Evaluating and Measuring Health Literacy Discussion Summary - Literature Information and Communication System (LINCS)

Evaluating and Measuring Health Literacy

Discussion Summary

Discussion Announcement | Guest Facilitator

In this discussion we began by exploring the existing screeners and measures of health literacy and discussing their uses and limitations. Several themes emerged, each of which were further discussed in some detail. These themes included: the conceptual framework of health literacy and how it should anchor any new tools; the purposes of measuring health literacy; who we are measuring: individuals only or also providers and systems; the differences between literacy and health literacy; and how to capture various social and contextural variables that affect health literacy.

We also discussed the elements that a rigorous measure of health literacy should include, and what kinds of conceptual work and testing are needed in order to ultimately create and validate such a measure.

Since the discussion, several things have happened to move this process along and take the ideas to a wider audience. Andrew has presented a review of the discussion at a few conferences, and he and Julie McKinney wrote an article in Nursing Outlook about the discussion and what came from it. (See below)

Also, a small workgroup was formed, initiated by list member RV Rikard. The workgroup met by phone and through email several times and discussed how to move forward from the consensus reached through the discussion. That group helped to explore what questions to address in the follow-up discussion, held the following June.

Coming to Consensus on Health Literacy Measurement: An Online Discussion and Consensus-Gauging Process
Nursing Outlook, volume 59, 2011
This article, by Andrew Pleasant and Julie McKinney describes the process and results of last year's discussion on evaluating and measuring health literacy. It explains how the online discussion worked as a consensus-gauging process in order to determine the needs of the field for a new measurement tool. The article includes the results of a survey given during the discussion, and discusses the level of consensus in the field on the conceptual framework of health literacy that should be used to underpin the new tool, and features of a tool that are considered.

Transcript of Compiled Daily Notes

Day 1 notes - the power of measurement (aka any tool is better than none)

Andrew Pleasant andrew@canyonranchinstitute.org

Hi everyone,

Another emerging theme in our discussion seems to be focusing on the power
of measurement and, by extension, the power of having health literacy
included in the formal health care, policy, and research systems. (Students
of the sociology of science are now perking their ears up.)

For example, we received these comments from participants on the first day
of our week-long discussion:

  • Karen Limkemann shared with us ...

    "Potential funding sources attached to health fields are beyond our reach
    without a useable measurement tool."
  • Andres Muro gave us his insight about ...

    "...the "official space" that the health establishment has created, vs. the
    "unofficial space" which is the language of the community at large."
  • Julie McKinney, our listserv leader, shared with us ..

    "In order to prove effectiveness, you have to have measures that are
    commonly accepted and then do rigorous studies using those measures."
  • Suzanne H. Boegli commented in regard to the Flesch being built into MS Word ...

    "It gives my advocacy leverage."

So I suggest we collectively accept some of the key lessons from the
sociology of science that I referred to earlier.

One of those findings, in general, is that measurement and science are not
free from social, political, and cultural pressures and, in turn, can create
social, political, and cultural pressures.

Putting that in other words, when someone knows they are being observed they
are very likely to change their behavior in an attempt to meet the
expectations of the person doing the observing. That is the power of
standardized measures being employed at the system level.

Some of the work that the field of health literacy has only started to do -
in my opinion - is to influence the health professions at large as well as
to influence cultural understandings and practices surrounding health care,
prevention of poor health, and an understanding of health as more than
merely the absence of disease but as a resource for life.

What do you all think about this?

How do the current assessment tools we have listed perform in this regard?

What would a measurement tool designed to meet these types of goals look

A mini review - Day one

Andrew Pleasant andrew@canyonranchinstitute.org

Hello everyone,

Let me say - you are all simply brilliant. I tip my hat (which I usually
don't wear) at the quality and quantity of the discussion today. As the week
progresses - and remember it is a week-long discussion so please keep your
insights coming - I hope we can further identify solid threads that provide
a foundation upon which we can move forward in a collective manner.

