Short Test Of Functional Health Literacy Research Articles

Validation of the Short-Test of Functional Health Literacy in Adults for the Samoan Population.

Background:Health literacy encompasses various levels of communication for an individual, provider, and an organization. Validated and reliable tools have been developed to assess health literacy; however, there is a paucity of tools available to assess health literacy in native languages for indigenous and racial/ethnic minority populations.Objective:This article shares the process taken to translate and evaluate validation and reliability of the Short Test of Functional Health Literacy in Adults for use with the Samoan population.Methods:Respondent-driven sampling was used to collect data from 1,543 adults age 45 years and older in American Samoa. A confirmatory factor analysis using a two-factor model for validation was conducted.Key Results:The validation results indicated a “good fit” in multiple indices and Cronbach's alpha indicated high internal consistency in both the English and Samoan languages.Conclusions:Developing culturally validated and reliable health literacy assessment tools is important to help health care professionals decrease health disparities and address inadequate health literacy in all cultures. [HLRP: Health Literacy Research and Practice. 2022;6(4):e247–e256.]Plain Language Summary:The INSPIRE project studied the Short Test of Functional Health Literacy in Adults (STOFHLA) tested on the American Samoan population age 50 years and older. The results would show if the STOFHLA is a valid tool to measure functional health literacy in American Samoa adults.

Does Health Literacy Reinforce Disease Knowledge Gain? A Prospective Observational Study of Hungarian COPD Patients.

We set out to measure the health literacy (HL) of COPD patients using the Short Test of Functional Health Literacy (S-TOFHLA), perception-based screening questions (BHLS), and a specific disease knowledge test (COPD-Q). Our main focus is the relationship between functional HL and patients’ disease-knowledge, which contributes to the clarification of the relationship between the different kinds of HL. In two prospective observational studies, 151 COPD patients (80 males, mean age: 62 ± 9 years) completed a questionnaire containing HL measurements, psychological tests (e.g., the Self-Control and Self-Management Scale), and questions regarding subjective health status. Medical data of the patients from the MedSole system were added. The HL scores of the COPD patients were compared to a representative sample using a t-test. Furthermore, correlations of HL with demographic, psychological, and medical variables were calculated within the patient group. The relations among the different HL measurements were tested by chi-square trials. COPD patients had significantly lower HL, as measured by S-TOFHLA. Younger and higher educated patients possessed higher S-TOFHLA scores. Unlike the demographic variables, general self-management showed significant correlations with both BHLS and with COPD-Q. Out of the medical variables, objective health status was associated with BHLS and COPD-Q. Neither BHLS nor S-TOFHLA had a correlation with COPD-Q, but they correlated with each other. We found S-TOFHLA to be a better tool in the medical context. There is a clear gap between self-perceived/functional HL and the necessary disease knowledge. Rehabilitation care for patients with lower HL was more advantageous.

Building a House of Skills-A Study of Functional Health Literacy and Numeracy among Patients with Type 2 Diabetes in Hungary.

The purpose of this study is to explore functional health literacy (FHL) and numeracy skills in an insulin-treated, type 2 diabetes mellitus (T2DM) patient population, and their impact on diabetes self-care activities. A non-experimental, cross-sectional quantitative design was used for this study. The sample consisted of 102 T2DM patients on insulin therapy, including 42 males and 60 females, with a mean age of 64.75 years (SD = 9.180) and an average diabetes duration of 10.76 years (SD = 6.702). Independent variables were sociodemographic variables (e.g., age, educational level, etc.) and diabetes and health-related factors (e.g., duration of diabetes (years), the frequency of blood glucose testing/day, etc.). For this study, the participants completed the reading comprehension exercise from the Short Test of Functional Health Literacy (S-TOFHLA) and the Shortened Version of the Diabetes Numeracy Test (DNT-15), which specifically evaluates the numeracy skills of patients living with diabetes. The associations between the variables were examined with Spearman’s rank correlation. Multivariate regression analysis was performed to examine whether measured FHL skills impact diabetes self-care activities. We found that DNT-15 test (β = 0.174, t(96) = 2.412, p < 0.018) had significant effect on the frequency of blood glucose testing/day. Moreover, the problem areas for patients with T2DM mostly included multi-step calculations according to food label interpretations, and adequate insulin dosage based on current blood glucose levels and carbohydrate intake. The results of regression analyses and Spearman’s rank correlation indicated that limited FHL and diabetes numeracy skills not only influenced the participants’ behaviors related to self-management, but they also affected their health outcomes. Thus, besides the personalization of insulin treatment, it is indispensable to provide more precise information on different types of insulin administration and more refined educational materials based on medical nutrition therapy.

