THE TEST OF FUNCTIONAL HEALTH LITERACY IN ADULTS - A NEW INSTRUMENT FOR MEASURING PATIENTS LITERACY SKILLS

OBJECTTVE: To develop a valid, reliable instrument to measure the func tional health literacy of patients. DESIGN: The Test of Functional Hea lth Literacy in Adults (TOFHLA) was developed using actual hospital ma terials. The TOFHLA consists of a 50-item reading comprehension and 17 -item numerical ability test, taking up to 22 minutes to administer. T he TOFHLA, the Wide Range Achievement Test-Revised (WRAT-R), and the R apid Estimate of Adult Literacy in Medicine (REALM) were administered for comparison, A Spanish version was also developed (TOFHLA-S). SETTI NG: Outpatient settings in two public teaching hospitals. PATIENTS: 25 6 English- and 249 Spanish-speaking patients were approached, 78% of t he English- and 82% of the Spanish-speaking patients gave informed con sent, completed a demographic survey, and took the TOFHLA or TOFHLA-S. RESULTS: The TOFHLA showed good correlation with the WRAT-R and the R EALM (correlation coefficients 0.74 and 0.84, respectively). Only 52% of the English speakers completed more than 80% of the questions corre ctly. 15% of the patients could not read and interpret a prescription bottle with instructions to take one pill by mouth four times daily, 3 7% did not understand instructions to take a medication on an empty st omach, and 48% could not determine whether they were eligible for free care. CONCLUSIONS: The TOFHLA is a valid, reliable indicator of patie nt ability to read health-related materials. Data suggest that a high proportion of patients cannot perform basic reading tasks, Additional work is needed to determine the prevalence of functional health illite racy and its effect on the health care experience.