Journal of General Internal Medicine

, Volume 10, Issue 10, pp 537–541

The test of functional health literacy in adults

A new instrument for measuring patients’ literacy skills
  • Ruth M. Parker
  • David W. Baker
  • Mark V. Williams
  • Joanne R. Nurss
Original Articles

DOI: 10.1007/BF02640361

Cite this article as:
Parker, R.M., Baker, D.W., Williams, M.V. et al. J Gen Intern Med (1995) 10: 537. doi:10.1007/BF02640361


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.

Key words

functional health literacy literacy and health health literacy measurement 

Copyright information

© Hanley & Befus, inc. 1995

Authors and Affiliations

  • Ruth M. Parker
    • 3
  • David W. Baker
    • 3
    • 1
  • Mark V. Williams
    • 3
  • Joanne R. Nurss
    • 2
  1. 1.the Harbor-UCLA Medical CenterLos Angeles
  2. 2.the Georgia State UniversityAtlanta
  3. 3.Department of MedicineEmory University School of MedicineSt, Atlanta

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