Date of Award

Spring 5-1-2018

Degree Type


Degree Name

Doctor of Philosophy (PhD)


Educational Studies and Research

Committee Chair

Kyna Shelley

Committee Chair Department

Educational Studies and Research

Committee Member 2

Lilian Hill

Committee Member 2 Department

Educational Studies and Research

Committee Member 3

Thomas Lipscomb

Committee Member 3 Department

Educational Studies and Research

Committee Member 4

Richard Mohn

Committee Member 4 Department

Educational Studies and Research


According to researchers, low health literacy is considered a worldwide health threat (Lee, Tsai-Tzul, Tsai, & Kuo, 2010). With the recent emphasis on healthcare and improving health status, knowledge has proven vital in the struggle for improved health status and health prevention. The purpose of this study was to investigate the measurement of health literacy utilizing a cross-validation approach. Health literacy measurement has been assessed using three health literacy instruments that are currently available: Short Test of Functional Health Literacy in Adults (STOFHLA), Newest Vital Sign (NVS), and Health Literacy Skills Instrument (HLSI). This study used an exploratory research design. Participants for this study were recruited online via Amazon’s Mechanical Turk, and then qualified participants were administered the instruments via Qualtrics survey software.

A total of 367 valid responses were collected during data collection. SPSS syntax was used to transform and score each of the three instruments. Transformation of the data included transforming individual items from two instruments into binary data where one was the correct answer and all other answers were zero. After the transformation of the data, SPSS syntax was used to score each instrument. To answer the research question regarding the consistency of the selected health literacy instruments, a Spearman’s rho was conducted. The results for Spearman’s rho indicate that all three instruments are significantly correlated at the p< .01 level. The correlations for each were moderate with the correlation between the NSV and HLSI being the weakest at .471. The strongest correlation was between the NSV and the STOFHLA at .642. The correlation between the STOFHLA and the HLSI was .586.

The ability to assess health literacy more accurately will continue to be an important issue as more emphasis is placed on patient outcomes. There are many instruments that endeavor to measure health literacy, but there are still many questions about the accuracy and consistency of available measures. The instruments used in this study show some consistency in their ability to measure health literacy across different domains, but also raised new questions about health literacy measurement.