Health Literacy Measurement Tools Research Articles

The quality of mental health literacy measurement tools evaluating the stigma of mental illness: a systematic review.

Stigma of mental illness is a significant barrier to receiving mental health care. However, measurement tools evaluating stigma of mental illness have not been systematically assessed for their quality. We conducted a systematic review to critically appraise the methodological quality of studies assessing psychometrics of stigma measurement tools and determined the level of evidence of overall quality of psychometric properties of included tools. We searched PubMed, PsycINFO, EMBASE, CINAHL, the Cochrane Library and ERIC databases for eligible studies. We conducted risk-of-bias analysis with the Consensus-based Standards for the Selection of Health Measurement Instruments checklist, rating studies as excellent, good, fair or poor. We further rated the level of evidence of the overall quality of psychometric properties, combining the study quality and quality of each psychometric property, as: strong, moderate, limited, conflicting or unknown. We identified 117 studies evaluating psychometric properties of 101 tools. The quality of specific studies varied, with ratings of: excellent (n = 5); good (mostly on internal consistency (n = 67)); fair (mostly on structural validity, n = 89 and construct validity, n = 85); and poor (mostly on internal consistency, n = 36). The overall quality of psychometric properties also varied from: strong (mostly content validity, n = 3), moderate (mostly internal consistency, n = 55), limited (mostly structural validity, n = 55 and construct validity, n = 46), conflicting (mostly test-retest reliability, n = 9) and unknown (mostly internal consistency, n = 36). We identified 12 tools demonstrating limited evidence or above for (+, ++, +++) all their properties, 69 tools reaching these levels of evidence for some of their properties, and 20 tools that did not meet the minimum level of evidence for all of their properties. We note that further research on stigma tool development is needed to ensure appropriate application.

Exploring College Student Health Literacy: Do Methods of Measurement Matter?

The purpose of this study was twofold: Assess health literacy among college students using an accepted assessment tool (the Newest Vital Sign, NVS) and utilize different methods of administration to explore strategies for practically increasing usage of health literacy measurement tools—which currently emphasize in-person, oral administration. Findings suggest the NVS may be employed on platforms more convenient for college health educators, notably through online or paper-and-pencil methods, such as health center paperwork.

Development of a health literacy measurement tool for primary school children in Germany

Development of a health literacy measurement tool for primary school children in Germany

A Preliminary Framework for the Development of a Health Literacy Measurement Tool for Asthma and COPD

A Preliminary Framework for the Development of a Health Literacy Measurement Tool for Asthma and COPD

The application of health literacy measurement tools (collective or individual domains) in assessing chronic disease management: a systematic review protocol.

BackgroundThe term “health literacy” (HL) was first coined in 1974, and its most common definition is currently defined as a person’s ability to access, understand, evaluate, communicate, and use health information to make decisions for one’s health. The previous systematic reviews assessing the effect of existing HL measurement tools on health outcomes have simply searched for the term “health literacy” only to identify measures instead of incorporating either one or more of the five domains in their search. Furthermore, as the domain “use” is fairly new, few studies have actually assessed this domain. In this protocol, we propose to identify and assess HL measures that applied the mentioned five domains either collectively or individually in assessing chronic disease management, in particular for asthma and chronic obstructive pulmonary disease (COPD). The ultimate goal is to provide recommendations towards the development and validation of a patient-centric HL measurement tool for the two diseases.Methods/designA comprehensive, electronic search will be conducted to identify potential studies dating from 1974 to 2016 from databases such as Embase, MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials, Web of Science, ERIC, PsycINFO, and HAPI. Database searches will be complemented with grey literature. Two independent reviewers will perform tool selection, study selection, data extraction, and quality assessment using pre-designed study forms. Any disagreement will be resolved through discussion or a third reviewer. Only studies that have developed or validated HL measurement tools (including one or more of the five domains mentioned above) among asthma and COPD patients will be included. Information collected from the studies will include instrument details such as versions, purpose, underlying constructs, administration, mapping of items onto the five domains, internal structure, scoring, response processes, standard error of measurement (SEM), correlation with other variables, clinically important difference, and item response theory (IRT)-based analyses. The identified strengths and weaknesses as well as reliability, validity, responsiveness, and interpretability of the tools from the validation studies will also be assessed using the COSMIN checklist. A synthesis will be presented for all tools in relation to asthma and COPD management.DiscussionThis systematic review will be one of several key contributions central to a global evidence-based strategy funded by the Canadian Institutes of Health Research (CIHR) for measuring HL in patients with asthma and COPD, highlighting the gaps and inconsistencies of domains between existing tools. The knowledge generated from this review will provide the team information on (1) the five-domain model and cross domains, (2) underlying constructs, (3) tool length, (4) time for completion, (5) reading level, and (6) format for development of the proposed tool. Other aspects of the published validation studies such as reliability coefficients, SEM, correlations with other variables, clinically important difference, and IRT-based analyses will be important for comparison purposes when testing, interpreting, and validating the developed tool.Systematic review registrationPROSPERO CRD42016037532Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-016-0267-8) contains supplementary material, which is available to authorized users.

