Literature Review on "Newest Vital Sign and Realm Screen Tools"

Literature Review 6 pages (1845 words) Sources: 15

[EXCERPT] . . . .

Newest Vital Sign and REALM screen tools in health literacy

In a clinical setting, the quality and robust nature of a number of diagnostic tools are central to both accurate results and a medical professional's ability to assess the medical situation. For example, there are numerous tools designed to assess health literacy within the clinical setting. Two of these tools, REALM (Rapid Estimate of Adult Literacy in Medicine) and the NVS (Newest Vital Sign Screening) tool, have very different approaches to the same problem set. Under this rubric, the seminal question becomes one of preference, ease of use, accuracy of results, and whether one too or another will influence usage and robustness of data. Since these types of tools are primarily used by registered nurses, it stands to reason that the nursing population's preference sets the tone and timbre of clinical acceptance (Arozulla, Yarnold, Benett, Soltysilk, et al., 2007).

Health literacy is defined as "the ability to read and comprehend prescription bottles, appointment slips, and other essential health related materials required to successfully function as a patient" (Health Litarcy: Report of the Council on Scientific Affairs, 1999, 552). This is typically something most medical professionals take for granted when dealing with the average adult population. It implies not only a basis for knowledge, but the ability to actively participate in the co-responsibility of their own healthcare by having the basic reading, writing, comprehension, and cognitive questioning skills. The facts, though, show a different paradigm: about 20% are completely unable to understand health related information, and another 20% able to read the

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materials, but not really understand what it means to their own healthcare situation (Berger, 2000).

In addition, and possibly more concerning within the paradigm of 20th century medicine, studies not that as many as 90 million Americans cannot fully understand health information (Powers, Trinh, and Hayden, 2010). Lack of understanding sometimes also means lack of acting on instructions, taking medications as required, and the ability to interact with medical professionals with cogent questions or concerns (Weiss, et al., 2005). Physicians, however, are not trained in pedagogy. Combined with the psychological "white coat syndrome," they often do not notice that patients are not understanding their explanation or directions. If we combine this with the average reading level of adults in America, we find that about three-fourths of medical materials were written above the average comprehension level (Davis and Wolf, 2004)

The REALM -- The REALM is one of the most widely used tools for studying literacy. Even though developed in the, it has remained an important asset desgiend to help clinicians identify patients who might be at the greatest risk for understanding healthcare related materials (Davis, Long and Jackson, 1993). REALM is constructed for ease of use as well as a quick assessment tool: 1) it is a word-pronounciation review with common patient direction and educational materials, 2) The newer, shortened list from 125 words and phrases to 66, focuses on issues that are highly discriminatory (Bass, Wilson and Griffith, 2003). The items are ordered by difficulty; one-syllable to multi-syllable words. The client reads as many as possible, but when they see a word they do not know they are asked to look at the rest of the words and pronounce as fluently as possible. A standard dictionary pronouciation is the scoring standard, and the number of words read correctly is translated into one of four literacy levels. The test typically takes less than 5 minutes to administer and score. Early research with REALM also shows a fairly high correlation with standard reading achievment assessments with coefficients from the .80-.95 range (Ibrahim, Reid, Shaw, Rowlands, et al., 2008).

The NVS -- Specifically in response to research showing that the two most misunderstood pieces of medical information were nutrition labels and prescription instructions, the NVS bi-lingual (English and Spanish) tool was developed. Additional research showed that despite decades of using REALM, inter-hospital programs, and even national literacy development, about 20% of the population were still unable to adequately understand basic medical terms. This population had a high incidence of needing help reading hosptial material, filing out medical forms, and understanding written medical information (Chew, Bradley, and Boyko, 2004).

The NVS is based on how well a patient can comprehend the use of nutrition label information from an ice cream container, administered and scored in less than 3 minutes typically. Clients are given the label and asked six questions concerning the information on the label. Based on the correct responses, health literacy levels are assessed, 0-6 (zero lowest, 6 highest). Scores at or above 6 are considered adequate literacy (Mpofu and Oakland, 2010, 686).

