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We also learned many new things about interventions to mitigate the effect of low health literacy. First, we identified several design features of interventions that were effective in one or a few studies (enumerated above); they all warrant further study in broader populations. Second, interventions focused on a broader range of outcomes, allowing us to make inferences about effect across outcomes. Preliminary examination of these studies suggests that effective interventions to mitigate the effects of low health literacy may work by increasing knowledge and self-efficacy or by changing behavior. Additionally, certain factors appear to be key in making the interventions. | Policy Information Report Literacy and Health in America Research Development Center for Global Assessment Policy Information Center This report was written by Rima Rudd Harvard School of Public Health Irwin Kirsch Center for Global Assessment Educational Testing Service Kentaro Yamamoto Center for Global Assessment Educational Testing Service The views expressed in this report are those of the authors and do not necessarily reflect the views of the officers and trustees of Educational Testing Service. Additional copies of this report can be ordered for 15 prepaid from Policy Information Center Mail Stop 19-R ETS Rosedale Road Princeton NJ 08541-0001 609 734-5694 pic@ets.org Copies can be downloaded from www.ets.org research pic Copyright 2004 by Educational Testing Service. All rights reserved. Educational Testing Service is an Affirmative Action Equal Opportun ity Em ployer. Educational Testing Service ETS and the ETS logo are registered trademarks of Educational Testing Service. April 2004 Center for Global Assessment Policy Information Center Research and Development Educational Testing Service Ere Preface . 1 Acknowledgments. 2 Executive Summary. 3 Introduction . 5 Categorizing Health Activities. 7 Procedures for Creating a Health Activities Literacy Scale. 10 Surveys of Adult Literacy . 10 Characteristics of Tasks Used in the Literacy Assessments . 11 Coding the Literacy Items.14 Understanding the Health Activities Literacy Scale HALS . 14 Health Literacy Skills Among America s Adults.19 Background . 19 Results for the Total Population and by Gender . 20 Results for Selected Vulnerable or At-Risk Groups . 21 Health Literacy Proficiency and Multiple Characteristics.29 HALS and Wealth Status . 29 HALS and Health Status.32 HALS and Reading Engagement .35 HALS and Civic Engagement.38 Portraits of U.S. Adults.41 Summary and Discussion . 42 Implications for Health Outcomes.42 Implications for Health Disparities.43 Implications for Research.43 Implications for .
