Eric S. Kiechle|Stacy Cooper Bailey|Laurie Hedlund|Anthony J. Viera|Stacey Sheridan
Different Measures, Different Outcomes? A Systematic Review of Performance-Based versus Self-Reported Measures of Health Literacy and Numeracy
University of North Carolina at Chapel Hill|University of North Carolina at Chapel Hill|Northwestern University|University of North Carolina at Chapel Hill|University of North Carolina at Chapel Hill
health literacy hl numeracy measured one two methods performance objective tests selfreport ones skills whether results methods differ relationship health outcomes use health services unknownwe performed systematic review identify evaluate articles measured performancebased selfreported hl numeracy examined relationship health outcomes health service use identify studies started ahrqfunded systematic review hl health outcomes looked newer studies searching medline 1 february 2010 9 december 2014 included english language studies meeting prespecified criteria two reviewers independently assessed abstracts studies inclusion graded study quality one reviewer abstracted information included studies second checked content accuracywe identified four fair quality studies met inclusion criteria review two studies measuring hl found differences performancebased selfreported hl association selfreported outcomes including diabetes stroke hypertension physiciancompleted rheumatoid arthritis disease activity score however hl measures differentially related patientcompleted health assessment questionnaire patients ability interpret prescription medication name dose medication bottle one study measured numeracy found difference performancebased selfreported measures numeracy colorectal cancer crc screening utilization however moderator analysis study performancebased selfreported numeracy differentially related crc screening utilization stratified certain patientprovider communication behaviors eg chance always ask questions get support neededmost studies found difference relationship results performancebased selfreported measures outcomes however identified studies using multiple instruments andor objective outcomes