Brief Questions to Identify Patients With Inadequate Health Literacy

ArticleinFamily medicine 36(8):588-94 · October 2004with82 Reads
Source: PubMed
No practical method for identifying patients with low heath literacy exists. We sought to develop screening questions for identifying patients with inadequate or marginal health literacy. Patients (n=332) at a VA preoperative clinic completed in-person interviews that included 16 health literacy screening questions on a 5-point Likert scale, followed by a validated health literacy measure, the Short Test of Functional Health Literacy in Adults (STOHFLA). Based on the STOFHLA, patients were classified as having either inadequate, marginal, or adequate health literacy. Each of the 16 screening questions was evaluated and compared to two comparison standards: (1) inadequate health literacy and (2) inadequate or marginal health literacy on the STOHFLA. Fifteen participants (4.5%) had inadequate health literacy and 25 (7.5%) had marginal health literacy on the STOHFLA. Three of the screening questions, "How often do you have someone help you read hospital materials?" "How confident are you filling out medical forms by yourself?" and "How often do you have problems learning about your medical condition because of difficulty understanding written information?" were effective in detecting inadequate health literacy (area under the receiver operating characteristic curve of 0.87, 0.80, and 0.76, respectively). These questions were weaker for identifying patients with marginal health literacy. Three questions were each effective screening tests for inadequate health literacy in this population.
    • "−10 confidence items modified from [46], measured on a 5-point scale ranging from " extremely " to " not at all " confident. 1. Telling the doctor what is wrong; 2. Understanding your doctor; 3. Reading and understanding medicine labels; 4. Filling out medical forms by yourself; 5. Preventing problems with your health; 6. Taking care of your family and friends' health; 7. Reading and understanding food labels; 8. Planning healthy meals; 9. Using a thermometer; 10. "
    [Show abstract] [Hide abstract] ABSTRACT: Background: People with low literacy and low health literacy have poorer health outcomes. Literacy and health literacy are distinct but overlapping constructs that impact wellbeing. Interventions that target both could improve health outcomes. Methods/design: This is a cluster randomised controlled trial with a qualitative component. Participants are 300 adults enrolled in basic language, literacy and numeracy programs at adult education colleges across New South Wales, Australia. Each adult education institute (regional administrative centre) contributes (at least) two classes matched for student demographics, which may be at the same or different campuses. Classes (clusters) are randomly allocated to receive either the health literacy intervention (an 18-week program with health knowledge and skills embedded in language, literacy, and numeracy training (LLN)), or the standard Language Literacy and Numeracy (LLN) program (usual LLN classes, specifically excluding health content). The primary outcome is functional health literacy skills - knowing how to use a thermometer, and read and interpret food and medicine labels. The secondary outcomes are self-reported confidence, more advanced health literacy skills; shared decision making skills, patient activation, health knowledge and self-reported health behaviour. Data is collected at baseline, and immediately and 6 months post intervention. A sample of participating teachers, students, and community health workers will be interviewed in-depth about their experiences with the program to better understand implementation issues and to strengthen the potential for scaling up the program. Discussion: Outcomes will provide evidence regarding real-world implementation of a health literacy training program with health worker involvement in an Australian adult education setting. The evaluation trial will provide insight into translating and scaling up health literacy education for vulnerable populations with low literacy. Trial registration: Australian New Zealand Clinical Trials Registry ACTRN12616000213448 .
