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Patient Educ Couns. 2015 Jul 29. pii: S0738-3991(15)30021-5. doi: 10.1016/j.pec.2015.07.013. [Epub ahead of print]

State of the science of health literacy measures: Validity implications for minority populations.

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School of Nursing, Boston College, Chestnut Hill, USA. Electronic address:
Department of Nursing, Towson University, Towson, USA.
School of Nursing, Johns Hopkins University, Baltimore, USA.
School of Public Health, Johns Hopkins University, Baltimore, USA.
Boston University School of Medicine, Boston Medical Center, Boston, USA.
Center of Innovation on Disability and Rehabilitation Research, James A. Haley VA Hospital, Tampa, USA; Department of Community and Family Health, College of Public Health, University of South Florida, Tampa, USA.
School of Nursing, University of Texas at Austin, Austin, USA.



To review the evidence supporting the validity of health literacy (HL) measures for ethnic minority populations.


PubMed, CINAHL, and PsycINFO databases were searched for HL measures between 1965 and 2013.


A total of 109HL measures were identified; 37 were non-English HL measures and 72 were English language measures. Of the 72 English language measures, 17 did not specify the racial/ethnic characteristic of their sample. Of the remaining 55 measures, 10 (18%) did not include blacks, 30 (55%) did not include Hispanics, and 35 (64%) did not include Asians in their validation sample. When Hispanic and Asian Americans were included, they accounted for small percentages in the overall sample. Between 2005-2013, a growing number of REALM and TOFHLA translations were identified, and new HL measures for specific cultural/linguistic groups within and outside the United States were developed.


While there are a growing number of new and translated HL measures for minority populations, many existing HL measures have not been properly validated for minority groups.


HL measures that have not been properly validated for a given population should be piloted before wider use. In addition, improving HL instrument development/validation methods are imperative to increase the validity of these measures for minority populations.


Health Literacy; Minority Health; Psychometric; Review

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