Journal

Club
Anabel Castaneda & Niani Coker
Article Review

HEALTH LITERACY Defined…

“...the degree to which individuals have the capacity to obtain, process, and
understand basic health information and services needed to make
appropriate health decisions.”
Healthy People 2010
SDOH: Health Literacy
 Summary/Overview of Article

We will cover... Strengths/Weaknesses

Contribution to Literature/
Implications to Policy

Discussion Questions

Q&A
Summary: The Prevalence of Limited Health Literacy
OBJECTIVE
● Systematically review U.S. studies on prevalence of health literacy
● Synthesize findings by evaluating demographic associations

DESIGN
● Identified 2,132 references based on set of specific terms
● Of 134 articles and published abstracts retrieved, 85 met inclusion criteria
● Inclusion criteria:
1. Conducted in U.S. with 25 or more adults
2. Addressed hypothesis related to health care
3. Identifies a measurement instrument
4. Presented primary data
Summary: The Prevalence of Limited Health Literacy

RESULTS:
● Data on 31,129 subjects was reviewed
● Prevalence of low health literacy ranged between 0%-68%
● Weighted prevalence of low health literacy was 26%
● Most studies used REALM or TOFHLA
○ REALM = Rapid Estimate of Adult
Literacy in Medicine
○ TOFHLA = Test of Functional Health
Literacy in Adults
Summary: The Prevalence of Limited Health Literacy

CONCLUSIONS
● This systematic review exhibits that limited
health literacy is prevalent and associated with:
○ Education
○ Ethnicity
○ Age
● It is essential to simplify health services
and improve health education
“Health literacy is
increasingly described
as the currency for
improving the quality of
health and health care
in America.”
Strengths of Article

● Inclusion criteria
● Large sample size
● Validated testing instruments used for literacy skills
○ prose and document literacy, subdomains of reading capacity, and numeracy
● Strong demographic association
● Reinforced the importance of SES on health and HS graduation as a key determining
factor in health literacy
Weaknesses of Article
● A pooled health literacy analysis cannot provide a national prevalence estimate
● Article published in 2004 - older data
● Few tests provide Spanish option; no other languages accomodated
● Testing was developed for literacy not in a health context /have limited clinical data
● Variation of tools used-Certain tools used isolated topics focusing solely on
pronunciation.
● Did not include listening or speaking
● Did not evaluate vision or cognition
● Participation bias - people with limited literacy less likely to participate
● Overrepresentation of Black american subjects in an all inclusive low SES study,
allows for skewed data
● Systematic confounding and ethnic history with standardized test
Contribution to Literature &
Implications to Policy
● While tests like the (TOFHLA) &
the (REALM) were once the
“golden standard” but today we
recognize that they may be
culturally insensitive or
inappropriate for non-native
English speakers and minorities.
Contribution to Literature &
Implications to Policy
● It is now more common to use :

HALES - Health Literacy Scale

HLQ - Health Literacy Questionnaire

in health lit assessment
Contribution to Literature &
Implications to Policy
● The (HALES) is designed to look
comprehensively at health literacy
between tasks and skill. So you can’t
spell it but can you do it?
● The (HLQ) is designed to conceptualize
cultural and conceptual knowledge,
speaking and listening skills, writing and
reading skills, and numeracy.
Discussion...
Discussion

● Why do you think minorities are so greatly disadvantaged when it comes to

having health literacy?
Discussion
WHY?

● Why do you need to address health

literacy issues? How can addressing
health literacy serve both patients' and
practitioners needs?
Discussion
TEAM APPROACH

Implementing and sustaining health literacy

practice requires strong, effective leadership
and a dedicated team.

● Can you identify key team members and explain their roles?
Discussion
LITERACY ≠ UNDERSTANDING

● Literacy does not equal understanding...what is meant by this statement?

Discussion
HEALTH LITERACY OUTCOMES

● What would success or improving health literacy look like? What are the
target outcomes?
○ Changes to process
○ Behavior and attitudes
○ Health outcomes
 ❏ Warm Greeting.
❏ Eye Contact.
❏ Listen.

Communication ❏
❏
Use Plain, Non-medical Language.
Slow Down.

Strategies
❏ Limit Content.
❏ Show How It’s Done.
❏ Use Teach-Back.
❏ Repeat Key Points.
❏ Use Graphics.
❏ Invite Patient Participation.
❏ Encourage Questions.

AHRQ Health Literacy Universal Precautions Toolkit, 2nd Edition

 ❏ Language differences

Also, consider:
❏ Culture, customs, beliefs and
backgrounds
❏ Connect to literacy and math resources
References
Paasche-Orlow, M. K., Parker, R. M., Gazmararian, J. A., Nielsen-Bohlman, L. T., &
Rudd, R. R. (2005). The Prevalence of Limited Health Literacy. Journal of
General Internal Medicine, 20(2), 175–184.
http://doi.org/10.1111/j.1525-1497.2005.40245.x

Brega AG, Barnard J, Mabachi NM, Weiss BD, DeWalt DA, Brach C, Cifuentes M,
Albright K, West, DR. AHRQ Health Literacy Universal Precautions Toolkit, Second Edition. (Prepared
by Colorado Health Outcomes Program, University of Colorado Anschutz Medical Campus under
Contract No. HHSA290200710008, TO#10.) AHRQ Publication No. 15-0023-EF. Rockville, MD.
Agency for Healthcare Research and Quality. January 2015.

https://journals.lww.com/md-journal/Fulltext/2018/03090/Simple_screening_tools_to_identify_limite
d_health.34.aspx
Thank you!