A simple question identifies patients with low health literacy
Research Activities, July 2011, No. 371
"How confident are you in filling out medical forms?" Asking this simple question, in either English or Spanish, may allow clinical researchers to identify persons with limited health literacy (HL) as effectively as using the English or Spanish versions of the short Test of Functional Health Literacy in Adults (s-TOFHLA), a new study reports. Earlier studies indicate that nearly half (46 percent) of the United States population has limited HL (inadequate or marginal HL), and that limited HL is associated with poor health outcomes. Unlike the versions of s-TOFHLA, which have to be administered in person, the single question, "How confident are you in filling out medical forms?" can be asked over the telephone.
Participants were asked to reply to this question on a 5-point Likert scale ("not at all," "a little," "somewhat," "quite a bit," and "extremely"). Responses of "not at all" through "somewhat" were found to be good predictors of having inadequate or marginal HL according to the s-TOFHLA (scores of 0-22), while responses of "quite a bit" or "extremely" corresponded with s-TOFHLA scores indicating adequate or better HL (scores of 23-36). Two other questions ("How often do you have problems learning about your medical conditions?" and "How often do you have someone help you read hospital materials?") were not as closely predictive of s-TOFHLA scores. The researchers conducted the validation study as part of trial of diabetes self-management support interventions in the San Francisco Department of Public Health.
Individuals were asked by bilingual research assistants to rate their responses to the three self-report questions on a 5-point (Likert) scale in their preferred language (English or Spanish). Participants also took the s-TOFHLA, in either English or Spanish. The study was funded in part by the Agency for Healthcare Research and Quality (HS17261).
More details are in "Validation of self-reported health literacy questions among diverse English- and Spanish-speaking populations," Urmimala Sarkar, M.D., M.P.H., Dean Schillinger, M.D., Andrea Lopez, B.S., and others in the March 2011 Journal of General Internal Medicine 26(3), pp. 265-271.