The Health Literacy of America’s Adults: Results from the 2003 National Assessment of Adult Literacy

This resource shares the results from the 2003 National Assessment of Adult Literacy that relate to health literacy.

Mark Kutner
Elizabeth Greenberg
Ying Jin
Christine Paulsen
Author(s) Organizational Affiliation
National Center for Education Statistics
Publication Year
Resource Type
Informational Material
Number of Pages

The Health Literacy of America’s Adults is the first release of the National Assessment of Adult Literacy (NAAL) health literacy results. The results are based on assessment tasks designed specifically to measure the health literacy of adults living in the United States. Health literacy was reported using four performance levels: Below Basic, Basic, Intermediate, and Proficient. The findings showed that over 90% of American adults did not have what is considered a “proficient” level of health literacy. About fifty-three percent had Intermediate health literacy, about 22 percent had Basic and 14 percent had Below Basic health literacy. Relationships between health literacy and background variables (such as educational attainment, age, race/ethnicity, where adults get information about health issues, and health insurance coverage) were also examined and reported. For example, adults with Below Basic or Basic health literacy were less likely than adults with higher health literacy to get information about health issues from written sources (newspapers, magazines, books, brochures, or the Internet) and more likely than adults with higher health literacy to get a lot of information about health issues from radio and television.

What the experts say

The NAAL has long been a relied upon source for national data regarding the literacy status of America’s adults. In this most recent assessment, specific questions are used to assess, beyond literacy, “health” literacy. Chapter 17 of the report is specific to this slice of literacy reporting on 12 prose, 12 document and 4 quantitative NAAL Tasks. Statistical analysis is used to determine and report the results.

The report confirms links between health and literacy, describes creation of measures, and gives clear examples in charts (performance levels, related tasks). It also describes results by demographic group and self-report outcome.

This can be useful to adult literacy practitioners in many ways. It clearly confirms the widespread urgency of inadequate health literacy, and shows which demographics are more at risk, both of which can help adult education programs appeal for administrative and financial support for addressing health literacy. It also starts to give us a picture of how adults get health information, which can inform the methods we use to teach health literacy.

There are some limitations to the research, however. The report has cautionary sections about this being descriptive rather than action-oriented. The measures, while carefully developed, come from a highly literacy-based definition of health literacy and do not take into account the broader aspects of health literacy that are now considered part of it. For example, the questions measured mostly reading comprehension of health information, and not pieces such as oral comprehension, evaluating the information, or using the information to take action.

There have also been some complaints among researchers that the data is hard to access in order to assess the measures themselves, and analyze the data in different ways for further study. The complete assessment methodology has not been opened up to public access. This prevents researchers and practitioners from using the assessment methodology to conduct validity and reliability studies or to produce comparable assessment data.

Some have seen the reporting of the information to under-represent the non-proficient portion of American adults by focusing too much on the Below Basic and Basic levels. This can weaken the power of the report to show how widespread the issue of low health literacy is in America. To balance this representation, look at the article from Issue 9B of Focus on Basics:
A Second Look at the Health Literacy of American Adults & the National Assessment of Adult Literacy  (Page 46.)