Brief Questions to Identify Patients With Inadequate Health Literacy

Health Services Research and Development Center of Excellence, VA Puget Sound Health Care System, Seattle, WA 98101, USA.
Family medicine (Impact Factor: 1.17). 10/2004; 36(8):588-94.
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.

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    • "The increased attention to health literacy and the evolution of shorter screening instruments has fostered interest in developing screening programs in the clinical context [(Seligman et al., 2005), p. 1006]. Therefore, many studies have been either using or developing screening questions, for they are effective and easy to use (Williams et al., 1995; Bennett et al., 2003; Chew et al., 2004; Lee et al., 2013). Instruments such as REALM and TOFHLA have some major disadvantages: they take much time to fill in, even in their short versions, and they may make patients feel ashamed as their low health literacy becomes apparent. "
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    ABSTRACT: This study aimed to validate a Turkish version of the Short Test of Functional Health Literacy (S-TOFHLA) (Baker et al., Development of a brief test to measure functional health literacy. Patient Educ Counsel 1999; 38: :33-42) and a Turkish version of the Chew self-report scale (Chew et al., Brief questions to identify patients with inadequate health literacy. Family Med, 2004; 36: :588-94) for measuring functional health literacy. The original English version of the S-TOFHLA and the Chew items were translated by applying standardized translation methods and cultural adaptations, and both were administered to a sample of diabetes patients (N = 302) in two diabetes clinics in one of the major cities in Turkey. Self-administered paper-pencil questionnaires were distributed to eligible outpatients who had a clinic appointment. In addition to the S-TOFHLA measurement and the Chew screening questions, gender, age, educational attainment, income, marital status and diabetes knowledge were obtained. The Turkish version of S-TOFHLA showed high internal consistency. Both S-TOFHLA and the Chew screening scale correlated significantly with known predictors of health literacy: age, education and income. The Chew scale was also related weakly but significantly with general diabetes knowledge. It is expected that the Turkish versions of S-TOFHLA and the Chew scale will be used in Turkey as well as in other countries with large Turkish communities. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email:
    Full-text · Article · Jan 2015 · Health Promotion International
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    • "Attribute of health literacy Number of definitions attribute appears within Use, function, and=or act 13 Understand 12 Find, access, and=or obtain 10 Evaluate or process 10 An appropriate or sound decision 5 To improve health 6 Reading and=or numeracy 5 A set of undefined skills 4 An informed decision 5 In a health care=clinical context only 3 Communicate 3 Empowerment=take responsibility 2 Listen 1 Print material 1 Graphic material 1 Note. Definitions used are from Agency for Healthcare Research and Quality, 2007; Ad Hoc Committee on Health Literacy for the Council on Scientific Affairs, 1999; Begoray & Kwan, 2011; Chew et al., 2008; Coleman et al., 2009; DeWalt et al., 2004; Kickbusch & Maag, 2008; Kirsch, Jugeblut, Jenkins, & Kolstad, 1993; Kwan et al., 2006; Nielsen-Bohlman et al., 2004; Nutbeam, 1998; Parker et al., 1995; Sewell, 2003; Sorensen et al., 2012; Yost et al., 2009; and Zarcadoolas et al., 2006. "
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    ABSTRACT: The concept of health literacy initially emerged and continues to gain strength as an approach to improving health status and the performance of health systems. Numerous studies clearly link low levels of education, literacy, and health literacy with poor health, poor health care utilization, increased barriers to care, and early death. However, theoretical understandings and methods of measuring the complex social construct of health literacy have experienced a continual evolution that remains incomplete. As a result, the seemingly most-cited definition of health literacy proposed in the now-decade-old Institute of Medicine report on health literacy is long overdue for updating. Such an effort should engage a broad and diverse set of health literacy researchers, practitioners, and members of the public in creating a definition that can earn broad consensus through validation testing in a rigorous scientific approach. That effort also could produce the basis for a new universally applicable measure of health literacy. Funders, health systems, and policymakers should reconsider their timid approach to health literacy. Although the field and corresponding evidence base are not perfect, health literacy—especially when combined with a focus on prevention and integrative health—is one of the most promising approaches to advancing public health.
    Full-text · Article · Dec 2014 · Journal of Health Communication
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    • "It describes an individual's capacity to cope within a health system by successfully applying literacy skills in a health context. People with low health literacy tend to have poorer knowledge about the conditions affecting them; use preventive services less often; have lower medication adherence rates; higher hospitalization rates and poorer self-reported health than those with high health literacy [3]. Poor health literacy is also associated with increased health care costs [4]. "
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    ABSTRACT: Objectives To develop and test a tool for measuring health competence. Methods In order to measure this attribute, we used a sequential exploratory mixed methods design in the rural and urban communities in Cameroon. In the qualitative phase, 67 clients constituted 10 focus group to elicit themes related to health competence. In the quantitative phase, self-rated items were tested on 300 participants and on a random selection of 25 participants two weeks later. Results The internal consistency for the subscales derived varied from 0.61-0.81. Older (F[45,339.1] = 1.2; p = 0.031) and more educated (F [3,22.6] = 2.1;p = 0.004) people were more likely to score higher on the scale. Interviewers also contributed to the variance (F [5,37.6] = 3.6;p < 0.001). Test- retest reliability was 0.66. The final scale with 15 items is made up of three subscales: knowledge of disease, how to stay in good health and health information. Conclusion We present a new self-rated scale for health competence with good psychometric properties. It circumvents the need to be literate, but requires well trained interviewers. We recommend that it be tested in other settings. Practice implications This tool should be used to appraise individual and community health education needs with minor context specific modifications.
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