• Report

Literacy and health outcomes. Summary


Berkman, N., DeWalt, D. A., Pignone, M. P., Sheridan, S. L., Lohr, K., Lux, L., ... Bonito, A. (2003). Literacy and health outcomes. Summary. (Submitted to Agency for Healthcare Research Quality, Rockville, MD). Research Triangle Park, NC: RTI International.


Literacy can be defined as “an individual’s ability to read, write, and speak in English and compute and solve problems at levels of proficiency necessary to function on the job and in society, to achieve one’s goals, and to develop one’s knowledge and potential.” Literacy sometimes describes a person’s facility with or knowledge about a particular topic (e.g., “computer literacy”). In that context, “health literacy” is a constellation of skills that constitute the ability to perform basic reading and numerical tasks for functioning in the health care environment and acting on health care information. Some authors include in this definition a working knowledge of disease processes, self-efficacy, and motivation for political action regarding health issues.

Instruments for measuring literacy in the health care setting have focused on the ability to read and, in some cases, to use numbers. Commonly used are the Wide Range Achievement Test (WRAT) reading subtest, the Rapid Estimate of Adult Literacy in Medicine (REALM), and the Test of Functional Health Literacy in Adults (TOFHLA). The WRAT and REALM are word recognition tests validated as instruments of reading ability; they are highly correlated with one another and with other traditional reading assessments. The TOFHLA assesses literacy by a modified Cloze method: subjects read passages in which every fifth to seventh word has been deleted and insert the correct word from a choice of four words. The TOFHLA also has subjects respond to prompts, such as pill bottle instructions and appointment slips, thus measuring patients’ ability to use basic numerical information (numeracy). A short version (STOFHLA) involves only two reading comprehension sections. All of these instruments are highly correlated with one another.