In addition to the separate emails highlighting specific themes that seem to
be emerging, allow me to point out these highlights (in my view) from Day 1.

  • Francisco Soto Mas, who I point out emailed from El Paso, TX, shared with us ...

    "Interestingly, our population consists of Spanish speaking adults so we
    initially proposed to use the Spanish TOFHLA. However, reviewers recommended using the English version arguing that in the US the health care system functions in English."
  • AP comments ...

    I would love for the NIH reviewer who made these comments to provide us with
    a further explanation and validation of that position. Does this not fly in
    the face of all the evidence on the value of culturally and linguistically
    appropriate communication and health care?
  • Jason Ketola shared ...

    If we respect people's autonomy, that's fine, and we can still feel good
    about doing the good work of helping people make informed decisions (and
    correcting disparities). If, however, we focus on outcomes, we're likely to
    take an instrumental view of health literacy and people themselves
    (particularly problematic given the vulnerable individuals we're talking
    about), and I submit that when we do that, we're not respecting individuals'
    dignity and autonomy.
  • AP comment ...

    Reflecting Jason, I continue to point out the importance of
    focusing on an "informed decision" versus an "appropriate decision." That
    also highlights the importance of definitions of health literacy and how
    they can and do influence measurement. Who decides, for example, what is an
    "appropriate decision" according to the Institute of Medicine's (and others)
    definition of health literacy -- and how can that measured?
  • Barbara Bayldon wrote ...

    For research etc., I think these tools may be great, that a screening
    question that takes little time to find many people especially at risk, but
    I feel that we should be looking at ways to efficiently and effectively make
    sure our families understand, all of them in the various situations in which
    they find themselves.
  • Ken Wallston ...

    I think that we in the field can do (and should do) much better in assessing
    health literacy than is currently done with the REALM or the TOFHLA, but the
    REALM and the TOEFLA are among the best assessments we have for the time
  • Sharon Barrett wrote ...

    I realize the importance of measuring health literacy for the purpose of
    research, but have we abandon(ed) the notion of using a "universal
    precaution" approach to communicating with patients during the clinical
  • Jose Arrom wrote ...

    If they make their tool available, it might be useful to understand how
    people at different levels of literacy navigate websites.
  • AP comment ...

    Jose, you might find this article I worked on useful. See
    http://www.ncbi.nlm.nih.gov/pubmed/12356289 for an abstract and if anyone
    wants a full text version please contact me directly off the listserv.
  • Suzanna Carbone observed ...

    The reality is that the patient can be what appears to be educated but still
    not hear what the health care professional is saying.

    And the health care professional may feel rushed because of a heavy workload
    that prohibits them from spending a sufficient amount of time to assess the
    patient's understanding prior to discharge.

  • Stan Hudson reminded us ...

    About the methodology Rima Rudd initially developed and others of us
    have used or adapted called The Health Literacy Environment of Hospitals and
    Health Systems
  • AP comment ...

    You can find a link to this and other useful materials at http://www.hsph.harvard.edu/healthliteracy

Among several comments reminding us of the complexity of health literacy,

  • Debra Smith wrote that ...

    "For example, health literacy involves recognizing pharmaceutical companies' biases and possibly fallacious reasoning in advertisements, having
    background knowledge of how the body (and mind) works and what it needs,
    judging whether a source of health information is trustworthy, being able to
    analyze family health/treatment traditions and cultural customs and weigh
    them against professional advice, paying attention to health news and having
    a framework to assess it, feeling sufficiently empowered to question medical
    practitioners for more or clearer information or ask for a second opinion,
    and so on."
  • Elissa Director from New Jersey (where a health literacy coalition is
    forming - so please contact Elissa or myself for more details if you are
    based in New Jersey) Provided us with a delightfully clear example of the limitation of word recognition and definitional exercises as measurement. If you missed it - do
    yourself a favor and review her email.
  • Aracely Rosales writes ....

    "However, I must say that the confusion many times is about the difference
    between the very basic terms, "literacy, readability and health literacy."
    But, if we listen close enough, we consistently hear a resounding and rather
    clear message: readability indices can be confusing and sometimes writers do
    not understand the differences among them nor the delicacies of their unique

    What should be the standards/metrics to measure health literacy? But then
    again, taking into consideration the feedback already given and what we
    know, perhaps we can't have only one. As a social issue with many complex
    areas and many diverse populations affected by it, maybe it could not be
    one, but many tools and we should try to stay away from the universal
  • Kathryn Anderson reminds us about the SAM (Suitability Assessment of
  • AP comment ...

    I am very sorry my fingers forgot to type this earlier,
    thanks for correcting my oversight!

A mini review - Day 2

Andrew Pleasant andrew@canyonranchinstitute.org

Hi everyone,

Again, thanks to everyone for your continued participation. Thanks also to
those with less of an interest in measurement for understanding why so many
people are interested in participating in this discussion.

I received enough positive response offline from the mini review of Day 1
that I feel it is a worthwhile practice to continue.

One note of housekeeping - please understand that I am very sympathetic
about the discussions beginning to move off measurement specifically - how
can we measure something we do not agree on what it is entirely?

Having written that, let's do please try to keep our eye on the main subject
- measurement of health literacy - as much as possible. So do digress when
necessary, but please always tie it back to measurement. I will try to do
the same myself - I might not always succeed but I will certainly try.

So, housekeeping chores complete, here are a few highlights from Day 2 ....

  • William McAfee self-admitted that he was coming out of lurking (yeah!). He wrote ...

    "Health literacy will help facilitate "exchanges in the healthcare market",
    but I doubt that anyone would "buy" health literacy for just the sake of
    having health literacy. Where is the value?"
  • AP question ...

    is this an argument for always including outcomes as part of
    a methodology/measure of health literacy?
  • Kristine Sorenson from The Netherlands let us all know that ...

    "We are currently in a consortium called the European Health Literacy Survey
    (HLS-EU) developing a tool to measure health literacy in eight countries in
    Europe: Austria, Bulgaria, Germany, Greece, Nederlands, Ireland, Poland and
    Spain and try to capture the domains of cure and care, disease prevention
    and health promotion"
  • AP comment ...

    How exciting! Hopefully there will be a mechanism for broad
    engagement and involvement in that process.
  • Jackie Taylor let us know of the increased profile health literacy is taking at this year's COABE conference - thanks Jackie! (As an aside - the state of Arizona is currently considering slashing all the state funding for GRE and ABE...but this is not an advocacy list so I will not digress further.)
  • Andrea Moxley questioned the group ....

    "Isn't it more important to measure reduction in health disparities and
    patient satisfaction than the patients ability to understand you?"
  • AP comment ...

    I am sort of surprised people have not taken up Andrea
    Moxley's very direct question. Clearly, there is more than one context from
    which people can respond to this query. One is the push for universal
    precautions in clinical settings versus the burden and potential stigma of
    measuring what we already recognize as a wide-spread issue. Another is the
    need to advance knowledge about the field and develop new interventions that
    actually work (in no small part because they are based on the evidence
    gathered through rigorous measurement).

    Where do you stand? What have been your experiences in this regard?

On a related note,

  • Sabrina Kurtz-Rossi offered this of the discussion ...

    "This is a somewhat different slant on measuring health literacy, but my
    interest is in how to evaluate the effectiveness of health literacy
    curricula. Ultimately, the goal is to improve health literacy but I base my
    assessments on skills-oriented, measurable objectives rather than changes in
    health literacy.

    I'd be interested in engaging in a discussion about what are the
    critical health literacy-related skills and how can we utilize these to
    measure health literacy."
  • AP comment ...

    the subject line for this email is "Evaluating Health Literacy
    Curricula" -- I encourage everyone to continue this discussion using this
    subject line.
  • AP comment ...

