General Reading and Literacy Test and Their Measurement in Nursing Education Part Two
What is TOFHLA (Test of Functional Health Literacy in Adults)
The TOFHLA was developed in the mid-1990s for measuring patients' health literacy skills using actual hospital materials, such as prescription labels, appointment slips, and in-formed consent documents. The test consists of two parts: reading comprehension and numeracy. It has demonstrated reliability and validity, requires approximately 20 minutes to administer, and is available in a Spanish version (TOFHLA-S) as well as an English version (Parker, Baker, Williams, & Nurss, 1995; Quirk, 2000; Williams et al., 1995).
An abbreviated version, known as the S-TOFHLA, was developed in 1999; it
takes only 12 minutes to administer. Not only has this short version been
tested for reliability and validity, but it is a more practical measure of
functional health literacy to determine who needs assistance with achieving
learning goals (Baker et al., 1999; Garcia, Espinoza, Lichtenstein, &
Hazuda, 2013). The TOFHLA instrument and directions can be accessed at
http://www.peppercornbooks.com /catalog/information.php?info id=5.
Limitations of TOFHLA and S-TOFHLA
Readability formulas and standardized tests for comprehension and
reading skills were never designed to serve as writing guides. Patient
educators may be tempted to write PEMs to fit the formulas and tests, but they
should be aware that doing so places emphasis on structure, not content, and
that comprehensibility of a written message may be greatly compromised.
Pichert and Elam (1985) recommend that readability formulas should
be used solely to judge material written without formulas in mind. Formulas are
merely methods to check readability, and standardized tests are merely methods
to check comprehension and word recognition. Neither method guarantees good
style in the form of direct, conversational writing.
Whats Is NVS (Newest Vital Sign)
The Newest Vital Sign is a tool developed to identify those at risk for low health literacy. It is easy and inexpensive to administer, taking as little as 3 minutes from start to finish (Johnson & Weiss, 2008; Shah, West, Bremmeyr, & Savoy Moore, 2010; Welch, VanGeest, & Caskey, 2011). Patients are asked to look at an ice cream label and answer questions in relation to the label, which also allows an assessment of numeracy (Collins et al., 2012; Kennard, 2016; Weiss, 2007).
Results of Test NVS
Each correct answer gives them one point, Patients are placed into one of three categories related to their literacy level: 1-2, likelihood of limited literacy: 3-4, possibility of limited literacy; and 5-6, adequate literacy (Johnson & Weiss, 2008).
Use of NVS In Helath Care
The NVS, which was developed by Weiss and colleagues (2005) with support from the Pfizer Clear Health Communication Initiative, is available in both English and Spanish versions. It is suggested that the tool be administered while the nurse is obtaining vital signs.
Early psychometric evaluation shows the NVS is
comparable to other available health literacy tests such as REALM and S-TOFHLA
and is recommended for use in the primary care environment (McCune et al.,
2016, Patel et al., 2011). More information on this tool can be found. free of
charge on the Internet at http://www pfizer.com/health/literacy. See Appendix A
and Exhibit A-1A and A-1B for more information about administering and scoring
the NVS.
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