I agree with Cynthia's characterization.  NCES is not a policy agency,
it is a statistical agency.

-----Original Message-----
From: healthliteracy-bounces at nifl.gov
[mailto:healthliteracy-bounces at nifl.gov] On Behalf Of Baur, Cynthia
(CDC/CCHIS/NCHM)
Sent: Thursday, September 20, 2007 3:57 PM
To: healthliteracy at nifl.gov
Subject: [HealthLiteracy 1266] A few somewhat technical NAAL questions


 I can answer a few of these, and think Mark is the better person on the
others. 

First, it should be recalled that the NAAL was a study by the National
Center for Education Statistics (NCES), U.S. Department of Education
(ED). The U.S. Department of Health and Human Services (HHS) was a
partner in developing the health literacy component, but the NAAL is an
ED product, as well as all the reports published so far. So, all the
questions you raise about reporting were made with HHS input, but final
decisions belonged to NCES. I can provide some specifics on a few of the
issues.   

The first set of performance categories were developed as a result of a
National Academies panel that was convened at the request of NCES. Rima
Rudd was one of the panel members. The panel made recommendations to
NCES, which reviewed and chose the ones used in the NAAL reporting.
Because everything about the health literacy component was consistent
with the overall NAAL study and there had been no separate effort to
consider categories for the health section, NCES made the decision to
report the  health data with those categories. 

The decision to set the zero line between below basic and basic was also
a NCES decision. It is consistent with the way the general literacy data
are reported. At the time they made the decision, we had not yet come to
consensus in the Healthy People 2010 Health Communication Workgroup on
how we would report the data for the 2010 health literacy objective, so
NCES published the health literacy figures to be consistent with their
other reports. 

Cynthia
    

-----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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