The test of functional health literacy in adults
- 5.3k Downloads
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 wordsfunctional health literacy literacy and health health literacy measurement
Unable to display preview. Download preview PDF.
- 1.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.Google Scholar
- 2.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.Google Scholar
- 3.U.S. Department of Commerce, Bureau of the Census. English Language Proficiency Study. Washington, DC: Government Printing Office, 1982.Google Scholar
- 9.Jastak S. Wilkinson GS. Wide Range Achievement Test-Revised (WRAT-R). San Antonio, TX: The Psychological Corporation, 1984.Google Scholar
- 11.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.Google Scholar
- 12.Taylor WS. Cloze procedure: a new test for measuring readability. Journalism Q. 1953;30:415–33.Google Scholar
- 13.Laubach RS, Koschnick K. Using Readability: Formulas for Easy Adult Materials. Syracuse, NY: New Readers Press, 1977.Google Scholar
- 14.SPSS-X Users Guide. 3rd edition. Chicago. IL: SPSS, Inc., 1988.Google Scholar