Standard health literacy measurement tools are not comprehensive assessments of health literacy

Issues: Understanding special populations' comprehension of health materials is important to ensure effective development of tailored health education materials. The standard measurement tools for health literacy (i.e., the REALM and TOFLHA) are advantageous because they are quick and easy to administer and score, have been used widely in the health communication literature, and have well-established criterion validity. However, these tests only measure narrow aspects of health literacy; they do not provide comprehensive information about special populations' areas of difficulty. Description: An in-depth analysis of the advantages and disadvantages of standard health literacy measurement tools was conducted, including an overview of the kinds of literacy information these tools provide. The conceptual framework for a proposed new assessment tool – that would encompass health literacy concepts related to language, context, culture, background knowledge, technology, and the ability to communicate about health – is provided. Lessons learned: Some of the major disadvantages identified from this review: 1) tests only measure one or two aspects of health literacy; 2) tests provide limited grade-ranges or scores, but not specific deficit area; 3) tests do not represent broad spectrum of health materials available outside of a clinical setting, 4) tests do not measure background knowledge; and 5) tests do not measure understanding of overall context. Recommendations: A new assessment tool that more thoroughly encompasses the various aspects of “health literacy” is needed to help identify specific deficit area in different populations.