Do Subjective Measures Improve the Ability to Identify Limited Health Literacy in a Clinical Setting?

Details

• Alternative Title:
  J Am Board Fam Med
• Personal Author:
  Goodman, Melody S. ; Griffey, Richard T. ; Carpenter, Christopher R. ; Blanchard, Melvin ; Kaphingst, Kimberly A.
• Description:
  Background
  
  Existing health literacy assessments developed for research purposes have constraints that limit their utility for clinical practice, including time requirements and administration protocols. The Brief Health Literacy Screen (BHLS) consists of 3 self-administered Single-Item Literacy Screener (SILS) questions and obviates these clinical barriers. We assessed whether the addition of SILS items or the BHLS to patient demographics readily available in ambulatory clinical settings reaching underserved patients improves the ability to identify limited health literacy.
  
  Methods
  
  We analyzed data from 2 cross-sectional convenience samples of patients from an urban academic emergency department (n = 425) and a primary care clinic (n = 486) in St. Louis, Missouri. Across samples, health literacy was assessed using the Rapid Estimate of Adult Literacy in Medicine-Revised (REALM-R), Newest Vital Sign (NVS), and the BHLS. Our analytic sample consisted of 911 adult patients, who were primarily female (62%), black (66%), and had at least a high school education (82%); 456 were randomly assigned to the estimation sample and 455 to the validation sample.
  
  Results
  
  The analysis showed that the best REALM-R estimation model contained age, sex, education, race, and 1 SILS item (difficulty understanding written information). In validation analysis this model had a sensitivity of 62%, specificity of 81%, a positive likelihood ratio (LR+) of 3.26, and a negative likelihood ratio (LR−) of 0.47; there was a 28% misclassification rate. The best NVS estimation model contained the BHLS, age, sex, education and race; this model had a sensitivity of 77%, specificity of 72%, LR+ of 2.75, LR− of 0.32, and a misclassification rate of 25%.
  
  Conclusions
  
  Findings suggest that the BHLS and SILS items improve the ability to identify patients with limited health literacy compared with demographic predictors alone. However, despite being easier to administer in clinical settings, subjective estimates of health literacy have misclassification rates >20% and do not replace objective measures; universal precautions should be used with all patients.
  
  
• Subjects:
  Biostatistics Cross-Sectional Studies Female Health Literacy Humans Likelihood Functions Male Mathematical Concepts Middle Aged Retrospective Studies ROC Curve Surveys And Questionnaires

  More +
• Source:
  J Am Board Fam Med. 28(5):584-594
• Pubmed ID:
  26355130
• Pubmed Central ID:
  PMC4987705
• Document Type:
  Journal Article
• Funding:
  U58 DP003435/DP/NCCDPHP CDC HHSUnited States/ ; 3U54CA153460-03S1/CA/NCI NIH HHSUnited States/ ; R21 HS020309/HS/AHRQ HHSUnited States/ ; P30 DK092950/DK/NIDDK NIH HHSUnited States/ ; U54CA153460/CA/NCI NIH HHSUnited States/ ; U54 CA153460/CA/NCI NIH HHSUnited States/ ; U58DP0003435/DP/NCCDPHP CDC HHSUnited States/ ; TL1 RR024995/RR/NCRR NIH HHSUnited States/ ; 1U13AG048721-01/AG/NIA NIH HHSUnited States/ ; UL1 RR024992/RR/NCRR NIH HHSUnited States/ ; P30 CA91842/CA/NCI NIH HHSUnited States/ ; P50 CA095815/CA/NCI NIH HHSUnited States/ ; P50CA95815/CA/NCI NIH HHSUnited States/ ; U13 AG048721/AG/NIA NIH HHSUnited States/ ; R01 CA168608/CA/NCI NIH HHSUnited States/ ; P30 CA091842/CA/NCI NIH HHSUnited States/ ; UL1 TR000448/TR/NCATS NIH HHSUnited States/ ; TL1RR024995/RR/NCRR NIH HHSUnited States/ ; TL1 TR000449/TR/NCATS NIH HHSUnited States/ ; KL2 RR024994/RR/NCRR NIH HHSUnited States/ ; KM1CA156708/CA/NCI NIH HHSUnited States/ ; KM1 CA156708/CA/NCI NIH HHSUnited States/ ; U54 CA155496/CA/NCI NIH HHSUnited States/ ; KL2 TR000450/TR/NCATS NIH HHSUnited States/
• Volume:
  28
• Issue:
  5
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:7968afa9187597997651090e956769178395e9c43898333a30103b59784d0917
• Download URL:
  https://stacks.cdc.gov/view/cdc/40930/cdc_40930_DS1.pdf
• File Type:
  [PDF - 129.16 KB ]