Critical appraisal of health literacy indices revealed variable underlying constructs, narrow content and psychometric weaknesses

Jordan, Joanne E., Osborne, Richard H. and Buchbinder, Rachelle 2011, Critical appraisal of health literacy indices revealed variable underlying constructs, narrow content and psychometric weaknesses, Journal of clinical epidemiology, vol. 64, no. 4, pp. 366-379.

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Title Critical appraisal of health literacy indices revealed variable underlying constructs, narrow content and psychometric weaknesses
Author(s) Jordan, Joanne E.
Osborne, Richard H.
Buchbinder, Rachelle
Journal name Journal of clinical epidemiology
Volume number 64
Issue number 4
Start page 366
End page 379
Total pages 14
Publisher Elsevier
Place of publication Amsterdam, The Netherlands
Publication date 2011-04
ISSN 0895-4356
1878-5921
Keyword(s) health literacy
tools
assessments
psychometrics
validity
reliability
Summary Objective
Health literacy refers to an individual's ability to seek, understand, and use health information. A range of indices exist that purport to measure health literacy across individuals and populations. This study aimed to review the development and content of existing indices and to critically appraise their properties.

Study Design and Setting
Using standardized search terms, published generic health literacy indices (1990–2008) were identified. Using a methodological framework, each was evaluated for purpose, validity (face, content, construct), reliability, responsiveness, feasibility, and generalizability.

Results
Nineteen instruments were evaluated. Three measurement approaches were identified: direct testing of individual abilities, self-report of abilities, and population-based proxy measures. Composition of underlying constructs and content varied widely across instruments, and none appeared to fully measure a person's ability to seek, understand, and use health information. The content was focused primarily on reading comprehension and numeracy; scoring categories were poorly defined and may not be mutually exclusive, and few indices had been assessed for reliability.

Conclusion

Health literacy is not consistently measured, making it difficult to interpret and compare health literacy at individual and population levels. Empirical evidence demonstrating validity and reliability of existing indices is required, and more comprehensive health literacy instruments need to be developed.
Language eng
Field of Research 111717 Primary Health Care
Socio Economic Objective 920205 Health Education and Promotion
HERDC Research category C1 Refereed article in a scholarly journal
HERDC collection year 2010
Copyright notice ©2010, Elsevier Inc.
Persistent URL http://hdl.handle.net/10536/DRO/DU:30031212

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