Differential Item Functioning Related to Age in the Reading Subtest of the Test of Functional Health Literacy in Adults

Differential item functioning (DIF) occurs when items in a measure perform in ways that are different for members of a target group when the different performance is not related to the individual’s overall ability to be assessed. DIF may arise for a number of reasons but is often evaluated in order to ensure that tests and measures are fair evaluations of a group’s abilities. Based on observations when administering the test, we developed the hypothesis that some items on the reading comprehension subtest of the Test of Functional Health Literacy (TOFHLA) might be differentially more difficult for older adults and the elderly due to its use of the cloze response format, in which the participant is required to determine what word, when placed in a blank space in a sentence, will ensure that the sentence is intelligible. Others have suggested that the cloze response format may make demands on verbal fluency, an ability that is reduced with the increasing age. Our analyses show that age-related DIF may present in a nearly one-half of reading comprehension items of the TOFHLA. Results of this measure in older persons should be interpreted cautiously.

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Is the Cloze Procedure Appropriate to Evaluate Health Literacy in Older Individuals? Age Effects in the Test of Functional Health Literacy in Adults

Journal of Aging Research ◽

10.1155/2014/194635 ◽

2014 ◽

Vol 2014 ◽

pp. 1-10 ◽

Cited By ~ 1

Author(s):

Raymond L. Ownby ◽

Amarilis Acevedo ◽

Drenna Waldrop-Valverde ◽

Robin J. Jacobs

Keyword(s):

Health Literacy ◽

Memory Task ◽

Close Relation ◽

Community Dwelling ◽

Functional Health ◽

Functional Health Literacy ◽

Older Individuals ◽

Age Related ◽

Item Functioning ◽

Cloze Procedure

Health literacy has received increasing attention because of its importance for older individuals’ health, as studies have shown a close relation between older individuals’ health literacy and their health. Research also suggests that older individuals have low levels of health literacy, but this finding is variable and may depend on which health literacy test is used. Older individuals assessed with the Test of Functional Health Literacy (TOFHLA) score lower than younger individuals, but a previous study suggested that this may result from age-related differential item functioning (DIF) on the TOFHLA. The study reported here assessed age-related DIF in a sample of community-dwelling volunteers. Twenty-two percent of items were differentially more difficult for older individuals independent of their overall ability, and when these items were eliminated from the total score, age differences were no longer found. Performance on a working memory task predicted older but not younger individuals’ performance on the age-related items. At least part of older individuals’ apparent deficits in health literacy when assessed by the TOFHLA may be related to DIF on its items. The TOFHLA, and any measure that employs the cloze procedure to evaluate reading comprehension, should be used cautiously in older individuals.

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Instruments used to evaluate functional health literacy in elderly persons with chronic kidney disease: Integrative review

Revista Brasileira de Geriatria e Gerontologia ◽

10.1590/1981-22562019022.180198 ◽

2019 ◽

Vol 22 (3) ◽

Cited By ~ 1

Author(s):

Monique de Freitas Gonçalves Lima ◽

Eliane Maria Ribeiro de Vasconcelos ◽

Anna Karla de Oliveira Tito Borba

Keyword(s):

Chronic Kidney Disease ◽

Health Literacy ◽

Kidney Disease ◽

Adult Literacy ◽

The Elderly ◽

Integrative Review ◽

Functional Health ◽

Elderly Persons ◽

Functional Health Literacy ◽

New Instruments

Abstract Objective: To identify the instruments used to evaluate the functional health literacy of elderly persons with chronic kidney disease, and to assess whether they are suitable for this population. Method: An integrative review of the Lilacs, PubMed, Ibecs, Scopus and Cochrane databases was carried out in July and August 2018, seeking original articles dealing with functional health literacy and chronic kidney disease in the elderly. Results: A total of 15 articles were evaluated and seven different instruments used in the research were identified, with the Rapid Estimate of Adult Literacy in Medicine (REALM) and Test of Functional Health Literacy in Adults (TOFHLA) the most prevalent. Conclusion: The instruments identified are applicable for the elderly, but are not specific for this population. The construction and/or adaptation of new instruments is suggested considering the specific characteristics of this age group.