Bias- Almost all tests are biased in some way. Linguist, cultural, educational, and even generational differences become accentuated when testing a rather amorphous concenpt like health literacy through traditional oral means. However, using other testing models, research found that both the REALM and NVS score in approximately the 75th percentile in predicting poor literacy outcomes, and even into the 95th and above percentile within certain demographic areas (Mpofu, 685).

The REALM test, for instance, seems to have a bias in favor of caucasian middle class and above participants, primarily due to word choice based on cultural bias. The choices of words, too, may be problematical; in some studies 40% of the questions were deemed unanswerable within the confines of a typical diverse American popuylation. The juxtaposition between measurement and prediction is also somewhat a problem in that numerous students show a 55% or better comprehension rate but an inability to remember and use many of the terms (Dowse, Lecoko and Ehlers, 2005).

Demographically and psychographically, the NVS seems to be more appropriate because it attempts to limit cultural bias. Almost everyone has seen or heard of an ice cream label, and using the two major population group languages in the United States allows for a larger grouping within population. Research in comparing the two tests for validity did not show significant differences in white populations, but did within minority and undereducated African-Americans (Shea, beers, McDonal, et al., 2005). In some geographic areas, the African-American population is large, and cultural research shows that they are more likely to prefer aggressive and sometimes complicated treatments in a variety of situations. Health literacy issues then become a vital concern due to the need for more complicated procedures and pharmacology (Volandes, Paasche-Orlow, Gillick, Cook, et al., 2008). Screening time, however, is almost equal, as is reading and interpreting of scores (Johnson and Weiss, 2008).

There will be significant socio-demographic differences between the two tests, depending again, on the populations assessed. In addition to diversity issues, some patients want to please the nurse or doctor so much that when asked if they "understand" something they are rife to admit they do not. For these patients, either test is appropriate because they must identify and articulate specific answers (VanGeest, Welct, and Weiner, 2010)

Implications -- Understandably, the level of literacy often correlates to patient outcome. If a patient is unable to understand directions, they will remain unable to act responsibly in assisting in their recuperation. Missed or wrong prescription dosages can actually harm or cause adverse medical outcomes. Ideal practices and standard care methodologies call for the increasing attention towards medical literacy. As part of recording vital signs and prepping the patient for the docto's visit, then, the nurse should assist by running a simple literacy lest to determine what, if any, alternative measure are necessary for this client. Appropriate and timely intervention and support promotes high quality care, optimal outcomes for patients, and certainly lower medica costs over the long-term (Nielsen-Bohlman, Panzer, and Kindig, 2004).

In certain disciplines the need for health literacy is accentuated. Dentistry requires very specific care instructions (Richman, Lee, Rozier, Gary, Gon, et al., 2007), post-operative or pre-test issues, and family medicine are also of concern to the medical population. If parents do not understand care instructions for their child, they are unable to assist in that child's well-being. Similarly, a number of misinterpretations are in evidence within sports medicine, school innoculations, and even post-birth situations, all which could have rather disastrous effects (Shah, Bremmeyer, Katazryna, and Ruth, 2010).

Conclusions- Based on the data, there is a clear preference for the NVS as a tool accessible and understandable to most population groups (Chew, Griffin, Partin, Noorbaloochi, et al., 2008). There is a weak, but consistent, relationship between fluency in healthcare literacy and patient satisfaction with their medical care (Shea, Guerra, Ravelnell, McDonal, et.al., 2007). What has not yet been established, however, are two major questions: 1) What is the overall relationship longitudinally between literacy scores and prognosis or overall health, and 2) What are the national implications of health literacy on an increasingly diverse population?

Works Cited

Health Litarcy: Report of the Council on Scientific Affairs. (1999). Journal of the American Medical Association, 28(1), 552-7.0

Arozulla, Y., Benett, S., Soltysilk, T., et al. (2007). Development and Validation of a Short-Form, Rapid Estimate of Adult Literacy in Medicine. Medical Care,… READ MORE

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Result <1. >

Unique Identifier

19885705

Status

MEDLINE

Authors

Rawson KA. Gunstad J. Hughes J. Spitznagel MB. Potter V. Waechter D. Rosneck J.

Authors Full Name

Rawson, Katherine A. Gunstad, John. Hughes, Joel. Spitznagel, Mary Beth. Potter, Vanessa. Waechter, Donna. Rosneck, James.

