Measuring Health Literacy Among U.S. Chinese-Speaking Populations with Limited English Proficiency

Abstract

It is important to assess health literacy level among individuals with limited English proficiency (LEP) because assessing their health literacy level is the first step to develop a tailored health education program and reduce health disparities. The purpose of my dissertation is to improve the health literacy measurement and theory among populations with LEP. My dissertation investigates the psychometric properties of two functional health literacy measures and evaluates the adequacy of a modified health literacy survey to elicit valid data among 405 U.S. Chinese-speaking individuals with LEP.

I found researchers assessed health literacy using the non-English Test of Functional Health Literacy in Adults (TOFHLA) with 15 languages in 13 counties with different translation processes. Also, I determined that only 16 of the 74 eligible studies reported reliability coefficients for their data, with a reporting rate of 21.6%.

I also found that the current functional health literacy construct and measurement tools are not applicable among populations with LEP. Most individuals with LEP had adequate functional health literacy when assessed in their native languages. The English TOFHLA was measuring functional health literacy along with language proficiency. The Numeracy items of the Chinese TOFHLA yielded scores with low reliability.

My dissertation results show that the participants earned higher health literacy scores when they encounter health information/situations in Chinese rather than in English. I also found that few participants believed they had a voice in influencing reforming U.S. health policy. Further, the theoretical health literacy model had a better fit with the data from the Chinese scenario questions than the data from the English scenario questions.

Based on the dissertation study findings, I have three implications for future health literacy research and practice. First, I recommend researchers use the short form for future non-English TOFHLA instruments application. Second, culturally related constructs such as English language proficiency are key components that should be added to the health literacy measurement and theoretical model for populations with LEP. Last, public health professionals should incorporate health interventions and policy approaches to improve critical health literacy among populations with LEP.