Abstract
OBJECTIVE: To develop a valid, reliable instrument to measure the functional health literacy of patients.
DESIGN: The Test of Functional Health Literacy in Adults (TOFHLA) was developed using actual hospital materials. The TOFHLA consists of a 50-item reading comprehension and 17-item numerical ability test, taking up to 22 minutes to administer. The TOFHLA, the Wide Range Achievement Test-Revised (WRAT-R), and the Rapid Estimate of Adult Literacy in Medicine (REALM) were administered for comparison. A Spanish version was also developed (TOFHLA-S).
SETTING: Outpatient settings in two public teaching hospitals.
PATIENTS: 256 English- and 249 Spanish-speaking patients were approached. 78% of the English- and 82% of the Spanish-speaking patients gave informed consent, completed a demographic survey, and took the TOFHLA or TOFHLA-S.
RESULTS: The TOFHLA showed good correlation with the WRAT-R and the REALM (correlation coefficients 0.74 and 0.84, respectively). Only 52% of the English speakers completed more than 80% of the questions correctly. 15% of the patients could not read and interpret a prescription bottle with instructions to take one pill by mouth four times daily, 37% did not understand instructions to take a medication on an empty stomach, and 48% could not determine whether they were eligible for free care.
CONCLUSIONS: The TOFHLA is a valid, reliable indicator of patient ability to read health-related materials. Data suggest that a high proportion of patients cannot perform basic reading tasks. Additional work is needed to determine the prevalence of functional health illiteracy and its effect on the health care experience.
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Kirsch IS, Jungeblut A, Jenkins L, Kolstad A. Adult Literacy in America: A First Look at the Results of the National Adult Literacy Survey. Washington, DC: National Center for Education Statistics, U.S. Department of Education, 1993;xiv.
General Accounting Office. Report to Congress. The Adult Basic Education Program: Progress in Reducing Illiteracy and Improvement Needs. Washington, DC: U.S. Office of Education, 1975.
U.S. Department of Commerce, Bureau of the Census. English Language Proficiency Study. Washington, DC: Government Printing Office, 1982.
Davis TC. Crouch MA, Wills G, Miller S, Abdehou DM. The gap between patient reading comprehension and the readability of patient education materials. J Fam Pract. 1990;31:533–8.
Jolly BT. Scott JL, Feied CF, Sanford SM. Functional illiteracy among emergency department patients: a preliminary study. Ann Emerg Med. 1993;22:573–8.
Jackson RH, Davis TC, Bairnsfather LE, George RB. Crouch MA, Gault H. Patient reading ability: an overlooked problem in health care. South Med J. 1991;84:1172–5.
Davis TC, Crouch MA. Long SW. et al. Rapid assessment of literacy levels of adult primary care patients. Fam Med. 1991;23:433–5.
Weiss BD. Hart G, McGee DL, D’Estelle S. Health status of illiterate adults: relation between literacy and health status among persons with low literacy skills. J Am Board Fam Pract. 1992;5:257–64.
Jastak S. Wilkinson GS. Wide Range Achievement Test-Revised (WRAT-R). San Antonio, TX: The Psychological Corporation, 1984.
Davis TC. Long SW, Jackson RH. et al. Rapid estimate of adult literacy in medicine: a shortened screening instrument. Fam Med. 1993;25:391–5.
Nurss JR, Baker DW, Davis TC, Parker RM, Williams MV. Difficulties in functional health literacy screening in Spanish-speaking adults. J Reading. 1995;38:632–7.
Taylor WS. Cloze procedure: a new test for measuring readability. Journalism Q. 1953;30:415–33.
Laubach RS, Koschnick K. Using Readability: Formulas for Easy Adult Materials. Syracuse, NY: New Readers Press, 1977.
SPSS-X Users Guide. 3rd edition. Chicago. IL: SPSS, Inc., 1988.
Doak L, Doak C. Patient comprehension profiles: recent findings and strategies. Patient Couns Health Educ. 1980;2:101–6.
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Supported by a grant from The Robert Wood Johnson Foundation.
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Parker, R.M., Baker, D.W., Williams, M.V. et al. The test of functional health literacy in adults. J Gen Intern Med 10, 537–541 (1995). https://doi.org/10.1007/BF02640361
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DOI: https://doi.org/10.1007/BF02640361