Institution

Department of Psychology, Kent State University, P.O. Box 5190, Kent, OH, 44242-0001, USA. krawson1@kent.edu

Title

The METER: a brief, self-administered measure of health literacy.

Source

Journal of General Internal Medicine. 25(1):67-71, 2010 Jan.

Other ID

Source: NLM. PMC2811598 [Available on 01/01/11]

Abstract

BACKGROUND: Given rapidly accumulating evidence that health literacy is correlated with important health-related measures, assessing patients*****' health literacy level is of increasing concern for researchers and practitioners. Practical limitations for use of existing health literacy measures include length of time and practitioner involvement in administration. OBJECTIVE: To develop and validate a brief, self-administered measure of health literacy, the Medical Term Recognition Test (METER). PARTICIPANTS: 155 participants were recruited from an outpatient cardiology program at an urban hospital. MEASURES: Patients completed measures of health literacy (METER and REALM), neuropsychological function, psychosocial health, and self-report questionnaires about health behaviors. Indicators of cardiovascular health were also recorded from patients*****' medical charts. KEY RESULTS: The measure took 2 min to complete. The internal consistency of the METER was 0.93, and it correlated hig!

hly with REALM (r = 0.74). Regarding sensitivity and specificity for identifying individuals below REALM*****'s cutoff for functional literacy, METER resulted in 75% correct identifications and 8% false positives. METER and REALM were both associated with various health-related measures (including significant correlations with measures of neuropsychological function and cardiovascular health). CONCLUSIONS: These initial findings show that the METER is a quick and practical measure of health literacy for use in clinical settings.

Publication Type

Comparative Study. Journal Article. Research Support, N.I.H., Extramural.

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Result <2. >

Unique Identifier

20574878

Status

MEDLINE

Authors

VanGeest JB. Welch VL. Weiner SJ.

Authors Full Name

VanGeest, Jonathan B. Welch, Verna L. Weiner, Saul J.

Institution

School of Community Health and Policy, Morgan State University, Baltimore, Maryland, USA.

Title

Patients*****' perceptions of screening for health literacy: reactions to the newest vital sign.

Source

Journal of Health Communication. 15(4):402-12, 2010 Jun.

Abstract

Difficulties in caring for patients with limited health literacy have prompted interest in health literacy screening. Several prior studies, however, have suggested that health literacy testing can lead to feelings of shame and stigmatization. In this study, we examine patient reaction to the Newest Vital Sign (NVS), a screening instrument developed specifically for use in primary care. Data were collected in 2008 in the Morehouse School of Medicine, Department of Family Medicine Primary Care Clinics, where health literacy screening was implemented as part of routine intake procedures. Following the visit, patients completed a series of questions assessing their screening experiences. A total of 179 patients completed both the NVS and the reaction survey. Nearly all (> 99%) patients reported that the screening did not cause them to feel shameful. There were also no differences in the reported prevalence of shame (p
ould recommend clinical screening, 97% of patients answered in the affirmative. These results suggest that screening for limited health literacy in primary care may not automatically elicit feelings of shame. Even patients with the lowest levels of literacy were both comfortable with and strongly supportive of clinical screening.

Publication Type

Journal Article. Research Support, Non-U.S. Gov*****'t.

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Result <3. >

Unique Identifier

20606152

Status

MEDLINE

Authors

Powers BJ. Trinh JV. Bosworth HB.

Authors Full Name

Powers, Benjamin J. Trinh, ***** V. Bosworth, Hayden B.

Institution

Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, 508 Fulton St, Durham, NC 27705, USA. power017@mc.duke.edu

Title

Can this patient read and understand written health information?. [Review] [46 refs]

Source

JAMA. 304(1):76-84, 2010 Jul 7.

