title: Measuring health literacy: a pilot study of a new skills-based instrument.
abstract: Although a number of instruments have been used to measure health literacy, a key limitation of the leading instruments is that they only measure reading ability or print literacy and, to a limited extent, numeracy. Consequently, the present study aimed to develop a new instrument to measure an individual's health literacy using a more comprehensive and skills-based approach. First, we identified a set of skills to demonstrate and tasks to perform. Next, we selected real-world health-related stimuli to enable measurement of these skills, and then we developed survey items. After a series of cognitive interviews, the survey items were revised, developed into a 38-item instrument, and pilot tested using a Web-based panel. Based on the psychometric properties, we removed items that did not perform as well, resulting in a 25-item instrument named the Health Literacy Skills Instrument. Based on confirmatory factor analysis, the items were grouped into five subscales representing prose, document, quantitative, oral, and Internet-based information seeking skills. Construct validity was supported by correlations with the short form of the Test of Functional Health Literacy in Adults and self-reported skills. The overall instrument demonstrated good internal consistency, with a Cronbach's alpha of 0.86. Additional analyses are planned, with the goal of creating a short form of the instrument.
authors.affiliation: RTI International, Research Triangle Park, North Carolina 27709, USA. Lmac@rti.org
authors.forename: Lauren
authors.initials: L
authors.lastname: McCormack
authors.forename: Carla
authors.initials: C
authors.lastname: Bann
authors.forename: Linda
authors.initials: L
authors.lastname: Squiers
authors.forename: Nancy D
authors.initials: ND
authors.lastname: Berkman
authors.forename: Claudia
authors.initials: C
authors.lastname: Squire
authors.forename: Dean
authors.initials: D
authors.lastname: Schillinger
authors.forename: Janet
authors.initials: J
authors.lastname: Ohene-Frempong
authors.forename: Judith
authors.initials: J
authors.lastname: Hibbard
mesh_terms: D000293:Adolescent; D000328:Adult; D004521:Educational Measurement / Q000379:methods*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D057220:Health Literacy; D006801:Humans; D057226:Information Seeking Behavior; D020407:Internet; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D015203:Reproducibility of Results; D055815:Young Adult