Health Literacy Month had me looking into health literacy assessment and screening tools.
Beyond the directive to write for Grade (6,7,8) reading level, there are many tools utilized by academics that the rest of us may or may not have access to or know how to use. Test of Functional Literacy in Adults (TOFHLA – pronounced Toe-Flaw) and Rapid Estimate of Adult Literacy in Medicine (REALM) are two of the most well-established. Both of these use medical terminology and health scenarios to assess the ability to read and understand.
An example of TOFHLA:
Doxycycline 100 MG 20/0
Take medication on empty stomach one hour before or two hours after a meal unless otherwise directed by your doctor.
If you eat lunch at 12:00 noon, and you want to take this medicine before lunch, what time should you take it?
Examples of REALM words:
Fat, Flu, Pill, Osteoporosis, Anemia, Colitis, Allergic, Fatigue, Constipation, Jaundice, Directed.
(Interestingly, Fat, Flu, and Pill are not actually part of the test. They're always the first words seen to try and reduce anxiety and encourage confidence)
The newest entry into the world of health literacy screening does not use any medical words, scenarios or jargon, but rather an ice cream label. Yes, a lowly ice-cream label is the basis to 'assess the ability to use and interpret text, documents, and numbers effectively'. The rationale:
When reading a food label or following medical instructions, patients need to:
- Remember numbers and make mathematical calculations
- Identify and be mindful of different ingredients that could be potentially harmful for them
- Make decisions about their actions based on given information”
Why does an ice cream label work as a predictor of the ability to understand medical instructions, from Pfizer’s Clear Health Communication Initiative explains the background, and provides PDF's of the tools. http://www.pfizerhealthliteracy.com/public-policy-researchers/newest-vital-sign.html.
Cited is research from the American Journal of Preventative Medicine (November 2006) that says even patients with better reading skills could have difficulties interpreting labels.
Developed by Dr. Barry Weiss and his colleagues from Arizona and North Carolina, they’ve trademarked their ice-cream-label tool’s name: The Newest Vital Sign, with results of their study published in the November/December 2005 issue of Annals of Family Medicine (www.annfammed.org).
While I applaud Dr Weiss and his team (and according to Dr Weiss, Pfizer should also be thanked for funding the study) for using a familiar-to-consumers label, when I first looked at the scoring questions, I was afraid: I have the courage and it takes less time for me to ask questions of my doctor and pharmacist, than it does to try to figure out the right answers to the ice cream label questions. I am prepared to acknowledge I am alone in my fear.
Do you think that even using something as familiar as an ice-cream label to test can provoke anxiety? Do you have any suggestions or methods for assessing health literacy?