    Of the many many impressive threads to this discussion so
    far, let me point out the thread with the subject line that follows as
    maintaining a focus on issues related to measurement and going well beyond a
    discussion of simple screening. You might do well to peruse these messages
    if you have not... But of course we will all have our various favorites.

    Re: narrowing the HL measurement disconnect: interactive health literacy
  • AP question ...

    The study that found a lack of effect from Ask Me 3 is being reported in
    multiple newspapers yesterday and today (some people had predicted this for
    some time we have to say in order to be fair to all parties).

    What does this development mean for health literacy as a field? What, if
    anything, does this outcome mean for measurement of health literacy?
  • Winston Lawrence from the Literacy Assistance Center in New York City joined the conversation today. I am a bit awkward here as facilitator because
    Winston refers to some of my work, but Winston wrote to the group ...
    (and really, apologies if you think this is self - promotion, I honestly think
    it is a worthy continuation of the dialogue)

    "The clinical setting represents only a sliver - in terms of
    health literate behaviors. Public health is a domain in which health
    literacy has to be practiced.

    Because of these dimensions, I'm afraid measurement becomes extremely
    difficult. As I see it, we may well need to find a very robust
    instrument that can capture the various elements - fundamental,
    scientific, cultural and civic - that Andrew and Chris have proffered
    in their work - Advancing Health Literacy

    The question is: Can these concepts be operationalized to provide an
    instrument that could yield a true measure of health literacy."
  • AP questions ...

    What do you think? Can this goal be accomplished for this
    or any of the (few) theories of health literacy?

Ok .. For a summary this is already too long - apologies.

Please keep your worthwhile additions to this discussion going .. I am very
curious to see how it will turn out. Tomorrow, I will throw out another
prompt or too as well I believe.

Andrew Pleasant

A mini review - Day 3

Andrew Pleasant andrew@canyonranchinstitute.org

Hello everyone again,

Another busy day on the listserv - thanks again to everyone for
understanding and accepting this level of interest that just keeps appearing
in your Inbox. Hopefully, we can begin to turn the corner from the large
number of broad and engaging streams of discussion and make sure the
discussion includes an evaluation of what is currently out there and what we
need to develop in order to continue to advance the field of health

Note also please, the attempt - which may fail I freely admit - to try to
identify some points of consensus.

I suggest that this week's content will be worth reviewing further when you
have more time - Julie McKinney is going to make the entire discussion
available for us to do just that, thanks Julie!

As has become the practice, following are a very few highlights extracted
from the emails of the day. I hope you at least review these and use this
email as a way to investigate the specific discussion they came from.

  • Michael Paasche-Orlow stole himself away from grant writing to observe ...

    Among other ideas, HL cannot be all things. For example culture - culture should be allowed to remain its own domain (i.e., not part of Health Literacy measurement tools) except in very discrete (but important) ways. For example, the choice of Standard English as the assumed basis upon which literacy and HL will be measured needs to be thought through. To be sure, Standard English is likely to be the starting point for many health contexts, but measures like
    the REALM are an ethnolinguistic offense.
  • AP question ...

    Is culture separate from health literacy or are language,
    culture, and health so inseparably bound up that in some ways culture has to
    be addressed as a component of health literacy theory and, thus,
  • Gary Kreps got straight to a point here ...

    Echoing Arthur Upham's longer post that is well worth reading also. See message #4263 Re: narrowing the HL measurement disconnect: from Arthur.

    "I endorse Arthur's suggestion that we focus on measuring the ability of the
    health care system to communicate effectively with diverse audiences of
    varying levels of health literacy. With these kind of data we can develop
    interventions to improve the effectiveness of health communication."
  • Len Doak - thanks for joining us - offered this advice about using multiple methodologies...

    " Today, if we were repeating this project, we would attempt to test all
    patients with both kinds of test."
  • Brenda Fuentes from El Paso, TX gave us a fine goal ...

    Hopefully, measuring health literacy (in a culturally-appropriate way)
    will lead to initiatives which will enable individuals to access and
    understand information in order for them to think critically and make
    healthy choices.
  • Lori Fabian wrote ...