Health literacy and related health behaviour: a community-based cross-sectional study from a developing country

Abstract Objectives The concept of health literacy (HL) is globally evolving, and understanding its nature and impact is essential for disease prevention and treatment. Therefore, we aimed in this study to assess level of HL and predictors of inadequate HL in Jordanian population as an example case of a developing country. Method This cross-sectional study was conducted in a public tertiary hospital and community pharmacies in Jordan. All respondents answered a questionnaire, which included demographic data, Rapid Estimate of Adult Literacy in Medicine-Revised (REALM-R), Short Test of Functional HL in Adults (S-TOFHLA), and All Aspects of HL Scale (AAHLS). Chi-square test and logistic regression analysis were conducted to determine the relationship and significant predictors for HL. Key findings Among 310 participants, REALM-R showed that around 27.1% had limited HL. Similar findings with S-TOFHLA and AAHLS were shown with a mean score 25.6 out of 35 (SD = 3.54, Range = 16–33) for AAHLS. Functional and critical HL were comparably low. Education level, age, living area and chronic conditions were significant predictors of HL (P &amp;lt; 0.05). Conclusions Health literacy was inadequate among Jordanians. Further research is required to assess the effect of inadequate HL on healthcare access and health outcomes. Health education programmes are required to improve HL particularly for patients with chronic diseases.

Health literacy and glycemic control in patients with diabetes: a tertiary care center study in Brazil

BackgroundThe primary objective of our study was to determine which factors influence health literacy (HL) in patients with type 1 diabetes (T1D) and type 2 diabetes (T2D), and the secondary one was to evaluate the influence of HL on glycemic control.MethodsThis was an observational, cross-sectional study with 347 patients (144 with T1D and 203 with T2D), conducted between December 2014/December 2017. Data were obtained from medical records and/or questionnaire. The short test of Functional Health Literacy (S-TOFHLA) was used to evaluate HL.ResultsAge and years of school attendance were the most important variables associated with better performance in S-TOFHLA mainly in patients with T1D. A correlation between age and years of school attendance with S-TOFHLA score was observed in both groups of patients. After an unadjusted analysis, more patients with T1D presented adequate HL [119 (82.6%) vs 87 (44.8%, p < 0.001)]. Patients with T1D had higher scores than patients with T2D (84.4 ± 21.4 vs 61.6 ± 26.8 points, p < 0.001), respectively. This difference did not persist after adjustment for age and years of school attendance (73.04 ± 2.14 ± vs 70.04 ± 1.76 points) respectively, p = 0.348). No difference was found in HbA1c levels according to S-TOFHLA. All patients with T1D and HbA1c levels < 7.0% (53 mmol/mol) had adequate HL.ConclusionsA considerable number of patients with either T1D or T2D did not have adequate HL. Overall, age and years of school attendance were the most important variables associated with better performance of S-TOFHLA. Although no difference was found in HbA1c levels according to S-TOFHLA, patients with T1D who self-reported as White, with more years of school attendance, and higher HL score reached more frequently a good glycemic control. Finally, in addition to therapeutic regimens, approaches on diabetes management should also include patients’ HL evaluation along with psychological and social aspects.

