Test Content for Health Activities Literacy Tests

Each day, millions of adults must make decisions, take actions and consider issues that influence not only their own well-being, but that of their family members and of their community. These actions are not confined to traditional healthcare settings such as doctors' offices, hospitals and clinics. They also take place in homes, at work and in communities across the country.

The Health Activities Literacy Tests are designed to assess the literacy skills adults need to perform these activities. ETS offers two separate tests of health activities: a full-length test and a locator test.

Both tests are available only electronically and consist of real-world tasks and open-ended questions that are automatically scored by the computer. They are also adaptive in that they adjust to an individual's level of skill.

Background for the Tests

Health researchers have not systematically examined tasks in these settings, which include how well people use package labels found on household goods, appliances, cleaning products or even over-the-counter medicines. There are also no measures currently available that take these broader activities into account. Yet literacy is likely to be one of the major pathways linking health and education, and might be a contributing factor to wide disparities in the quality of health care that many receive.

The first step in the creation of our health activities literacy measure was considering a variety of health activities — behaviors related to where and why people take health-related actions. Researchers applied a commonly used lexicon to differentiate among various health-related activities, including:

  • health promotion
  • health protection
  • disease prevention
  • health care and maintenance
  • systems navigation

Next, researchers reviewed each of the hundreds of materials and tasks used in the various literacy assessments of adults and, where appropriate, classified them using this framework. This resulted in the identification of some 191 health-related literacy tasks that cut across the three literacy scales — prose, document and quantitative — and provided a link across the various surveys that was then used to create a new health activities literacy scale.

Finally, researchers selected a subset of these health-related literacy tasks for inclusion in the construction of two health activities literacy tests.

Full-length Test

The full-length test consists of a short set of background questions plus three sets of health-related literacy tasks that incorporate prose, document and quantitative items.

Purpose: This test can be used to provide a profile of an individual's skill at performing health-related literacy tasks or to determine whether skills have changed over time as the result of some intervention.

Test time: About one hour is required. These tests are not timed or speeded. Instead, test takers can work at their own pace within a reasonable period of time.

Scores: Scores are provided in five-point increments, from 0 to 500, along a single health literacy scale and are broken into one of five levels of literacy proficiency.

The score can be used to characterize an individual's performance, in terms of national and international survey results, and to describe an individual's strengths and weaknesses with respect to the types of literacy tasks they can perform.

Locator Test

The primary differences between the full-length test and the locator test are the number of test items each person receives and the amount of testing time that is required.

Purpose: The locator test provides a general evaluation of an individual's skills at performing health-related literacy tasks. Because of how it's scored, the locator test is not appropriate for pre- and post-testing.

Test time: About 30 to 40 minutes is required. The test is not timed or speeded. Instead, test takers can work at their own pace within a reasonable period of time.

Scores: Scores are reported in terms of levels rather than points. So, for example, each test taker will receive a score that indicates whether they are in Level 1, Level 2 or Level 3 and higher.

A score report will provide a general overview of an individual's skills as demonstrated on the test and can be used for comparative purposes.

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