title: The test of functional health literacy in adults: a new instrument for measuring patients' literacy skills.
abstract: OBJECTIVE
  To develop a valid, reliable instrument to measure the functional health literacy of patients.
  
  
  METHODS
  The Test of Functional Health Literacy in Adults (TOFHLA) was developed using actual hospital materials. The TOFHLA consists of a 50-item reading comprehension and 17-item numerical ability test, taking up to 22 minutes to administer. The TOFHLA, the Wide Range Achievement Test--Revised (WRAT-R), and the Rapid Estimate of Adult Literacy in Medicine (REALM) were administered for comparison. A Spanish version was also developed (TOFHLA-S).
  
  
  METHODS
  Outpatient settings in two public teaching hospitals.
  
  
  METHODS
  256 English- and 249 Spanish-speaking patients were approached. 78% of the English- and 82% of the Spanish-speaking patients gave informed consent, completed a demographic survey, and took the TOFHLA or TOFHLA-S.
  
  
  RESULTS
  The TOFHLA showed good correlation with the WRAT-R and the REALM (correlation coefficients 0.74 and 0.84, respectively). Only 52% of the English speakers completed more than 80% of the questions correctly. 15% of the patients could not read and interpret a prescription bottle with instructions to take one pill by mouth four times daily, 37% did not understand instructions to take a medication on an empty stomach, and 48% could not determine whether they were eligible for free care.
  
  
  CONCLUSIONS
  The TOFHLA is a valid, reliable indicator of patient ability to read health-related materials. Data suggest that a high proportion of patients cannot perform basic reading tasks. Additional work is needed to determine the prevalence of functional health illiteracy and its effect on the health care experience.
authors.affiliation: Emory University School of Medicine, Atlanta, Georgia 30303, USA.
authors.forename: R M
authors.initials: RM
authors.lastname: Parker
authors.forename: D W
authors.initials: DW
authors.lastname: Baker
authors.forename: M V
authors.initials: MV
authors.lastname: Williams
authors.forename: J R
authors.initials: JR
authors.lastname: Nurss
mesh_terms: D000328:Adult; D004522:Educational Status; D005260:Female; D006801:Humans; D008297:Male; D010353:Patient Education as Topic; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires