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Practical Assessment of Adult Literacy in Health Care

Department of Internal Medicine and Pediatrics, Louisiana State University Medical Center, School of Medicine, Department of Medicine, 1501 Kings Hwy., Shreveport, LA 71130-3932 (LSUMC-S); phone: 318-675-5813; fax: 318-675-4319; tdavis{at}mail-sh.lsumc.edu

Robert Michielutte, PhD

Department of Family and Community Medicine, Bowman Gray School of Medicine, North Carolina

Eunice N. Askov, PhD

Institute for the Study of Adult Literacy, Pennsylvania State University

Mark V. Williams, MD

Emory University School of Medicine, Georgia

Barry D. Weiss, MD

Department of Family Practice, University of Texas/San Antonio

Low literacy is a pervasive and underrecognized problem in health care. Approximately 21% of American adults are functionally illiterate, and another 27% have marginal literacy skills. Such patients may have difficulty reading and understanding discharge instructions, medication labels, patient education materials, consent forms, or health surveys. Properly assessing the literacy level of individual patients or groups may avoid problems in clinical care and research. This article reviews the use of literacy assessments, discusses their application in a variety of health care settings, and cites issues providers need to consider before testing. The authors describe informal and formal methods of screening for reading and comprehension in English and Spanish including the Rapid Estimate of Adult Literacy in Medicine, the Wide Range Achievement Test-3, the Cloze procedure, the Test of Functional Health Literacy in Adults, and others. Practical implications and recommendations for specific use are made.

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