    I understand that there is a crying need to evaluate and work to change the
    way the health care system communicates. That is certainly a worthy area of
    exploration, discussion, and vigorous intervention. But that kind of
    systemic change is going to take a very long time. In the meantime, those
    "on the ground" need to find effective ways to help people who are dying too
    soon because they lack the knowledge or skills to manage their health today.

    And that ...

    "It is critical for the academic field to come to consensus as to
    definition, and to examine the ways that it communicates health literacy
    concepts to those with the means to influence it."
  • AP - Amen
  • Carol Collins reminds us of the value of involving people early and often

    Something I often include as one of the Golden Rules of Health Literacy
    - and a step I believe any developers of a new measurement approach must
    include. Are you all doing that? If not, why not?
  • Stan Hudson from Health Literacy Missouri gave this nice summary of one
    situation ...

    ...even highly educated and informed patients with exceptional health
    literacy skills can still be impacted by the health literacy gap, if the
    provider practices poor health literacy and doesn't give their patients
    ample opportunity (useful knowledge and interactions) to use their skills.

    From the service side, without focusing on both, you could be setting
    yourself up for failure.
  • Aracely Rosales reminded us to always take into consideration a person's
    feelings when we are assessing skills.
  • AP - thank you!

A mini review - Day 4

Andrew Pleasant andrew@canyonranchinstitute.org

A little housekeeping reminder - of course it is a listserv intended to
discuss all aspects of health literacy - and we do - but if you can tie your
submissions to the measurement discussion back to measurement that would be
helpful. Thanks!

Note -- in no way do I mean that people should not send in regular
submissions on other matters as is fortunately occurring ... Just reminding
us to keep the measurement discussion on measurement. :)

Also ... And this is perhaps more important. As the week is getting on, the
email length is also getting longer - so please remember to delete what you
are replying to in your emails unless absolutely necessary. I suspect not
doing so must make it especially trying on people who receive digest mode.

Now - the mini review of the next to last day of our discussion on

  • For those of you tired of the measurement discussion, I point out two new subjects that you may find of interest and that should not be lost in the
    quantity of emails. See the subject lines "Marketing the Brand vs.Teaching the Patient" "Reference help please: cost-benefit analysis of HL interventions in a fertility/gyn outpatient office?"
  • Linda Shohet requested:

    Clarity on appropriate contexts for measurement -- and I believe people have
    replied. Also take a look at related draft consensus statements. More discussion on qualitative approaches - Any takers?
  • Kristine kindly gave us a bit more information on the work ongoing in

    "The HLS-EU instrument is conceptual based, and is focused on the
    processing of information and resources relevant to health in terms of
    access/exposure to information, understanding the information, appraising
    the information and using it, or applying it to situations related to care
    and cure, disease prevention and health promotion. The sample will consist
    of 1000 people from every participating country, so hopefully 8000 in total.
    As the tool is still under construction, I will examine the responses
    carefully to match the tool to the needs as much as we can within our budget
    and resources."
  • Michele Erikson (who puts on a keen conference in WI among other good works) reminded us ...

    " ... I remember them [DeWalt and Malone] reporting how very satisfied
    clinician staff at all levels were in their new health literacy-sensitive
    roles. While they all had to make shifts in their methods of practice and
    communication, and in some cases take on more responsibility, staff moral
    increased greatly. I would guess when our efforts show improved health
    outcomes for patients, increased patient satisfaction and understanding, it
    is a win-win for all involved."
  • Andres Muro contributed an insightful narrative as part of the literacy vs
    health literacy subject line. I hesitate to cut a snippet and inadvertently
    lose some of his message - so I'll just suggest you read his message.

