Evolution of Health literacy measurement tools

Abstract

Abstract Introduction This study aimed to provide a review of the tool characteristics and dimensions of health literacy measurement tools. Indeed, it is crucial to establish a clear correlation between what the tools detect and the definition of health literacy. The research question is therefore to what extent health literacy measurement tools are able to detect the ability and levels to make judgment and take decisions in everyday life concerning health. Methods A systematic review was conducted. PubMed, EMBASE, Web of Science, PsycINFO, and Cochrane Central Register of Controlled Trials were searched using MeSH, EMTREE terms, keywords, and keyword phrases on Health literacy tools and instruments from 1990 through 2020. An environmental scan was conducted to identify other health literacy measurement tools. For each tool, researchers evaluated validation, items and conceptual dimensions, and psychometric properties. Results 198 tools were identified, 96 measured general health literacy, 38 measuring comprehension, the others were aimed to assess health literacy for specific diseases or populations. Most tools are performance-based, require in-person administration, and are exclusively available in a pencil and paper testing mode. Reported administration times vary, from less than 1 to 30 minutes. Validation procedures for most of the tools are limited by inadequate power to ensure reliability across subgroups. Conclusions The health literacy measurement tools currently available represent a narrow set of conceptual dimensions with limited modes of administration. Most of the tools are lacking key psychometric properties. Significant work is needed to establish important aspects of the construct, convergent, and predictive validity for many tools. Furthermore, from a more practical point of view doubts emerged about the actual suitability of these tools in the day to day health care/promotion settings. Work is needed to develop more rapid and straightforward tools for practice. Key messages Measure health literacy save lives. Health literacy is a vital sign.