Cross-sectional correlation of single-item health literacy screening questions with established measures of health literacy in patients with rheumatoid arthritis.

Research suggests that health literacy (HL) is associated with rheumatoid arthritis (RA) patients' functional status. Single-item health literacy screening (SILS) questionnaires may establish patients' HL; however, the wording of SILS may be misinterpreted by RA patients as a query regarding physical limitations. Despite this threat to validity, multiple publications have employed the SILSs as a measure of health literacy. We assessed the construct validity of two SILS's versions by correlating scores with standardized HL measures. English-speaking adult RA patients at a hospital serving low-income patients were enrolled in a cross-sectional study. Subjects completed two SILS versions, as well as two longer HL measurement tools [short test of functional health literacy in adults (s-TOFHLA) and the rapid estimate of adult literacy in medicine (REALM)]. Spearman correlation was used to compare these tools. The study enrolled 110 subjects. There was a good correlation between the two SILS versions (r = 0.705). The correlation of SILS2 and REALM or s-TOFHLA was less robust. The distribution of scores within each SILS2 category demonstrated substantial variation. The SILS2 has construct validity in the assessment of HL in patients with RA, though its correlation with traditional methods of assessing HL is weak.

Development of a conceptual model of cancer caregiver health literacy.

Caregivers play a vital role in caring for people diagnosed with cancer. However, little is understood about caregivers' capacity to find, understand, appraise and use information to improve health outcomes. The study aimed to develop a conceptual model that describes the elements of cancer caregiver health literacy. Six concept mapping workshops were conducted with 13 caregivers, 13 people with cancer and 11 healthcare providers/policymakers. An iterative, mixed methods approach was used to analyse and synthesise workshop data and to generate the conceptual model. Six major themes and 17 subthemes were identified from 279 statements generated by participants during concept mapping workshops. Major themes included: access to information, understanding of information, relationship with healthcare providers, relationship with the care recipient, managing challenges of caregiving and support systems. The study extends conceptualisations of health literacy by identifying factors specific to caregiving within the cancer context. The findings demonstrate that caregiver health literacy is multidimensional, includes a broad range of individual and interpersonal elements, and is influenced by broader healthcare system and community factors. These results provide guidance for the development of: caregiver health literacy measurement tools; strategies for improving health service delivery, and; interventions to improve caregiver health literacy.

Health Literacy and Medication Adherence Among Patients Treated in a Free Health Clinic: A Pilot Study.

Background:A patient’s health literacy is not routinely assessed during visits with a health care provider. Since low health literacy is a risk factor for poor health outcomes, assessing health literacy should be considered as part of the standard medical workup.Objectives:To evaluate the health literacy levels and medication adherence of patients treated by pharmacists in both the general medicine and the chronic care clinics at an urban free health clinic.Methods:Eligible patients from the free health clinic completed the Rapid Estimate of Adult Literacy in Medicine (REALM), a health literacy measurement tool, during their clinic visit in 2011. Medication adherence was self-reported by the patients.Results:A total of 100 patients participated (mean age = 48). The majority of participants were female (56%) and white (55%). Most (64%) of the patients scored at a high school reading level according to REALM. Only 21% of participants read at a seventh- to eighth-grade level. Overall medication adherence rate was 73%. Forgetting to take medication was the most popular reason given for nonadherence.Conclusion:Disease state and adherence were significantly related in patients with HIV/AIDS and hypertension. Patient’s ethnicity was significantly associated with literacy levels (P < .05). Although patients’ literacy levels were not significantly associated with self-reported adherence in this population, availability of a patient’s baseline health literacy level as a part of the medical record may help clinicians to individualize their interaction based on the patient’s health literacy level in order to achieve better health outcomes, including improved medication adherence, especially for underserved populations.

