title: Evaluation of instruments to assess health literacy in Arabic language among Iraqis.
abstract: BACKGROUND
  Low health literacy is associated with lack of medical information, less use of preventive measures, low medication adherence rates, high health care costs and high risk of hospitalization.
  
  
  OBJECTIVE
  The aims were to compare the results of the three health literacy tests, to measure for the first time the health literacy level of Iraqis, to describe the use of standardized health literacy tests, to evaluate reliability and validity of the Arabic versions of these tests, and to investigate whether there is relationship between the participant characteristics and the health literacy level.
  
  
  METHODS
  A convenience sample of 95 subjects was studied in five community pharmacies in Al-Najaf and Babylon governorates, Iraq. Three health literacy tests, the Single Item Literacy Screener (SILS), the New Vital Sign (NVS) and the Short version of the Test of Functional Health Literacy in Adults (S-TOFHLA), were translated in the Arabic language and administered to the pharmacy customers.
  
  
  RESULTS
  There were no statistically significant associations between age, gender, education and current education status and NVS score, but there were significant positive associations between the level of education and each one of SILS, New SILS, and S-TOFHLA scores.
  
  
  CONCLUSIONS
  SILS has one subjective, possibly culturally biased question. Since Iraqis are generally not exposed to reading product labels, the NVS test might be not an accurate measure for them. S-TOFHLA was the most comprehensive test and gave equitable results. The Arabic version of S-TOFHLA can be used to measure health literacy in 22 Arabic speaking countries.
authors: University of Iowa, College of Pharmacy, Iowa City, IA, USA; University of Baghdad, College of Pharmacy, Baghdad, Iraq. Electronic address: aliazeezali-aljumaili@uiowa.edu.
authors: Ali Azeez
authors: AA
authors: Al-Jumaili
authors: University of Kufa, Faculty of Pharmacy, Al-Najaf, Iraq.
authors: Mohammed Dakhil
authors: MD
authors: Al-Rekabi
authors: University of Iowa, College of Pharmacy, Iowa City, IA, USA.
authors: Bernard
authors: B
authors: Sorofman
mesh_terms: D000293:Adolescent; D000328:Adult; D018912:Arabs; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D057220:Health Literacy; D006801:Humans; D007493:Iraq; D007802:Language; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires / Q000592:standards*; D055815:Young Adult
keywords: Health literacy; Iraq; NVS; Pharmacy; S-TOFHLA; SILS