JMIR Publications

ABSTRACT

Background:

A plethora of health literacy instruments were developed over the decades. However, they are costly to build and difficult to customize for new usage scenarios.

Objective:

In this study, we developed and evaluated a framework for dynamically creating test instruments that can provide focused assessment of patients’ health literacy.

Methods:

A health literacy framework and scoring method are extended from vocabulary knowledge test to accommodate a wide range of item difficulties and various degrees of uncertainty in the participant’s answer. Online surveys from Amazon Mechanical Turk users were used to assess reliability and validity.

Results:

Parallel forms of our tests showed high reliability (correlation = 0.78 95% CI 0.69–0.85). Validity measured as correlation with an EHR comprehension instrument was higher (0.47–0.61 among 3 groups) than two existing tools, SAHL-E (0.38–0.43) and S-TOFHLA (0.34–0.46). Our framework is able to distinguish literacy levels above the most basic that is often not measured by other instruments. It is also flexible, allowing customizations to the test designer’s focus on a particular interest in a subject matter or domain. The framework is among the fastest health literacy instrument to administer.

Conclusions:

We proposed a valid and highly reliable framework to dynamically create health literacy instruments, alleviating the need to repeat a time-consuming process when a new use scenario arises. This framework can be customized to a specific need on demand, and can measure skills beyond the basic level.