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

Objectives: To review the evidence supporting the validity of health literacy (HL) measures for ethnic minority populations. Methods: PubMed, CINAHL, and PsycINFO databases were searched for HL measures between 1965 and 2013. Results: 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. Conclusions: 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. Practice Implications: 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.