The approach of Health Literacy Missouri has been to adopt a program planning model that integrated the requisite needs assessment, ecological framework, and program evaluation. Launching a statewide health literacy campaign without those requisite elements would be a daunting task for a number of reasons. First, since there is still not a comprehensive measure of health literacy, there is disagreement on how to assess a population with a varied socioeconomic and culturally diverse background. Secondly, program planning functions best when based on a conceptual framework that focuses on ecological, multilevel determinants of health38. Successful implementation of the health literacy effort requires the interaction of a broad-based, multidisciplinary core of individuals and institutions, which are not historically characterized as collaborative.