++
In previous chapters we have explored the different ways in which health literacy has been defined and operationalised in clinical, community and organisational settings. In each chapter we have provided case studies and other references reporting on research that has helped us to understand how to work effectively with patients and consumers, community groups and organisations to improve health literacy and/or minimise the impact of poor health literacy. In most cases, this research has involved the measurement of health literacy among individuals and population groups.
++
Over the past 30 years, several tools have been developed to measure health literacy. Some of these are intended for general use among all types of populations, while others have been developed for more specific purposes and contexts. Like all measurement tools, each has strengths and limitations. In this chapter, we provide an overview of these health literacy measurement tools as well as additional methods for monitoring and evaluation, with an emphasis on their application and utility in different settings.
+++
6.2 Why measure health literacy?
++
Before deciding on a measurement approach or instrument, it is necessary to consider the purposes of measurement in your circumstances. Being clear about purpose will help you to weigh up the strengths and limitations of different measures and approaches that are discussed later in this chapter.
++
One common reason for measuring health literacy is to provide an estimate of the proportion of the population within a specific geographical area, health region or health facility that have higher or lower health literacy. Once we have a useable measure of health literacy in a population, we are in a position to identify the personal and social characteristics most associated with higher and lower levels of health literacy (such as age, gender, ethnicity, education and employment status) and explore these relationships. We can also examine the relationship between higher and lower health literacy and health outcomes. This information can then inform subsequent decisions, such as where to concentrate actions and resources. For example, measuring health literacy in clinical settings can help us to determine optimal approaches to written and verbal communication with different patients, and indicate ways to modify services to improve accessibility.
++
In circumstances where we are engaged in proactive communication and education designed to improve specific health knowledge, skills and competencies, health literacy measurements can be used to evaluate the impact of these interventions (or other actions and policy changes). This would typically involve using a valid health literacy measurement tool with the target population before and after an intervention so that change in knowledge, skills and competencies can be reliably observed.
++
The focus in this chapter is on measurement, and not on evaluation methods. For more information on the science of evaluation design and methods, please refer to the companion volume to this book Evaluation in a Nutshell: a practical ...