All Aspects of Health Literacy Scale (AAHLS): developing a tool to measure functional, communicative and critical health literacy in primary healthcare settings

Patient Educ Couns. 2013 Feb;90(2):247-53. doi: 10.1016/j.pec.2012.10.019. Epub 2012 Nov 30.


Objective: Our aim was to develop and pilot a tool to measure health literacy in primary health care settings, encompassing functional, communicative and critical health literacy.

Methods: Following consultation with providers and users of primary health care we developed a fourteen-item self-report scale, which was piloted on 146 participants. The reliability, content and construct validity of the scale was investigated as well as relationships between scores on the scales and participant characteristics.

Results: The overall scale had adequate reliability (Cronbach's alpha=0.74), though reliability of the subscales was less consistent. Principal component analysis indicated that scale items loaded on four factors, corresponding to skills in using written health information; communicating with health care providers; health information management and appraisal assertion of individual autonomy with regards to health. Overall scores and different subscale scores were associated with ethnic minority status, educational level, and self-rated health status, though the picture was complex.

Conclusion: Health literacy is a complex and evolving construct. Nevertheless, we succeeded in developing a brief measure relating to different health literacy competencies, beyond functional literacy skills.

Practice implications: Assessment using the AAHLS can provide important information for health care practitioners about the health literacy needs and capabilities of service users.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Communication*
  • Female
  • Health Knowledge, Attitudes, Practice*
  • Health Literacy*
  • Health Personnel
  • Humans
  • London
  • Male
  • Middle Aged
  • Primary Health Care / organization & administration*
  • Psychometrics
  • Reproducibility of Results
  • Sensitivity and Specificity
  • Socioeconomic Factors
  • Surveys and Questionnaires*
  • Young Adult