Expanding estimates of health literacy

Tiffany M Jones, The University of Texas School of Public Health


This study explores the construct and measures of health literacy. It utilizes demographics to predict health literacy for all adults aged 18 years and older in a health literacy validation sub-study (HLVS) and a nationally representative dataset (2010 Medical Expenditure Panel Survey, MEPS). It also examines the construct of health literacy using structural equation modeling. Six hundred thirty-three (n=633) participants reported age, gender, race, ethnicity, preferred survey language, highest degree completed, as well as the shortened Test of Functional Health Literacy in America (s-TOFHLA), three single-item health literacy questions, the revised Rapid Estimate of Adult Literacy in Medicine (REALM-R) for English speakers, and the Short Assessment of Health Literacy for Spanish-speaking adults (SAHL-SA) using a health literacy validation questionnaire. The regression weights for the significant predictors of age, gender, race, and highest degree completed were applied to the HLVS and MEPS samples. The regression weights for age, gender, race, and highest degree completed were applied to the HLVS and MEPS samples. The weights, considered the imputed health literacy score (IHLS), significantly predicted general self-rated health in the HLVS (R2=0.09) and MEPS (R2=0.06) samples. Higher IHLS was also associated with lower total health expenditures and less likelihood of being in the top 25%, top 10%, and top 5% of total health expenditures. A measurement model of health literacy is also presented, and a single health literacy latent variable best fit the HLVS data (RMSEA=0.05).

Subject Area

Public health

Recommended Citation

Jones, Tiffany M, "Expanding estimates of health literacy" (2014). Texas Medical Center Dissertations (via ProQuest). AAI3643628.