    Full-text · Article · Dec 2016
    • "Health Literacy [36] Participant understanding of medical information and forms HIV Symptom Index [37] A 20-item HIV symptom index of patient-reported symptoms Sexually Transmitted Diseases Assesses if participants have ever been treated for sexually transmitted diseases HIV Sex Risk Behaviors [38] Questions about vaginal, oral, and/or anal sexual practices with any sexual partners and use of substances before or during sex Sexual Partners a Questions about number and gender of recent sexual partners HIV Disclosure a [39, 40] Discussion of HIV status with others, including sexual partners HIV Stigma a [41] Experiences and feelings participants may have because of HIV Center for Epidemiologic Studies-Depression Scale (CES-D) a [42, 43] A measure of depressive symptomatology State Trait Anxiety Inventory (STAI)– Short Form a [44, 45] A measure of current feelings of anxiety Partner Violence and Sexual Assault a Experiences of having been hurt physically or sexually The Fagerstrom Test for Nicotine Dependence [46, 47] A measure of nicotine dependence Alcohol Use Disorders Identification Test (AUDIT) [48] Identifies persons with hazardous alcohol use Texas Christian University (TCU): Drug Screen [49, 50] Assesses drug use in the past year Drug Use [51, 52] Assesses frequency and type of drugs used and drug risk behaviors Overdose and Suicide [53] Questions regarding overdose and suicide attempts Household Food Insecurity Access Scale (HFIAS) [54] Assesses access to food in the past 4 weeks Barratt Impulsiveness Scale [55] Assesses participant impulsivity Social Support Scale [56] Measures access to companionship, assistance, or other types of support Involvement with Police [57] Assesses experiences with police officers RAND36 Health Survey [58] General assessment of overall health "
    [Show abstract] [Hide abstract] ABSTRACT: Background Russia and Eastern Europe have one of the fastest growing HIV epidemics in the world. While countries in this region have implemented HIV testing within addiction treatment systems, linkage to HIV care from these settings is not yet standard practice. The Linking Infectious and Narcology Care (LINC) intervention utilized peer-led strengths-based case management to motivate HIV-infected patients in addiction treatment to obtain HIV care. This paper describes the protocol of a randomized controlled trial evaluating the effectiveness of the LINC intervention in St. Petersburg, Russia. Methods/design Participants (n = 349) were recruited from the inpatient wards at the City Addiction Hospital in St. Petersburg, Russia. After completing a baseline assessment, participants were randomly assigned to receive either the LINC intervention or standard of care. Participants returned for research assessments 6 and 12 months post-baseline. Primary outcomes were assessed via chart review at HIV treatment locations. Discussion LINC holds the potential to offer an effective approach to coordinating HIV care for people who inject drugs in Russia. The LINC intervention utilizes existing systems of care in Russia, minimizing adoption of substantial infrastructure for implementation. Trial Registration NCT01612455
    Full-text · Article · Dec 2016
    • "Immigrants' health literacy was obtained from a validated single, five-point Likert type question: " How often do you have problems learning about your medical condition because of difficulty understanding written information? " (responses ranged from " always " to " never " ) [27]. Oral health-related quality of life was examined using the previously validated Brazilian version of the short-form of the Oral Health Impact Profile scale (OHIP-14) with higher scores indicating greater impact of oral conditions on quality of life [28]. "
    [Show abstract] [Hide abstract] ABSTRACT: Background: Inadequate functional health literacy is a common problem in immigrant populations. The aim of this study was to investigate the association between oral (dental) health literacy (OHL) and participation in oral health care among Brazilian immigrants in Toronto, Ontario, Canada. Methods: The study used a cross-sectional design and a convenience sample of 101 Brazilian immigrants selected through the snowball sampling technique. Data were analyzed using descriptive statistics and logistic regression modeling. Results: Most of the sample had adequate OHL (83.1 %). Inadequate/marginal OHL was associated with not visiting a dentist in the preceding year (OR = 3.61; p = 0.04), not having a dentist as the primary source of dental information (OR = 5.55; p < 0.01), and not participating in shared dental treatment decision making (OR = 1.06; p = 0.05; OHL as a continuous variable) in multivariate logistic regressions controlling for covariates. A low average annual family income was associated with two indicators of poor participation in oral health care (i.e., not having visited a dentist in the previous year, and not having a dentist as regular source of dental information). Conclusion: Limited OHL was linked to lower participation in the oral health care system and with barriers to using dental services among a sample of Brazilian immigrants. More effective knowledge transfer will be required to help specific groups of immigrants to better navigate the Canadian dental care system.
    Full-text · Article · Dec 2016
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