    When you do so, I'd suggest you ask yourself - what are the outcomes of
    health literacy and who gets to decide what they are.
  • Cliff Coleman added the perspective of a practicing and teaching physician

    "I teach our medical students and residents that health literacy is a shared
    process between patients and health care professionals, but that the
    RESPONSIBILITY for ensuring that health literate communication has occurred
    is actually somewhat more on the shoulders of the health care professional
    at the end of the day. If it has not already been mentioned in this context,
    the Calgary Charter on Health Literacy attempts to reframe the
    concept of health literacy in these terms. "
  • AP ...

    and everyone who agrees with the attempt of the Calgary Charter is
    invited to add their names at the above web site as well.
  • In multiple submissions, Sandra Smith added several interesting concepts to the discussing about positioning health literacy and measurement in regard
    to outcomes. I suggest you all take a look at her submissions.

A mini review - last day

Andrew Pleasant andrew@canyonranchinstitute.org

Hi everyone,

I tip my hat to you all.

Your responses have been thoughtful, considerate, concerned, helpful,
intelligent, questioning, insightful, enjoyable, stimulating, fun,
difficult, challenging, gracious, inspiring, and, of course, numerous.

Thank you all for that.

Clearly, we have more work ahead of us to further advance health literacy,
but we can also be confident in knowing that the field has also come a long

I remind everyone to please respond to the draft consensus statements before midnight Sunday March 14, 2010 at: http://www.surveymonkey.com/s/JVTJXMY

For some time now, I have felt there is a need to convene a process to
address the question of health literacy measurement. This week starts that
work, but more is required. Stay tuned.

The immediate plan to move forward is that Julie and I will prepare a
summary in the near future and will share that with you all.

Many of you have been complimentary of this process - and I want to thank
you for the kind words. What is very true, however, is that we could not
have had such a successful week without the participation of each and every
person. We also have to thank those on the listserv who may not be so
interested in measurement of health literacy, but who accepted the high
number of emails -- without complaint to the best of my knowledge. Thanks

Now, special thanks are due to a few key individuals - some of whom have
been invisible but critically important. Of course this includes Julie
McKinney - our valiant listserv moderator. Can't say enough about how
important her role is - you all know this already I am sure.

Two people you may not know are Rochelle Kenyan who stepped in to help on
the logistical side and Connie Yu who consistently helps this listserv
function so smoothly - thanks to you both.

Also invisible to many but not all of you are my colleagues at the Canyon
Ranch Institute. This week they are all busily leading the organization and
convening of the National Call to Action on Cancer Prevention and
Survivorship 2010 Workshop: Innovation in the War on Cancer - which includes
advancing health literacy as a core strategy - but they also graciously
carved out the possibility for my time to be spent on this effort - thanks
to them all!

Finally, we should also acknowledge that none of this would be possible
without the National Institute for Literacy who sponsors this and the other
valuable literacy related listservs.

Now, highlights from the final day of our scheduled discussion

  • Molemisi Kono asked us ...

    "I wonder how many people - those without or with little access to ICT -
    Africa and else could be reached in the future. Maybe establish contacts
    with universities, colleges, clinics with the hope that those working there
    would take the message and spread/share it with those in rural villages."
  • AP -- a worthy goal many of us work toward every day. Thanks for sharing!
  • Ken Wallston, Christina Zarcadoolas, Sandra Smith and others moved a thread forward on measuring various conceptualizations of literacy and the burden that may place on participants - as well as the possible value of
    measurement in terms of valuing the skills people have and use versus just
    prioritizing the codified knowledge of health professionals.

    I recommend reading their entries to be sure.
  • Sabrina Kurtz-Rossi asked us ...

    I know there are folks on this list that teach "health literacy" in medical
    schools, schools of public health, hospitals, ESL classes, GED classes,
    middle schools etc. I want to know what is the research base justifying the
    use of these curricula and materials. And, how are you evaluating the
    effectiveness of these approaches within your settings? I am one of these
    folks and would like to engage in a discussion of health literacy education
    in practice.
  • AP question ...

    how advantageous or not is it in terms of measurement that
    curricula (should) have outcomes and key content specified in advance?
  • AP question 2 ...

