All ETDs from UAB

Advisory Committee Chair

Connie Kohler

Advisory Committee Members

Monica Baskin

Kathy Harrington

Nataliya Ivankova

Angela Jukkala

Suzanne Martin

Document Type


Date of Award


Degree Name by School

Doctor of Philosophy (PhD) School of Public Health


Health literacy includes the ability to understand and process written and spoken health information, and numbers and calculations related to health information. Low health literacy is associated with negative health outcomes, and poor patient-provider communication. In order to advance health literacy research, there is a need to assess health literacy comprehensively and to develop an understanding of how health literacy impacts people at various stages of their lives. A sequential explanatory mixed methods study was conducted to assess college students' health literacy. During the quantitative phase, the Short Test of Functional Health Literacy in Adults (S-TOFHLA), the Newest Vital Sign (NVS), the Cancer Message Literacy Test-Listening (CMLT-Listening), and the e-Health Literacy Scale (eHEALS) were used to assess the students' print literacy, health-related numeracy, aural cancer literacy, and eHealth literacy, respectively. During the qualitative phase, in-depth interviews were conducted with a subset of the original participants to obtain further evidence supporting the results of the literacy assessments and to identify factors in their social cultural environment that influence their health-related decisions including uptake of the Human Papillomavirus (HPV) vaccine. During the quantitative phase, 160 students completed four health literacy assessments. The mean scores on the health literacy assessment were: S-TOFHLA: 35.2; CMLT-Listening: 82%; eHEALS: 80.9%; and NVS: 5.1. The scores of 3 of the 4 health literacy assessments were not correlated with their uptake of the HPV vaccine. Twenty students participated in in-depth interviews during the qualitative phase. The students' scores on the quantitative health literacy assessments indicated that they had adequate health literacy. However, the qualitative data showed that the students' cancer literacy, eHealth literacy, and numeracy skills were not as adequate as their health literacy test scores indicated. Furthermore, the qualitative data revealed that the majority of the students who had received the HPV vaccine had done so as the result of a recommendation from a healthcare provider or their parents. Therefore, it did not appear that they made an autonomous decision to get the HPV vaccine. The results of this study indicate that assessing health literacy using a one-dimensional approach may not accurately reflect college students' level of health literacy. In addition, students tend to rely on their aural literacy and eHealth literacy skills when seeking health information and making healthcare decisions. Therefore, there is a need for the development and implementation of intervention aimed at improving these skills among college students.

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