Health Literacy Measurement: An Inventory and Descriptive Summary of 51 Instruments

This article aimed to provide a descriptive review of the psychometric properties and conceptual dimensions of published health literacy measurement tools. PsycINFO and PubMed search from 1999 through 2013, review of the grey literature, and an environmental scan was conducted to identify health literacy measurement tools. For each tool, we evaluated the conceptual dimensions assessed, test parameters, and psychometric properties. Of the 51 tools identified, 26 measured general health literacy, and 15 were disease or content specific, and 10 aimed at specific populations. Most tools are performance based, require in-person administration, and are exclusively available in a pencil and paper testing mode. The tools assess 0 (proxy measure) to 9 of the 11 defined dimensions of health literacy. Reported administration times vary, from less than 1 to 60 minutes. Validation procedures for most of the tools are limited by inadequate power to ensure reliability across subgroups (i.e., race, age, ethnicity, and gender). The health literacy measurement tools currently available generally represent a narrow set of conceptual dimensions with limited modes of administration. Most of the tools lack information on key psychometric properties. Significant work is needed to establish important aspects of the construct, convergent, and predictive validity for many tools. As researchers develop new measures, inclusion of a full range of conceptual dimensions of health literacy, more representative sampling for testing, and additional modes of administration will allow a more refined and flexible approach to research in this field.

Taking stock of health literacy measurement tools: choosing the right tool for the right purpose

Introduction Health literacy is a fast developing field in European public health. One of the aspects in focus is how to measure health literacy as a multidimensional construct. This study seeks to identify and critically review existing measures of health literacy with the aim to clarify characteristics and determine, which tool is appropriate for which purpose …

Measuring health literacy in emergency departments

Background : Literacy and health literacy are important concepts that are related to how important health care messages are understood by patients. Emergency nurses are engaged in health promotion and require an understanding of the patient’s health literacy. To assist emergency nurses in assessing a patient’s level of health literacy a series of valid and reliable health literacy measurement tools have been presented. The aim of this paper is to nominate one of these tools to be used by emergency nurses in testing individual and group levels of health literacy. Methods : Databases searched included Scopus, Science direct, PubMed, PsycINFO and Educational Resources Information Center (ERIC). Included articles were published between 1990 and 2011, English language only, and articles that discussed word recognition tools and tools that take five minutes or less to administer resulting in sixteen articles. Results : The Rapid Estimate of Adult Literacy in Medicine-Short Format (REALM-SF) has been used successfully within an emergency setting to identify patients’ level of health literacy and to supply appropriate health information. This tool was found by nursing staff to be easily administered, and more acceptable when used in private areas. However, further research within varying age groups is recommended. Conclusion : Most of the available tools are related to each other and have the ability to measure varying levels of health literacy. The REALM-SF is a simple quick approach to measuring health literacy in busy clinical settings. Emergency nurses require training in administering these tests in a non-threatening and accurate manner.

Systematic Review of Consistency between Adherence to Cardiovascular or Diabetes Medication and Health Literacy in Older Adults

To review the relationship between health literacy and adherence to cardiovascular/diabetes medication. We searched EMBASE (1974-February 2012) and MEDLINE (1948-February 2012). Search terms included health literacy, numeracy, health education and related terms, health literacy measurement tools, and medication adherence. English-language articles of all study designs were considered. Articles were included if they had a measurement of health literacy and medication adherence and if participants were older adults taking drugs for cardiovascular illness or diabetes mellitus. A total of 1310 citations were reviewed, including 9 articles that reported on 7 research studies. Most studies were retrospective, and all were based in the US. Because there was considerable diversity in measurements, participant characteristics, and outcome measures, we conducted a narrative synthesis rather than a meta-analysis. In assessing study validity, we looked at participant selection, method of measuring health literacy and medication adherence, missing data or losses, and adjustment for confounders. Of the 7 included studies, only 1 found a demonstrable association between health literacy and refill adherence. One clinical trial failed to show significant improvements in medication adherence after an intervention to improve health literacy. The current evidence does not show a definite association between health literacy and medication adherence in older adults with cardiovascular disease or diabetes mellitus. In the absence of a definite link, efforts to develop interventions to improve health literacy would not necessarily improve adherence to cardiovascular medications. There is an urgent need for robust studies outside of the US, with wider, generalized recruitment of participants.