    I wonder just how many curricula and educational materials
    really have a research base justifying the use? Any thoughts?
  • On a somewhat related note to Sabrina's question, in specific contexts
    Andrea Harrow asks ...

    could you test whether a curriculum offered to physicians (and hopefully
    other hospital staff) on HL increases patient satisfaction? Showing an
    increase in patient safety numbers, after an HL education intervention,
    would also be relevant.
  • Carol Collins provided us to a link to an interesting article in the BMJ
    detailing how inequities in health are related to education at
  • And in a fairly different social and health system setting from the sick care system in the U.S. Another article somewhat related to this issue also came out recently and explored the relation between IQ to cardiovascular disease mortality in Scotland. See the abstract at

    This is not a free access journal however.
  • Alec McKinney is a member of the list! And he wrote ...

    Are their tools, checklists, or measurement devises that are specifically
    geared to and validated for the provider setting that can be used to
    facilitate change management and CQI [continuous quality improvement]
    activities? I think we have enough information to prove that health
    literacy is a problem, I think we need to start identifying and accelerating
    the adoption of practices that are known to create positive outcomes and
    work in populations with low health literacy.
  • Ken Wallston provided a well reasoned {my opinion} response to the social
    determinant question Stan Hudson posed. Here is part of the answer...

    ...because it is probably more logical to believe that health literacy (a
    personal/social factor) influences health status rather than the other way
    around, those findings are consistent with HL being a social determinant of
    health. Unfortunately, much of the research is cross-sectional and can't,
    therefore help us reach causal conclusions. Only controlled experiments can
    help us do that conclusively, but well-designed longitudinal cohort studies
    that assess HL and health at multiple points in time can also shed some
    light on what is the cause and what is the effect.
  • Caroline Marshall specifically asks for advise on the SAHLSA. She wrote ...

    I have read with interest the ongoing discussion. I have been asked by a
    physician to find a short health literacy test for Spanish speakers similar
    to the REALM. However he tells me the SAHLSA is too long and wants a
    Spanish version of the REALM with only a few words. However from what I
    have read on the list the SAHLSA is the test for Spanish speakers and the
    comprehension section is an important part of the test. It is included
    because the pronunciation of the words is not a reliable indication of the
    health literacy level. ( I cannot remember off the top of my head why) He is
    also concerned because it needs a Spanish speaker to administer it. ! Can
    someone help me out here on how I explain the nature of the test to him and
    why it was created this way or is there something else he should use. He
    wants to give the test to all new patients.
  • AP reply ...

    Caroline, if the developer(s) of the SAHLSA don't contact you
    directly, please let me know and I will talk with you about these questions
    offline, OK?
  • Julie McKinney delivered us more than one spot-on response late last night
    from the road AND while maintaining the list - definitely read those!!

And I believe ... That makes it an end to a fantastic week. Thanks again for all your valuable participation.

Best wishes and happy weekend!

Andrew Pleasant

Thank you to Andrew and all for a fantastic discussion!

Julie McKinney julie_mckinney@worlded.org

Hi everyone,

I am thrilled and impressed that we had so many of you put so many good
thoughts into our discussion of evaluation and measurement of health
literacy. It is really interesting that, as we consider this specific
issue of measurement, we still find ourselves going back to hashing out
the larger concept of health literacy, along with its implications, its
many dimensions and its many complex pieces.

I suspect that this will be the case for a while as health literacy
evolves, but I do think that we are honing in on a more complete and
well defined concept of it--one that can support the new challenges that
developing comprehensive measures will require. And I think that we have
made definite progress toward that end during this discussion. As
always, we can continue to discuss this on the list anytime.

I also want to give a huge thanks to Andrew Pleasant for all he did last
week to facilitate the discussion, infuse his own considerable
expertise, compile the daily mini-reviews, and set up the Survey Monkey
site to help us try for some consensus. (I hope you will all fill that
out!) Thank you, Andrew!

In a couple weeks, we will revisit this issue informally, share with you
the results of the survey, and propose some ideas for next steps.

Again, many thanks to everyone!

All the best,