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Application of the Cloze Procedure to Evaluate Comprehension and Demonstrate Rewriting of Pharmacy Educational Materials

Annals of Pharmacotherapy ◽

10.1345/aph.1l642 ◽

2009 ◽

Vol 43 (4) ◽

pp. 650-657 ◽

Cited By ~ 9

Author(s):

Michael J Miller ◽

Jane E DeWitt ◽

Erin M McCleeary ◽

Kelly J O'keefe

Keyword(s):

Reading Comprehension ◽

Health Literacy ◽

Adult Literacy ◽

College Graduates ◽

Relevant Information ◽

Functional Health ◽

Functional Health Literacy ◽

Educational Materials ◽

Highly Educated ◽

Cloze Procedure

Background: Written materials are commonly used to communicate pharmacy-relevant information to patients. However, they are often composed at a level that limits comprehension, mitigating a well-intended effect. Objective: To (1) use the cloze procedure (a test designed to assess reading comprehension) to evaluate an individual's understanding of a pharmacy-relevant educational pamphlet; (2) compare results of the cloze procedure with the reading comprehension component of the Short Test of Functional Health Literacy in Adults (S-TOFHLA); and (3) use results to demonstrate rewriting of the educational pamphlet. Methods: The cloze procedure was applied to a pharmacy-relevant educational pamphlet describing safe medication practices. A total of 162 subjects were recruited from university faculty, staff, and students; a local adult literacy center; and community senior centers. Subjects completed a background interview, the S-TOFHLA. and cloze procedure for the pharmacy-relevant educational pamphlet. S-TOFHLA and cloze procedure scores were described and compared. Cloze procedure responses were used to demonstrate revision of the pamphlet RESULTS: Of the 154 subjects analyzed, mean ± SD age was 56.5 ± 20.4 years. Subjects were predominantly white (93.5%), female (71.4%). and college graduates (42.2%). Mean score on the S-TOFHLA was 92.1%. A majority (95.5%, 147/154) of subjects demonstrated adequate functional health literacy. In contrast, mean score on the cloze procedure was 53.3%. Internal consistencies of the S-TOFHLA and the cloze procedure were 0.92 and 0.90, respectively. Scores on the cloze procedure and the S-TOFHLA were highly correlated (r = 0.71, p < 0.001), Performance on the cloze procedure indicated that 55.2% of subjects required supplemental teaching. Conclusions: In this highly educated, health-literate sample, a majority did not understand the pharmacy-relevant educational pamphlet despite adequate performance on a standard measure of health literacy. The cloze procedure can be used to assess comprehension of educational materials, solicit feedback from intended users, and guide the revision of educational materials.

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Performance of a Brazilian population on the test of functional health literacy in adults

Revista de Saúde Pública ◽

10.1590/s0034-89102009005000031 ◽

2009 ◽

Vol 43 (4) ◽

pp. 631-638 ◽

Cited By ~ 74

Author(s):

Maria Teresa Carthery-Goulart ◽

Renato Anghinah ◽

Renata Areza-Fegyveres ◽

Valeria Santoro Bahia ◽

Sonia Maria Dozzi Brucki ◽

...

Keyword(s):

Health Literacy ◽

The Elderly ◽

Multiple Regression Model ◽

Functional Health ◽

Southeastern Brazil ◽

Short Version ◽

Functional Health Literacy ◽

Partial Correlations ◽

Study Population ◽

The Mean

OBJECTIVE: To analyze the scoring obtained by an instrument, which evaluates the ability to read and understand items in the health care setting, according to education and age. METHODS: The short version of the Test of Functional Health Literacy in Adults was administered to 312 healthy participants of different ages and years of schooling. The study was conducted between 2006 and 2007, in the city of São Paulo, Southeastern Brazil. The test includes actual materials such as pill bottles and appointment slips and measures reading comprehension, assessing the ability to read and correctly pronounce a list of words and understand both prose passages and numerical information. Pearson partial correlations and a multiple regression model were used to verify the association between its scores and education and age. RESULTS: The mean age of the sample was 47.3 years(sd=16.8) and the mean education was 9.7 years(sd=5; range: 1 - 17). A total of 32.4% of the sample showed literacy/numeracy deficits, scoring in the inadequate and marginal functional health literacy ranges. Among the elderly (65 years or older) this rate increased to 51.6%. There was a positive correlation between schooling and scores (r=0.74; p<0.01) and a negative correlation between age and the scores (r=-0.259; p<0.01). The correlation between the scores and age was not significant when the effects of education were held constant (rp=-0.031, p=0.584). A significant association (B=3.877, Beta =0.733; p<0.001) was found between schooling and scores. Age was not a significant predictor in this model (B=-0.035, Beta=-0.22; p=0.584). CONCLUSIONS: The short version of the Test of Functional Health Literacy in Adults was a suitable tool to assess health literacy in the study population. The high number of individuals classified as functional illiterates in this test highlights the importance of special assistance to help them properly understand directions for healthcare.

