March 13, 2014
Cynthia Baur, Ph.D.
Centers for Disease Control and Prevention (CDC)
Thinking about Health Literacy Measures and Outcomes
Measures and outcomes are part of an evaluation process. It is important to know and understand
why you want to measure and what you intend to do with the results before you begin.
One model: CDC’s Framework for Program Evaluation
A strong evaluation approach ensures that the following questions will be addressed as part of
the evaluation so that the value of program efforts can be determined and judgments about value
can be made on the basis of evidence:
 What will be evaluated? (i.e., what is "the program" and in what context does it exist?)
 What aspects of the program will be considered when judging program performance?
 What standards (i.e., type or level of performance) must be reached for the program to be
considered successful?
 What evidence will be used to indicate how the program has performed?
 What conclusions regarding program performance are justified by comparing the
available evidence to the selected standards?
 How will the lessons learned from the inquiry be used to improve public health
effectiveness?
http://www.cdc.gov/evaL/framework/index.htm
March 13, 2014
Cynthia Baur, Ph.D.
Centers for Disease Control and Prevention (CDC)
Begin by identifying the communication and health literacy programs or activities in your organization
and the context for these.
 Is communication a valued or undervalued area? Visible or invisible?
 Which programs and activities not explicitly labeled communication or health literacy include
these elements?
 What do you already measure about communication?
 What types of systems do you have for collecting, analyzing, and reporting communication data?
 Who can reliably collect and report data for you?
Possible sources of communication and health literacy measures
1. Healthy People 2020 www.healthypeople.gov
a. Health literacy measures and data sources
2. National Action Plan to Improve Health Literacy
http://www.health.gov/communication/hlactionplan/
a. Goals and strategies that can be translated into measures
3. National Standards on Culturally and Linguistically Appropriate Services
https://www.thinkculturalhealth.hhs.gov/Content/clas.asp
a. Standards that can be translated into measures
4. Federal Plain Language Guidelines www.plainlanguage.gov
5. Attributes of a health literate healthcare organization
http://www.iom.edu/Activities/PublicHealth/HealthLiteracy.aspx
a. Organizational characteristics that can be translated into measures
b. Example: Proportion of clinicians with patient contact trained to use the teach-back
method; audited for their use of teach-back; and whose patients report use of teach-back
6. Core measures from IOM Roundtable on Value & Science-Driven Health Care
http://www.iom.edu/Activities/Quality/VSRT.aspx
a. Example: patient-centered measures about patient knowledge and understanding of care
plan
b. Example: coordination and communication measures about communication among
healthcare team members, including the patient
7. Consumer Assessment of Healthcare Providers and Systems (CAHPS) https://cahps.ahrq.gov/
a. Example: patient questions about their experience, including providers’ communication
skills
b. Example: specific health literacy provider module
8. The Joint Commission Accreditation Standards
http://www.jointcommission.org/assets/1/18/Patient_Centered_Communications_7_3_12.pdf
a. Example: 2010 Roadmap
9. Environmental assessments http://www.hsph.harvard.edu/healthliteracy/practice/environmentalbarriers/
a. Example: partnering with community to walk your facilities and see it through their eyes
10. Individual organization’s satisfaction and experience surveys and qualitative assessments
11. Material assessments
a. Example: CDC Clear Communication Index
http://www.cdc.gov/healthcommunication/ClearCommunicationIndex/
b. Example: Number or proportion of materials produced using clear communication
techniques
12. Training evaluations