Health Literacy is defined as the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions [1]. The need for a health-literate public has become critical, because of rapid innovations in biomedical sciences and the proliferation of information delivery services, such as the Internet, cable, and satellite TV. These innovations are steadily increasing the amount of health information in mass media and the Internet, and propelling a movement towards informed and shared decision making [2,3,4]. These developments have led to an expectation of an informed citizenry, a literate public, which can make intelligent and rational choices about behaviors to stay healthy or to become healthy if one is ill.

This normative definition of health literacy requires that a citizen obtain information, understand it, and act on it. Yet, this normative assumption is challenged by the existence of wide disparities in access to and utilization of health services, and in morbidity and mortality among different social classes and racial and ethnic groups [5,6,7]. For instance, the 2003 National Assessment of Adult Literacy found that Hispanics had a lower average health literacy rate than any of the other racial/ethnic groups, and that 36 % of the population had basic and below basic health literacy levels [8]. Concomitantly, this assumption is also challenged by the documentation of profound inequalities in the distribution of communication services, and in obtaining, processing, learning, and acting on information [9,10]. That is, the medically underserved are also likely to be underserved in terms of information and communication.

Most health literacy research to date documents the mismatch between the literacy demands of health systems and the literacy skills of the people using those systems [10]. Researchers have used reading assessment tools, such as the Rapid Estimate of Adult Literacy in Medicine (REALM) and the Test of Functional Health Literacy in Adults (TOFHLA) to assess patients’ health-related reading skills, and to correlate these readability/literacy levels with poor health outcomes [11,12]. This body of research has helped to shape the field of health literacy, but more research is required to rigorously examine the full breadth of health literacy, as defined by Healthy People 2010 and the Institute of Medicine. This definition goes beyond one’s ability to read and identify health terms; it speaks more to one’s ability to:

1. access health information
2. effectively navigate the information
3. retrieve relevant information
4. ultimately act on this information