The 67 percent was established by a committee from the National Academy
of Sciences.  It was established for the NAAL as a whole, and not
specifically for the health literacy component.  The establishment of
this success rate is both a policy judgement, and also influence by
statistics.  In fact, the best statistical approach would be to
establish a 50 percent success rate.  

To me, the fact that so many adults are at the lowest levels with a 67
percent success rate as you put it is in itself a loud call for action
and should be the focus of the policy debate if you will.

The specific categorical classifications were also established by a
committee from the National Academy of Sciences, with some minor
tinkering from the government.  The labels are not meant to imply that a
"basic" level is good enough--for health literacy, or literacy in
general.  

The data is set off between the basic level and above because some sort
of distinction needed to be used to present the data in a meaningful and
somewhat comparative way.  The data were presented this way because it
is the same way that the data were presented for the other literacy
reports, and the same way that data are presented for the National
Assessment of Educational Progress (NAEP).

The measures hold up very well as a separate health literacy domain.
While the health literacy items measure navigation, clinical
information, and prevention, there were not a sufficient number of items
to enable there to  be separate scores for each.

The types of analyses provided in the report are consistent with the
information presented in NCES report, i.e., mostly correlations.

Please let me know if I can provide you with any additional information.

Thanks

-----Original Message-----
From: healthliteracy-bounces at nifl.gov
[mailto:healthliteracy-bounces at nifl.gov] On Behalf Of Andrew Pleasant
Sent: Thursday, September 20, 2007 12:34 AM
To: The Health and Literacy Discussion List
Subject: [HealthLiteracy 1252] A few somewhat technical NAAL questions

If these have been asked previously, apologies for the redundancy ... 
but when going through a quick overview of the NAAL publications with 
students in my health literacy class, they (and I generally concur) 
raised a number of questions/ themes ... so since the opportunity to 
ask has luckily been provided by Julie on the listserv, here is a not 
complete list of the concerns that emerged ... I'd love to be able to 
share the official responses with the class. thanks.

Why a 67% success rate as a decision rule?  Wouldn't you want people 
to always read a medication label correctly versus 2 out of 3 times?

How different would the NAAL profile of health literacy in the U.S. 
be if that bar were raised to say 80% or even 100% correct responses?

Why those specific categorical labels - e.g. 'below basic', 'basic', 
etc.? Were other options considered? What is the basis for these 
choices?

Why the emphasis on categories versus treating health literacy as a 
continuous variable in analysis?

Why is the data generally depicted with below basic set off against 
the other three categories? Is there a statistical basis for that? It 
doesn't always appear to be the appropriate grouping of health 
literacy levels as it may diminish the problem by making it appear 
'basic' is good enough. For example, in the charts of health literacy 
by self-reported health and health literacy by health insurance, 
Basic and Below Basic seem to exhibit the same trend (negative 
correlation) while intermediate and proficient levels seem to exhibit 
the opposite (and normatively more desirable) trend. Is there an 
overall trend in terms of these relationships between the NAAL health 
literacy levels and the variables of interest they were cross-tabbed 
with?

How do the questions in the sets of domains, in essence separate 
measurement scales, hold together statistically (e.g. Cronbach's 
alpha or other) for both the health literacy component (navigation/ 
prevention/ clinical) and the larger NAAL (document/ prose/ numeracy).

Finally, have factor analytic procedures been applied to the NAAL or 
NAAL health literacy data? If so, are  those analyses available ? 
(e.g. any relationship between race/ ethnicity status and such an 
analysis)?

And as I just read in a message here that the health literacy 
questions were also included in the  three NAAL domain scores, how 
were the health literacy foci of navigation, prevention, and clinical 
mapped onto NAAL areas of document, prose, and numeracy. What do the 
health literacy item/ NAAL total correlations for the individual 
statements look like?  Do they all reflect the correlation between 
the health literacy methodology and the overall NAAL methodology?

Best and thanks ...

Andrew Pleasant

and fyi, you can find the course syllabus at 
http://www.aesop.rutgers.edu/~healthlit




-- 
-----------------------------------------------
Andrew Pleasant
Assistant Professor
Department of Human Ecology
Extension Department of Family and Community Health Sciences
Rutgers, the State University of New Jersey
Cook Office Building, 55 Dudley Road #207
New Brunswick, NJ 08901
phone: 732-932-9153 x. 320; fax: 732-932-6667


It is from numberless diverse acts of courage and belief that human 
history is shaped. Each time an individual stands up for an ideal, or 
acts to improve the lot of others, or strikes out against injustice, 
they send forth a tiny ripple of hope, and crossing each other from a 
million different centers of energy and daring, those ripples build a 
current that can sweep down the mightiest walls of oppression and 
resistance.

Robert F. Kennedy, South Africa, 1966
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