Table 3 Tools for measuring health literacy

Davis [43] (1993)

REALM

Read aloud the 66 medical terms and score points for the number of words pronounced correctly

Sum score (0–66) converted to 4 grades:

0–18: 3rd grade or less

(Lower health literacy),

19–44: 4th through 6th grade

(Lower health literacy),

45–60: 7th or 8th grade

(Marginal health literacy),

61–66: 9th grade or more

(Adequate health literacy)

SORT-R r = 0.96; PIAT-R r = 0.97; WRAT-R r = 0.88

Parker [44] (1995)

TOFHLA

Read and answer in a four-choice multiple-question format using materials used at the medical site to assess reading comprehension (50 questions) and math skills (17 questions)

Sum score (0–100) converted to 3 grades:

0–59: Inadequate health literacy,

60–74: Marginal health literacy,

75–100: Adequate health literacy

TOFHLA r = 0.91, REALM r = 0.80, Cronbach’s alpha = 0.98

Weiss [45] (2005)

NVS

Review the nutritional information tables in foods and assess whether you understand them correctly

Sum score (0–6) converted to 2 grades:

0–4: Limited health literacy,

4–6: Adequate health literacy

REALM r = 0.41, S-TOFHLA r = 0.61, Cronbach’s alpha = 0.76

McCormackL [46] (2010)

HLSI-SF

25 items consisting of multiple choice, T/F, and subjective questions, including the ability to read and understand documents, ability to find and interpret information (reading ability), ability to use quantitative information (repair ability), ability to listen effectively (oral ability), and ability to search for information via the Internet

Assessment Method = Percent Correct (%)

Sum score (0–100) converted to 3 grades:

 ≥ 82: Proficient literacy

70–81: Basic literacy,

 < 70: Below basic literacy

S-TOFHLA r = 0.47, Cronbach’s alpha = 0.86

Sørensen [47] (2015)

HLS-EU-Q47

Answer 47 questions including obtaining, understanding, identifying, and using health information (very, 4 points—yes—difficult—very difficult, 1 point)

Assessment method = (overall mean score—1) * (50/3)

Sum score converted to 4 grades:

0–25: Inadequate

 > 25–33: Problematic-limited

 > 33–42: Sufficient

 > 42–50: Excellent

Goodness-of-fit indices (0.9) in six Asian countries

Chew [48] (2004)

BHLS

The following two questions each have five level scores

1. How confident are you filling out medical forms by yourself? 2. How often do you have someone help you read hospital materials?

Sum score converted to 2 grades:

 < 9: Inadequate health literacy

 ≥ 9: Adequate health literacy

S-TOFHLA r = 0.42,

REALM r = 0.40