Table 1.

Profile of literacy skills as related to health care practice

	Identifying Problems	Potential Resources
Analytic	Analytic literacy skills can be generically applied to a number of sources and circumstances. These are foundational skills that are required to participate in daily informational life. Training aids are commonly found in many countries.
Traditional Literacy and Numeracy	Inability to read simple language Difficulty understanding printed materials in day-to-day interactions (eg, street signs) Inability to perform basic mathematical functions such as addition, subtraction, division, and multiplication with small whole numbers Difficulty in balancing a check book or calculating bank balances Difficulty reading maps or understanding simple charts	Many countries have national organizations that can provide free services for learners and professionals. Some examples include the following: Frontier College (Canada) [31] the National Literacy Trust (UK) [32] National Research and Development Centre for Adult Literacy and Numeracy (UK) [33] National Center on Adult Literacy (US) [34]
Media Literacy	Lack of awareness of media bias or perspective Inability to discern both explicit and implicit meaning from media messages Difficulty in deriving meaning from media messages	The Office of Communications strategy for enhancing media literacy (UK) [35] The National Institute of Adult Continuing Education (NIACE) media literacy guide (UK) [36] The Media Awareness Network (Canada) [37]
Information Literacy	Inability to see connections between information from various sources such as books, pamphlets, or Internet websites Lack of familiarity with libraries and other information repositories available in the community Inability to frame search questions in a manner that produces desired answers	The American Library Association has a resource page including toolkits and reference sources to aid in instruction and research [38]. Local libraries can provide support for information searches and self-directed learning; details are available through The Chartered Institute of Library and Information (UK) [39].
Context-Specific	Context-specific literacy skills are centered on specific issues, problem types, and contexts. These skills often require more specialized training than analytical literacy skills. Finding local resources may require more focused searches.
Computer Literacy	Unfamiliarity with basic computer terms such as email, mouse, keyboard, and so forth Inability to use a mouse or other input devices Lack of exposure to computers in everyday life	Computer training courses are widespread; however, accessibility is an issue for those on fixed incomes. Many libraries offer special programs to teach patrons both computer and search skills for little or no cost. Some countries have job training centers that provide basic computer courses as part of their core mandate.
Science Literacy	Lack of understanding about the cumulative impact of scientific knowledge No awareness that science can be understood by nonscientists Unfamiliarity with science terms, the process of discovery, or the application of scientific discoveries to everyday life	Few widespread resources exist to teach people science literacy. The most common approach to learning about science is through formal education; however, many science institutions such as universities and colleges have open lectures and educational events for the public on a regular basis. In Canada, the Royal Institute for the Advancement of Science holds monthly lectures on science topics to educate the public, as does the Royal Society in the UK.
Health Literacy	Difficulty following simple self-care directions or prescription instructions Fear of taking medications without assistance Unfamiliarity or lack of understanding of basic health care terms	Two instruments have been developed and validated for use in assessing health literacy: The Test of Functional Health Literacy in Adults (TOFHLA) and the Rapid Estimate of Adult Literacy in Medicine (REALM). Both have been widely used and are designed to assess health literacy within 30 minutes. The TOFHLA has 67 items and includes a numeracy component (the ability to read and understand numbers) and a reading comprehension component. The REALM has 66 items. Fostering health literacy is a challenge; however, attending to people’s media preferences (text, video, audio) and using plain language in interactions is a place to begin.