Assignment: Nurse Practicing Within A Family Practice

Assignment: Nurse Practicing Within A Family Practice

Assignment: Nurse Practicing Within A Family Practice

Using a self-report questionnaire also has its drawbacks, compared to real-time assessment of health literacy capabilities, given that an admission of literacy problems may well be perceived as potentially stigmatising by participants. We did not check the association between our measure and other standar- dised measures of health literacy such as TOFHLA and REALM as a way of exploring the validity of the AAHLS. However, evidence already exists on the association between the sorts of questions relating to functional health literacy common to our measure and the work of Chew et al. [13,57] and direct tests of reading. We also acknowledge that using mixed methods in the administration of the AAHLS, with some participants reading the questionnaire, and others having it read to them may have disadvantaged those with poor reading skills who nevertheless chose to read the measure themselves. It may be worth noting that other studies using self-report health literacy measures have also used multiple administration methods [14,35] in order to include participants who would struggle to fill in a questionnaire by themselves. Additional variance may have been introduced by also including a group who were read a Sylheti translation of the questionnaire. Further studies are needed to compare groups receiving different forms of administration of the AAHLS.

Health literacy is an evolving construct and there is no agreed definition of the concept or its components. We adopted a different approach to defining communicative and critical health literacy to other researchers [35,41]. Any approach using questionnaires and checklists will necessarily entail an oversim- plification of a very complex set of competencies and should be complemented by qualitative and ethnographic research meth- ods [8,58] to derive a more nuanced and contextualised understanding of health literacy as a social practice, rather than a set of predefined skills responsive to quantitative measurement and analysis.