Application of the Cloze Procedure to Evaluate Comprehension

Functional health literacy is “…theconstellation of skills, including the ability to perform basic reading and nu-merical tasks required to function in the healthcare environment.”1 Historically, literacy has been conceptualized in myri-ad ways, often perceived simply as read-ing ability or defined by education level. While fundamental to adequate function-al health literacy, reading ability and ed-ucation level do not sufficiently describe the skills necessary to comprehend and act on information essential to making informed and appropriate healthcare de-cisions. Two key studies have demonstrated the magnitude of inadequate functional health literacy in the indigent and elder-ly, estimating that 25%2 and 29%3 of study participants, respectively, had in-adequate functional health literacy. An additional 11 % and 14 % of participants, respectively, had marginal functional health literacy. The 2003 National As-sessment of Adult Literacy estimated that 14 % of adult Americans had “below basic ” health literacy skills and an addi-tional 22 % demonstrated only “basic