Relação entre adesão à medicação e letramento funcional em saúde em pessoas idosas

Objetivou-se verificar se há relação entre adesão à medicação e letramento funcional em saúde em pessoas idosas atendidas na Estratégia Saúde da Família da zona oeste de um município no sul do Brasil. Estudo transversal, exploratório-descritivo, quantitativo, realizado em 17 equipes de saúde da família, com 350 pessoas idosas, aplicando-se uma versão em português da Morisky Medication Adherence Scale, que verificou o grau de adesão à medicação e uma versão traduzida do Short-Test of Functional Health Literacy in Adults, que verificou o grau de letramento funcional em saúde. Foi realizada análise estatística descritiva e inferencial. Verificou-se que 224 (64%) participantes foram considerados não aderentes à medicação, e 206 (58,9%) tiveram letramento inadequado, não havendo associação significativa entre essas variáveis. Os participantes relataram outras dificuldades no tratamento medicamentoso, entre elas, o esquecimento teve relação significativa com a adesão. A não compreensão de informações em saúde não influenciou a adesão ao tratamento medicamentoso dos participantes. Os profissionais devem atentar para outras dificuldades que podem surgir, principalmente o esquecimento, elencando estratégias voltadas à minimização do mesmo, como o acompanhamento e monitorização do tratamento medicamentoso.

Measuring functional health literacy in Hungary: Validation of S-TOFHLA and Chew screening questions.

The first efforts to measure health literacy have recently started in Hungary, thus there remains a need for tools that can be effectively used in the clinical setting. The goal of the present study was two-fold: to validate tools for measuring functional health literacy in Hungary using the Short Test of Functional Health Literacy (S-TOFHLA) and the Chew screening measure, and to provide an overview of the health literacy level of the Hungarian population. The original English versions of both instruments were translated following the principles of cultural adaptation and standardized translation methods. The measures were administered to a random sample (N = 302) that was close to representative of the Hungarian population regarding age, gender and educational background. The Newest Vital Sign functional health literacy test and numerous socio-demographic variables (such as age, gender, education and income) were also administered to test convergent validity. The Hungarian version of the S-TOFHLA and the Chew questions showed adequate internal consistency. Lower functional health literacy scores showed the expected association with known predictors of health literacy: higher age, male gender and lower education. Especially people above 65 years of age and individuals with a low level of educational attainment or being chronically ill are vulnerable to have marginal health literacy. The Hungarian version of the S-TOFHLA is a valid and reliable measure of health literacy. Moreover, the Hungarian version of the Chew screening questions provides a valid self-reported assessment, which is particularly useful to rapidly detect patients with inadequate health literacy in hospitals. It is expected that these health literacy measurements will be used for not only scientific purposes, but also serve as tools for developing public health policy, especially health education and campaigns reducing potential health disparities in Hungary.

Correlates of Health Literacy Among Polish Immigrants With Chronic Health Conditions: Preliminary Results.

The rapid increase in immigration to the United States in the past decades has resulted in an influx of individuals who have to familiarize themselves with a completely new health care system and practices, often in a new language. The purpose of this study was to assess health literacy and investigate its correlates among older U.S. Polish immigrants living in the Greater Chicago area. We conducted a cross-sectional study on 60 older adults (24 men, 36 women; mean age = 71.1 years) who completed the Short Test of Functional Health Literacy (S-TOFHLA) and a demographic survey. Scores on S-TOFHLA were lower among older and less-educated immigrants. Undocumented immigrants reported using health care services less frequently than those with legal status. These results confirm the findings of previous studies that older age and fewer years of education are associated with inadequate health literacy. Being familiar with at least the basic information about one’s condition will help patients to better understand a diagnosis, manage their symptoms, and improve any preventive treatment. The findings emphasize the importance of health education among older Polish immigrants. More research employing diverse groups of immigrants is needed to better understand the factors associated with health literacy.

