Development of an item bank of health literacy questions appropriate for limited literacy public sector patients in South Africa:

The majority of current health literacy measures emanate from high-income countries. In South Africa, there is no appropriate measure available for use by the diverse public sector population, many of whom have some literacy limitations. The objective was to develop a bank of questions for this population informed by a broader definition of health literacy, which acknowledges both traditional cognitive skills and explores the influence of the collective social environment on health literacy. Thirty questions for the Item Bank were developed to ensure cultural, contextual and educational appropriateness, and were continuously subjected to critical review by an expert consultant panel. Patients (n = 120) were recruited from a local primary care clinic and individually interviewed with the assistance of an interpreter to collect data on the Item Bank, Multidimensional Screener of Functional Health Literacy (MSFHL) and sociodemographics