title: Health Literacy INDEX: development, reliability, and validity of a new tool for evaluating the health literacy demands of health information materials.
abstract: There is no consensus on how best to assess the health literacy demands of health information materials. Comprehensive, reliable, and valid assessment tools are needed. The authors report on the development, refinement, and testing of Health Literacy INDEX, a new tool reflecting empirical evidence and best practices. INDEX is comprised of 63 indicators organized into 10 criteria: plain language, clear purpose, supporting graphics, user involvement, skill-based learning, audience appropriateness, user instruction, development details, evaluation methods, and strength of evidence. In a sample of 100 materials, intercoder agreement was high: 90% or better for 52% of indicators, and above 80% for nearly all others. Overall scores generated by INDEX were highly correlated with average ratings from 12 health literacy experts (r = 0.89, p < .0001). Additional research is warranted to examine the association between evaluation ratings generated by INDEX and individual understanding, behaviors, and improved health. Health Literacy INDEX is a comprehensive tool with evidence for reliability and validity that can be used to evaluate the health literacy demands of health information materials. Although improvement in health information materials is just one aspect of mitigating the effects of limited health literacy on health outcomes, it is an essential step toward a more health literate public.
authors.affiliation: Washington University School of Medicine, Division of Public Health Sciences, 660 S. Euclid Avenue, Campus Box 8100, St. Louis, MO 63110, USA. kkaphingst@gwbmail.wustl.edu
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Kaphingst
authors.forename: Matthew W
authors.initials: MW
authors.lastname: Kreuter
authors.forename: Chris
authors.initials: C
authors.lastname: Casey
authors.forename: Luisa
authors.initials: L
authors.lastname: Leme
authors.forename: Tess
authors.initials: T
authors.lastname: Thompson
authors.forename: Meng-Ru
authors.initials: MR
authors.lastname: Cheng
authors.forename: Heather
authors.initials: H
authors.lastname: Jacobsen
authors.forename: Ryan
authors.initials: R
authors.lastname: Sterling
authors.forename: Joy
authors.initials: J
authors.lastname: Oguntimein
authors.forename: Carl
authors.initials: C
authors.lastname: Filler
authors.forename: Arthur
authors.initials: A
authors.lastname: Culbert
authors.forename: Megan
authors.initials: M
authors.lastname: Rooney
authors.forename: Christy
authors.initials: C
authors.lastname: Lapka
mesh_terms: D004521:Educational Measurement / Q000379:methods*; D057220:Health Literacy; D006301:Health Services Needs and Demand; D006801:Humans; D010353:Patient Education as Topic; D015203:Reproducibility of Results; D013664:Teaching Materials / Q000592:standards