 percent of adults who took the alternative assessment could not answer the question.
 

Overlap Between Below Basic and Nonliterate in English

Narrative:  This slide shows that 13 percent of all adults, or 30 million people, had Below Basic prose literacy.  The adults at the bottom of the Below Basic health literacy level did poorly on the easiest test questions.  They represent 3 percent of the population, or 7 million adults.  These adults were considered to be Nonliterate in English.  Another 2 percent of the population, or 4 million adults, couldn't take the test because of language barriers.  These 4 million adults, along with the 7 million who did very poorly on simple test questions, are considered to be Nonliterate in English.  Thus, a total of 11 million adults were found to be Nonliterate in English.