Feasibility and Diagnostic Accuracy of Brief Health Literacy and Numeracy Screening Instruments in an Urban Emergency Department

Details

• Alternative Title:
  Acad Emerg Med
• Personal Author:
  Carpenter, Christopher R. ; Kaphingst, Kimberly A. ; Goodman, Melody S. ; Lin, Margaret J. ; Melson, Andrew T. ; Griffey, Richard T.
• Description:
  Objectives
  
  To evaluate the diagnostic accuracy of five health literacy screening instruments in emergency department (ED) patients: the Rapid Evaluation of Adult Literacy in Medicine-Revised (REALM-R), the Newest Vital Sign (NVS), Single Item Literacy Screens (SILS), health numeracy, and physician gestalt. A secondary objective was to evaluate the feasibility of these instruments as measured by administration time, time on task, and interruptions during test administration.
  
  Methods
  
  This was a prospective observational cross-sectional study of a convenience sampling of adult patients presenting during March 2011 and February 2012 to one urban university-affiliated ED. Subjects were consenting non-critically ill, English-speaking patients over the age of 18 years without aphasia, dementia, mental retardation, or inability to communicate. The diagnostic test characteristics of the REALM-R, NVS, SILS, health numeracy, and physician gestalt were quantitatively assessed by using the short Test of Functional Health Literacy in Adults (S-TOHFLA). A score of 22 or less was the criterion standard for limited health literacy (LHL).
  
  Results
  
  Four hundred thirty-five participants were enrolled, with mean age of 45 years (SD ±15.7 years) and 18% had less than a high school education. As defined by an S-TOHFLA score of 22 or less, the prevalence of LHL was 23.9%. In contrast, the NVS, REALM-R, and physician gestalt identified 64.8%, 48.5%, and 35% of participants as LHL, respectively. A normal NVS screen was the most useful test to exclude LHL, with a negative likelihood ratio of 0.04 (95% CI = 0.01 to 0.17). When abnormal, none of the screening instruments, including physician gestalt, significantly increased the post-test probability of LHL. The NVS and REALM-R require 3 and 5 minutes less time to administer than the S-TOHFLA. Administration of the REALM-R is associated with less test interruptions.
  
  Conclusions
  
  One-quarter of these ED patients had marginal or inadequate health literacy. Among the brief screening instruments evaluated, a normal Newest Vital Sign result accurately reduced the probability of limited health literacy, although it will identify two-thirds of ED patients as high-risk for limited health literacy. None of the brief screening instruments significantly increases the probability of limited health literacy when abnormal.
  
  
• Subjects:
  Adolescent Adult Aged Aged, 80 And Over Cross-Sectional Studies Educational Measurement Emergency Service, Hospital Feasibility Studies Female Health Literacy Humans Language Likelihood Functions Male Mathematical Concepts Middle Aged Prospective Studies ROC Curve Time Factors Urban Health Services Young Adult

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• Source:
  Acad Emerg Med. 21(2):137-146
• Pubmed ID:
  24673669
• Pubmed Central ID:
  PMC4042843
• Document Type:
  Journal Article
• Funding:
  R21 HS020309/HS/AHRQ HHSUnited States/ ; P30 DK092950/DK/NIDDK NIH HHSUnited States/ ; U54 CA153460/CA/NCI NIH HHSUnited States/ ; P50 CA95815/CA/NCI NIH HHSUnited States/ ; TL1 RR024995/RR/NCRR NIH HHSUnited States/ ; R01 CA168608/CA/NCI NIH HHSUnited States/ ; UL1 TR000448/TR/NCATS NIH HHSUnited States/ ; TL1 TR000449/TR/NCATS NIH HHSUnited States/ ; 1KM1CA156708-01/CA/NCI NIH HHSUnited States/ ; KM1CA156708/CA/NCI NIH HHSUnited States/ ; KM1 CA156708/CA/NCI NIH HHSUnited States/ ; KL2 TR000450/TR/NCATS NIH HHSUnited States/ ; U58 DP003435/DP/NCCDPHP CDC HHSUnited States/ ; 3U54CA153460-03S1/CA/NCI NIH HHSUnited States/ ; UL1 RR024992/RR/NCRR NIH HHSUnited States/ ; P50 CA095815/CA/NCI NIH HHSUnited States/ ; KL2 RR024994/RR/NCRR NIH HHSUnited States/ ; U58 DP0003435/DP/NCCDPHP CDC HHSUnited States/
• Volume:
  21
• Issue:
  2
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:c07811cbc6df4cc7054cafa92e3536dac566188fd7c64780c0e654cba2737346
• Download URL:
  https://stacks.cdc.gov/view/cdc/29979/cdc_29979_DS1.pdf
• File Type:
  [PDF - 265.25 KB ]