HEALTH LITERACY OF INDIVIDUALS UNDERGOING DIALYSIS THERAPY

ABSTRACT Objective: to assess the functional levels of health literacy in individuals undergoing dialysis. Method: a cross-sectional study with 42 patients of the Nephrology Unit of a public hospital in Recife, Brazil, from May to August 2016. Data were collected through scripted interviews and chart analysis. Functional health literacy was measured using the Brazilian version of the Short-Test of Functional Health Literacy in Adults questionnaire. Data analysis was performed using the Statistical Package for Social Sciences (SPSS®) software, version 18.0, with a univariate analysis to verify the association between independent variables and functional health literacy levels using Fisher's exact test. Results: 80.9% of the patients presented inadequate health literacy and 19.1% presented adequate health literacy. The number of correct answers remained between 0-18 in the reading comprehension and in the scheduling appointment card. Among the independent variables, only marital status (p-value=0.018) and personal income (p-value=0.009) were factors associated with the worst scores in the test, indicating that these variables influence the increase in inadequate literacy. Conclusion: the prevalence of inadequate functional literacy was high, reflecting difficulties in understanding and processing health information, which may interfere with therapeutic management and self-care.

Parental health literacy and progression of chronic kidney disease in children.

Limited health literacy has been associated with adverse outcomes in children. We evaluated this association in the setting of chronic kidney disease (CKD). We assessed theparental health literacy of 367 children enrolled in the Chronic Kidney Disease in Children (CKiD) Study, using the Short Test of Functional Health Literacy (STOFHLA). We evaluated the association between parental health literacy and CKD progression, defined as time to the composite event of renal replacement therapy (RRT, dialysis, or kidney transplant) or 50% decline in estimated glomerular filtration rate (eGFR). Median CKiD participant age was 9.5years, 63% were male, and 59% non-Hispanic white. Median eGFR at baseline was 63ml/min/1.73m2, and median urine protein-to-creatinine ratio was 0.22. The median STOFHLA score was 98. Over a median follow-up of 3.7years, the overall CKD progression ratewas 2.8 per 100person-years. After adjustment for demographic and clinical factors, the relative time to CKD progression was 28% longer per 1 SD increase in STOFHLA score (relative time, 95% CI, 1.28, 1.06-1.53). In this cohort of children with CKD, higher parental health literacy was associated with a nearly 30% longer time to the composite CKD progression outcome.

The relationship between health literacy and knowledge about heart failure with recurrent admission of heart failure patients

Introduction: Having good health literacy can improve quality of life and decrease re-hospitalization of the patients including patients with heart failure (HF). Considering the importance of knowledge about HF and health literacy in these patients and the existence of contradictory texts, this study aimed to determine the relationship between health literacy and knowledge of HF, with re-admission of HF patients. Methods: The present study was a cross-sectional study in which 238 patients aged over 18 years old with an ejection fraction of 35% and less with the ability to read, write, and speak, and no psychological, neurological and cognitive disorders were included in the study after they signed the consent form of the research. Data collection was done through demographic information questionnaire, Short-Test of Functional Health Literacy in Adult-16 standard health literacy questionnaire, and Van Der Wal knowledge about HF questionnaire (2005). Both questionnaires were validated and their reliability was investigated before starting the study. The Chi-square test, Fisher's exact test, or the Mann–Whitney tests were used to compare variables. Results: Most of the patients were male (66%) and married (80%). The results showed that the majority of study population had proper health literacy and about half of them had enough information about HF. This study showed that there is a significant relationship between health literacy and knowledge. In other words, the higher the health literacy of the people, the greater their awareness of their illness (P = 0.02). However, the findings showed that there is no significant relationship between health literacy and awareness of HF with the number of admissions. Conclusion: The results of this study show that the higher the health literacy of the people may lead to the higher their knowledge and awareness about HF and better understanding the recommendations regarding their illness.