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Effects of an eHealth Intervention on Patient-Provider Interaction and Functional Health Literacy in Adults With Hypertension

SAGE Open Nursing ◽

10.1177/23779608211005863 ◽

2021 ◽

Vol 7 ◽

pp. 237796082110058

Author(s):

Ronald L. Hickman ◽

John M. Clochesy ◽

Marym Alaamri

Keyword(s):

Health Literacy ◽

Community Dwelling ◽

Attention Control ◽

Functional Health ◽

Self Management ◽

Functional Health Literacy ◽

Convenience Sample ◽

Management Interventions ◽

Modifiable Factors

Introduction Hypertension is a life-limiting, chronic condition affecting millions of Americans. Modifiable factors, quality of the patient-provider interaction and functional health literacy, have been linked to effective hypertension self-management. However, there has been limited interventional research targeting these modifiable factors. Electronic hypertension self-management interventions, in particular those incorporating virtual simulation, may positively influence the quality of the patient-provider interaction and functional health literacy status of adults with hypertension. Yet there is a dearth of evidence examining the efficacy of eHealth interventions targeting these modifiable factors of hypertension self-management. Objective Evaluate the effects of two electronic hypertension self-management interventions on the quality of the patient-provider interaction and functional health literacy in adults with hypertension. Methods A convenience sample of community-dwelling adults (>18 years) with hypertension were recruited and randomized to an avatar-based simulation (eSMART-HTN) or a video presentation on hypertension self-management (attention control). Participants were administered questionnaires to capture demographic characteristics, the quality of the patient-provider interaction, and functional health literacy. Questionnaire data were collected at baseline, and then monthly across three months. Two separate repeated measures analysis of covariance models were conducted to assess the effects of the interventions across the time points. Results The sample included 109 participants who were predominately middle-aged and older, nonwhite, and female. Scores for the quality of the patient-provider interaction demonstrated significant within-group changes across time. However, there were no significant differences in the quality of the patient-provider interaction or functional health literacy scores between experimental conditions while adjusting for covariates. Conclusion An avatar-based simulation (eSMART-HTN) intervention proved to have a positive effect on patient-provider interaction compared to an attention control condition. Although the results are promising, future research is needed to optimize the effectiveness of eSMART-HTN and enhance its efficacy and scalability in a larger cohort of adults with hypertension.

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HEALTH LITERACY OF INDIVIDUALS UNDERGOING DIALYSIS THERAPY

Texto & Contexto - Enfermagem ◽

10.1590/1980-265x-tce-2017-0418 ◽

2019 ◽

Vol 28 ◽

Author(s):

Jéssica Naylla de Melo Bezerra ◽

Sara Rebeca de Oliveira Lessa ◽

Marcelo Francisco do Ó ◽

Givaneide Oliveira de Andrade Luz ◽

Anna Karla de Oliveira Tito Borba

Keyword(s):

Health Literacy ◽

Univariate Analysis ◽

Cross Sectional Study ◽

Functional Health ◽

P Value ◽

Functional Health Literacy ◽

Cross Sectional ◽

Exact Test ◽

Independent Variables ◽

Adequate Health Literacy

ABSTRACT Objective: to assess the functional levels of health literacy in individuals undergoing dialysis. Method: a cross-sectional study with 42 patients of the Nephrology Unit of a public hospital in Recife, Brazil, from May to August 2016. Data were collected through scripted interviews and chart analysis. Functional health literacy was measured using the Brazilian version of the Short-Test of Functional Health Literacy in Adults questionnaire. Data analysis was performed using the Statistical Package for Social Sciences (SPSS®) software, version 18.0, with a univariate analysis to verify the association between independent variables and functional health literacy levels using Fisher's exact test. Results: 80.9% of the patients presented inadequate health literacy and 19.1% presented adequate health literacy. The number of correct answers remained between 0-18 in the reading comprehension and in the scheduling appointment card. Among the independent variables, only marital status (p-value=0.018) and personal income (p-value=0.009) were factors associated with the worst scores in the test, indicating that these variables influence the increase in inadequate literacy. Conclusion: the prevalence of inadequate functional literacy was high, reflecting difficulties in understanding and processing health information, which may interfere with therapeutic management and self-care.

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