• cognitive interviews conducted with a subset:
• the majority were comfortable answering the questions
• the majority correctly described the steps needed to answer each type of question (prose, document, quantitative):

Comments  the majority reported that the touchscreen was easy to use
"The instructions are clear; you read the question and choose the correct answer to complete the sentence." 
"Look at entire chart, look at question, then back at chart and choose answer." 
"I read the question and looked at choices below; I used math skills."
The words were big so I didn’t have to put glasses on. The screen was nice and bright. 
I like the headphones and it allowed me to concentrate better. 
It was fun.

•   completed Health LiTT on a tablet touchscreen in the clinic waiting room
•  the majority (93%) had no difficulty using the touchscreen, including those who were computer-naïve (87%)
•  average length of time to complete 30 items was 18 minutes
•  the majority (75%) rated their study participation experience “better than expected”

Comments: 

It was interesting and challenging to me because I have never used a computer easy. But it was easy. 

It was exciting to use because I felt that I learned something new. Being my first time using the computer, it was enjoyable. 

It was easy; you can answer the questions at your own pace.

• English and Spanish Item Development and Translation Advisory Panels provided input on item content, difficulty and quality.
• Only one concept is clearly articulated for each item.
• Content information is accurate.T
• Topics were selected based on interest and importance to both clinicians and patients.
  Item content is expected to be fairly fixed (i.e., not likely to change due to advances in medicine or technology).
  

Construct Validity (Yost et al.,2010; Hahn et al., 2011): 

• lower health literacy for those with lower education or lower income

 

Criterion Validity (Yost et al., 2011):

• Correlated with the Test of Functional Health Literacy in Adults (TOFHLA; Parker et al., 1995), Rapid Assessment of Adult Literacy in Medicine (REALM; Davis et al., 1993) and the Newest Vital Sign (NVS; Weiss et al. 2005).

•  Associated with TOFHLA categories (inadequate, marginal, adequate)

• The importance of health literacy has grown considerably among researchers, clinicians, patients and policymakers. Better instruments and measurement strategies are needed. 
• Health LiTT meets psychometric standards (reliability of 0.90 or higher) for measurement of individual respondents in the low to middle range (Hahn, 2011)  Better measurement precision will enhance the ability to estimate the size of the population at risk from low health literacy, and to identify vulnerable patients in clinical settings.  
• The Health LiTT measurement system provides a useful strategy for those who may want to explore health literacy screening in clinical practice.

• Health LiTT is incorporated into Assessment Center^SM which is a free, online research management tool (http://www.assessmentcenter.net/).   
• Assessment Center^SM enables customization of items and instruments, real-time scoring of CATs, secure storage of protected health information, automated accrual reports, real-time data export, and many other features.  
• Use of Assessment Center^SM for Health LiTT will enable administration of Health LiTT on the same touchscreen used for other patient-reported outcomes, thus providing a feasible way to assess patients’ literacy in clinical practice and research.

•  Contact Us for access to Health LiTT.

• Item responses are scored using an IRT algorithm. See IRT definition in FAQs 
• Health LiTT uses a T-score (mean=50, SD=10). 
• The Health LiTT score meets psychometric standards (reliability of 0.90 or higher) for measurement of individual respondents in the low to middle range (Hahn et al., 2011) .
• Reports (coming soon)

• Health LiTT uses a T-score (mean=50, SD=10). 
• A T-score of 50 corresponds to the mean score of the primary care development sample which involved 608 patients being treated in clinics for underserved populations (Hahn et al., 2011)
• A score of 50 was reported for a group of older adults (age 55-74) (Yost et al., 2011) with marginal health literacy on the Test of Functional Health Literacy in Adults (TOFHLA; Parker et al., 1995).