In contrast, the National Assessment of Adult Literacy NAAL USAA 2003) used the same methods of measurement and determined the majority of adults (53%) to have intermediate health literacy when classified as proficient, intermediate, basic and below basic [ 3].
Education and literacy, i.e. health literacy.
This article proposes research hypotheses to address two questions: (1) What are the causal pathways or intermediate steps that link low health literacy to poor health status and high utilization of expensive services such as hospitalization and emergency care?
Health literacy has a "measurable impact on numerous intermediate factors affecting health outcomes" and is not accounted for in standard patient education and care programs [ 26].
A score of 4 or more would correctly identify all those with adequate health literacy skills, a score of 2 – 3 would indicate intermediate health literacy skills, and a score of 0 – 1 would indicate low health literacy skills.
The assessment in 2011 involved numeracy and literacy tests among six million foundation phase (grades 1 to 3) and intermediate phase (grades 4 to 6) learners at government schools.
"For students with intermediate levels of basic skills, much more needs to be done within universities to develop quite basic literacy and numeracy skills, alongside higher level study skills".
Specifically, NAAL health literacy scores range from 0 to 500, and are categorised as below basic (0 184), basic (185 225), intermediate (226 309), or proficient (310 500).
Our review supports the need to develop and validate better instruments for measuring health literacy (particularly interactive and critical health literacy) and for more studies to evaluate health literacy as an intermediate outcome rather than simply the health behavior as the endpoint.
However, the increasing maternal mortality in the 1990s was not mirrored by declining female literacy, and the effect of literacy on MMR may follow a significant time lag enough for other changes intermediate to reduced MMR to manifest.
The study, which was administered jointly by Carnegie Mellon University (CMU) and the Intermediate Unit 1 (IU1) Center for STEM Education, noted that U.S. educators were unsure of the implications of STEM, particularly when scientific and technological literacy of all students was the goal.
