Brief questions to identify patients with inadequate health literacy.

TLDR

No practical method exists for identifying patients with low health literacy. The study aimed to develop screening questions to identify patients with inadequate or marginal health literacy. The authors administered 16 Likert‑scale screening questions to 332 VA preoperative patients, then classified their health literacy using the Short Test of Functional Health Literacy in Adults and evaluated each question against inadequate and inadequate‑or‑marginal standards. Three 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?”—effectively detected inadequate health literacy with AUCs of 0.87, 0.80, and 0.76, respectively, but were less effective for marginal literacy.

Abstract

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.