The relationship between anticoagulation knowledge, health literacy, and medication adherence in patients with atrial fibrillation

Introduction: Atrial fibrillation (AF) is associated with significant morbidity, mortality and economic implications. Patients with AF are often prescribed anticoagulants for the prevention of cardioembolic stroke and other embolic events. Patients’ anticoagulation knowledge, level of medication adherence and health literacy are known to affect treatment outcomes. However, contemporary data regarding the relationships between these variables are lacking. Aims: The aim of this study was to determine the relationships between anticoagulation knowledge, health literacy and medication adherence, and to investigate if knowledge is affected by health literacy levels. Methods: A cross-sectional survey was conducted in 48 patients with AF identified from general practices. The Anticoagulation Knowledge Tool (AKT) was used to assess anticoagulation knowledge, the Short Test of Functional Health Literacy in Adults (s-TOHFLA) for health literacy and the 8-item Morisky Medication Adherence Scale (MMAS) for medication adherence. The relationships between study variables were assessed using Pearson’s correlation coefficient, t-tests and regression analysis. Result: Participants in the study had mean scores of 61.6±15.8 for the AKT, 7.2±1.1 for the MMAS-8, and 24.7±9.5 for the sTOHFLA. A significant correlation was observed between both anticoagulation knowledge and health literacy with medication adherence (0.45, p<0.01 and 0.36, p < 0.05, respectively). Participants with adequate health literacy had a significantly higher knowledge score than those with limited health literacy (66.1% vs 55.8%, p <0.05), and regression analysis showed that both anticoagulation knowledge and health literacy scores were significant independent predictors of adherence levels (0.03(95%CI,0.01–0.05), p=0.001 and 0.04(95%CI, 0.01–0.07), p= 0.01, respectively). Discussion: Anticoagulation knowledge, health literacy and medication adherence were closely related and suboptimal in patients with AF. Further research in a larger population is required to definitely elucidate the magnitude of this problem. Future studies should also focus on developing effective interventions to improve anticoagulation knowledge, health literacy and medication adherence in this patient population.

Low health literacy and healthcare utilization among immigrants and non-immigrants in Switzerland

ObjectiveThis study aimed at investigating the association between functional health literacy and knowledge on when to seek medical help for potentially harmless (overutilization) or serious (underutilization) situations among immigrants and non-immigrants in Switzerland. MethodsData was collected among three immigrant groups and the native population (N=1146) in the German- and Italian-speaking part of Switzerland. Health literacy was assessed with the Short Test of Functional Health Literacy (S-TOFHLA) and three Brief Health Literacy Screeners. Over- and underutilization of healthcare services was assessed with items asking participants about when to seek medical help for minor, respectively major, physical symptoms. ResultsImmigrants were more likely to seek medical help when unwarranted (overutilization). Health literacy, when assessed with the S-TOFHLA, was significantly associated with over- and underutilization. Yet, once controlled for covariates, the association between health literacy and overutilization was negative. Immigration background and micro-cultural differences emerged as important predictors of utilization. ConclusionsResults suggest that functional health literacy is directly related to healthcare utilization. The effects might be amplified by (micro-)cultural differences. Practice implicationsHealthcare providers should be aware of differences in health literacy and utilization patterns among different population groups. Communication between patients and providers should be literacy and culturally sensitive.

Oral health conceptual knowledge and its relationships with oral health outcomes: Findings from a Multi-site Health Literacy Study.

