A Practical Framework for Selecting Health Literacy Measurement Tools in Rural and Agricultural Communities: A Narrative Review
Health literacy is a key public health competency that enables individuals to access, understand, appraise, and apply health information in daily decision-making. Rural and agricultural communities require particular attention because health information is often delivered in contexts shaped by limited formal education, work-related hazards, restricted access to health services, uneven digital connectivity, and culturally diverse communication practices. Although many studies use well-known health literacy instruments, tool selection is often based on popularity rather than methodological fit for field conditions, respondent literacy level, cultural adaptation, occupational risk exposure, and interviewer burden. This narrative review aims to compare commonly used health literacy measurement tools and to propose a practical framework for selecting instruments for rural and agricultural populations, particularly in low- and middle-income countries. Literature was identified through targeted searches in PubMed/MEDLINE, Google Scholar, ScienceDirect, and official instrument sources, with priority given to validation studies, psychometric papers, reviews, and publications involving rural or agricultural populations. The review discusses multidimensional tools such as the European Health Literacy Survey instruments and the Health Literacy Questionnaire, functional and clinical tools such as TOFHLA, S-TOFHLA, and the Newest Vital Sign, digital tools such as eHEALS, and occupation-specific tools such as the Agricultural Safety and Health Literacy Tool. A purpose-based selection framework is proposed to guide the choice of instruments for community surveys, clinical screening, digital health assessment, agricultural safety, and intervention development. For rural and agricultural settings, the most feasible approach is often a short-validated tool, culturally adapted, administered with interviewer assistance, and supplemented with context-specific items on work-related health risks and access to health information.