In 2010, a health literacy instrument designed to measure oral health conceptual knowledge was introduced. This developmental work was limited in that it included a relatively small and homogeneous study population and few oral health measures against which to test concurrent validity. The purpose of the present investigation is to expand upon the earlier work by utilizing a larger study sample and additional outcome variables. Data for this report came from the Multi-site Oral Health Literacy Research Study (MOHLRS), a large, cross-sectional survey conducted at two university-based dental clinics in the United States. MOHLRS included multiple assessments administered during face-to-face interviews. Conceptual knowledge was measured with the Comprehensive Measure of Oral Health Knowledge (CMOHK). Questions about self-efficacy, utilization, and dental beliefs and attitudes were also asked. Covariates included recruitment site, age, gender, race/ethnicity, education level, and languages spoken. Overall, 18% of 909 adult participants exhibited "low" conceptual knowledge. CMOHK scores were significantly associated with three health literacy instruments, the REALM, Short-test of functional health literacy in adults (TOFHLA), and confidence filling out forms. In both bivariate and multivariable analyses, CMOHK scores were also significantly associated with dental beliefs and attitudes and self-efficacy to prevent both dental caries and periodontal disease. CMOHK scores were not associated with utilization, measured either as having a dental visit or a dental cleaning in the last year. The present investigation provides additional support for the CMOHK's validity. Researchers are encouraged to incorporate oral health conceptual knowledge into their theoretical frameworks, especially as it relates to beliefs and self-efficacy.

Health literacy, health-related quality of life, and atrial fbrillation.

Atrial fbrillation (AF) is a chronic heart rhythm disorder associated with significant adverse outcomes. Health-related quality of life (HRQoL) is an established metric of health status in individuals with AF, and health literacy is highly relevant to how individuals experience HRQoL. We conducted a pilot investigation to examine the association of health literacy and health related quality of life (HRQoL) in a limited-sized cohort of individuals with AF, all of whom had AF and were ≥60 years old. We used the Short-Test of Functional Health Literacy in Adults to categorize participants by health literacy status. We used the SF-36 to examine HRQoL in eight subscales and two composite scores, and related health literacy to HRQoL. In our cohort of 40 participants with AF (45% female, age 77.9 ± 8.0 years), 62.5% had inadequate health literacy. However, we did not identify a significant association between health literacy and HRQoL. We expect our limited-sized sample is a chief limitation for why we did not see an association between health literacy and HRQoL in this convenience cohort. Further studies examining health literacy and its impact on patient-centered outcomes in AF are essential.

Does acculturation narrow the health literacy gap between immigrants and non-immigrants—An explorative study

ObjectivesTo compare functional health literacy (HL) levels in three immigrant groups to those of the German- and Italian-speaking non-immigrant population in Switzerland. Moreover, to investigate whether language-independent, respectively language-dependent, functional HL and variables of acculturation were associated with self-reported health status among immigrants. MethodsLanguage-independent HL was assessed with the Short Test of Functional Health Literacy (S-TOFHLA) in the respective native languages. Language-dependent HL was measured using Brief Health Literacy Screeners (BHLS) asking about participants’ confidence in understanding medical information in the language of the host country. Measures of acculturation included length of stay and age when taking residency in Switzerland. ResultsIn particular Albanian- and Portuguese-speaking immigrants had lower levels of functional HL. In unadjusted analysis “age when taking residency in Switzerland” was associated with the BHLS. Adjusted analysis showed that the BHLS were significantly associated with self-reported health among all immigrant groups (p≤0.01). ConclusionsFunctional HL that is dependent on understanding of medical information in the language of the new host country is a better predictor for self-reported health status among immigrants than language-independent HL. Practice implicationsIn the clinical setting limited functional HL might be a significant obstacle to successful disease treatment and prevention in immigrants.

„Hogy minden beteg megértse!” – Az egészségműveltség (health literacy) mérése Magyarországon

Inroduction: The efficiency of healing is determined by the ability of the patients to comprehend and to apply properly the information provided by the doctors. This ability is influenced by age, intelligence and social background, but above all by health literacy. Aim: The aim of the present study was to translate and adapt the Hungarian version of the Short-Test of Functional Health Literacy, which is a performance based measure and the perception-based Chew screening questions for health literacy in Hungary. Method: The sample consisted of 302 people, and it was closely representative for the Hungarian population. Results: The reliability of the reading part of the Short-Test of Functional Health Literacy was excellent, and it was also acceptable regarding the Chew screening questions, but it showed low internal consistency concerning the numeracy part of the Short-Test of Functional Health Literacy. Based on the Short-Test of Functional Health Literacy reading scores, participants were categorized into three groups: 8% had inadequate, 6% marginal and 86% adequate health literacy levels. Regarding participants without a chronic illness tended to possess higher health literacy levels based on all the three measurments. Conclusions: The availability of these measures of health literacy in Hungary can play a crucial role in doctor-patient communication as well as health promotion, that can contribute to develop health literacy policies leading to reduced health care costs in the future. Orv. Hetil., 2016, 157(23), 905–915.

Validation of Turkish health literacy measures.

This study aimed to validate a Turkish version of the Short Test of Functional Health Literacy (S-TOFHLA) (Baker et al, Development of a brief test to measure functional health literacy. Patient Educ Counsel 1999; 38: :33-42) and a Turkish version of the Chew self-report scale (Chew et al., Brief questions to identify patients with inadequate health literacy. Family Med, 2004; 36: :588-94) for measuring functional health literacy. The original English version of the S-TOFHLA and the Chew items were translated by applying standardized translation methods and cultural adaptations, and both were administered to a sample of diabetes patients (N = 302) in two diabetes clinics in one of the major cities in Turkey. Self-administered paper-pencil questionnaires were distributed to eligible outpatients who had a clinic appointment. In addition to the S-TOFHLA measurement and the Chew screening questions, gender, age, educational attainment, income, marital status and diabetes knowledge were obtained. The Turkish version of S-TOFHLA showed high internal consistency. Both S-TOFHLA and the Chew screening scale correlated significantly with known predictors of health literacy: age, education and income. The Chew scale was also related weakly but significantly with general diabetes knowledge. It is expected that the Turkish versions of S-TOFHLA and the Chew scale will be used in Turkey as well as in other countries with large Turkish communities.

The S-TOFHLA as a Measure of Functional Literacy in Patients with Mild Alzheimer's Disease or Mild Cognitive Impairment

In developing countries, education levels vary dramatically, and the number of years of schooling does not always correlate with the true level of educational competency. This study was designed to verify the accuracy of the Short-Test of Functional Health Literacy in Adults (S-TOFHLA) in individuals with mild cognitive impairment (MCI) and mild Alzheimer's disease (AD), when compared with healthy controls (HCs), in order to assess its utility as a measure of functional literacy. One hundred forty-eight subjects were divided into three groups: HC (n = 61), MCI patients (n = 42), and AD patients (n = 45). The S-TOFHLA does not seem to be suitable as an instrument to measure functional literacy for patients with advanced cognitive impairment, but proved to be appropriate in both the HC group and MCI patients in numeracy and prove to be useful as an adjuvant to estimate IQ, reading ability, and premorbid IQ, as an indicator of cognitive reserve.

Functional health literacy in Switzerland—Validation of a German, Italian, and French health literacy test

ObjectiveThis study aimed to translate and validate German, Italian, and French versions of the Short-Test of Functional Health Literacy (S-TOFHLA), to be used in Switzerland and its neighboring countries. MethodsThe original English version of the S-TOFHLA was translated by applying standardized translation methods and cultural adaptations. 659 interviews were conducted with Swiss residents in their preferred language (249 German, 273 Italian, and 137 French). To assess the validity of the measures, known predictors for health literacy (age, education, and presence of a chronic condition) were tested. ResultsFor all three language versions, results show that younger participants, participants with a higher education and participants with chronic medical conditions had significantly higher levels of health literacy. Furthermore, the three health literacy scales categorized participants into three health literacy levels with most people possessing either inadequate or adequate levels. The highest levels of health literacy were found in the Swiss-German sample (93%), followed by the Swiss-French (83%) and Swiss-Italian (67%) samples. ConclusionThe German, Italian, and French versions of the S-TOFHLA provide valid measures of functional health literacy. Practice implicationsThe translated versions can be used in the three different language regions of Switzerland as well as in neighboring countries following ‘country specific’ adjustments and validations.