Abstract

CONTEXT: Patients with limited literacy are at higher risk for poor health outcomes; however, physicians*****' perceptions are inaccurate for identifying these patients. OBJECTIVE: To systematically review the accuracy of brief instruments for identifying patients with limited literacy. DATA SOURCES: Search of the English-language literature from 1969 through February 2010 using PubMed, Psychinfo, and bibliographies of selected manuscripts for articles on health literacy, numeracy, reading ability, and reading skill. STUDY SELECTION: Prospective studies including adult patients 18 years or older that evaluated a brief instrument for identifying limited literacy in a health care setting compared with an accepted literacy reference standard. DATA EXTRACTION: Studies were evaluated independently by 2 reviewers who each abstracted information and assigned an overall quality rating. Disagreements were adjudicated by a third reviewer. DATA SYNTHESIS: Ten studies using 6 different ins!

truments met inclusion criteria. Among multi-item measures, the Newest Vital Sign (English) performed moderately well for identifying limited literacy based on 3 studies. Among the single-item questions, asking about a patient*****'s use of a surrogate reader, confidence filling out medical forms, and self-rated reading ability performed moderately well in identifying patients with inadequate or marginal literacy. Asking a patient, *****"How confident are you in filling out medical forms by yourself?*****" is associated with a summary likelihood ratio (LR) for limited literacy of 5.0 (95% confidence interval [CI], 3.8-6.4) for an answer of *****"a little confident*****" or *****"not at all confident*****"; a summary LR of 2.2 (95% CI, 1.5-3.3) for *****"somewhat confident*****"; and a summary LR of 0.44 (95% CI, 0.24-0.82) for *****"quite a bit*****" or *****"extremely confident.*****" CONCLUSION: Several single-item questions, including use of a surrogate reader and confidence with medical forms, were moderately effective for quickly id!

entifying patients with limited literacy. [References: 46]

Publication Type

Journal Article. Research Support, N.I.H., Extramural. Research Support, Non-U.S. Gov*****'t. Research Support, U.S. Gov*****'t, Non-P.H.S.. Review.

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Result <4. >

Unique Identifier

20207930

Status

MEDLINE

Authors

Shah LC. West P. Bremmeyr K. Savoy-Moore RT.

Authors Full Name

Shah, Lisa Ciccarelli. West, Patricia. Bremmeyr, Katazryna. Savoy-Moore, Ruth T.

Institution

Department of Family Medicine, St. John Hospital, Detroit, MI, USA. lshahpcfp@gmail.com

Title

Health literacy instrument in family medicine: the *****"newest vital sign*****" ease of use and correlates.

Source

Journal of the American Board of Family Medicine: JABFM. 23(2):195-203, 2010 Mar-Apr.

Abstract

BACKGROUND: Health literacy has been defined as the ability to obtain, process, and understand the basic information needed to make appropriate health decisions. Half of adults lack the health literacy skills needed for our complex health care environment. In 2005, Weiss et al introduced the Newest Vital Sign (NVS), an instrument that can be used to quickly assess health literacy. The purpose of this study was to determine the acceptability and timeliness of using the NVS to measure the level of health literacy in various suburban, urban, and rural primary care settings. A secondary purpose was to determine the influence of taking a health class on one*****'s level of health literacy. METHODS: In this cross-sectional design, adults were recruited from 4 primary care settings and student athletes were recruited during preparticipation sports physicals. The NVS was administered and health literacy rates were compared with known trends. A subset of 50 patients was timed during tes!

t administration, and refusals were logged throughout. The adults and the athletes were analyzed separately. RESULTS: One thousand fourteen patients (including athletes) agreed to participate (response rate, 97.5%). Average time needed to complete the NVS was 2.63 minutes. Of the adults tested, 48.1% demonstrated adequate health literacy. In logistic regression analysis, younger age, more formal education, health class participation, and body mass index were positive predictors of adequate health literacy among adults. An interaction term was used for gender/race, with white women used as the comparator. The gender/race odds ratio negatively affected literacy, with white men at 0.497 (95% CI, 0.328-0.753), non-white women at 0.177 (95% CI, 0.111-0.282), and non-white men at 0.210 (95% CI, 0.110-0.398). Among the participating middle- and high-school athletes, 59.7% had adequate health literacy. In logistic regression of this population, body mass index was a positive predic!

tor whereas gender/race was a negative predictor. CONCLUSION: The NVS

revealed health literacy status in less than 3 minutes, was widely accepted, and provided results comparable to more extensive literacy tests. Particularly, taking a health education class was associated with higher levels of health literacy among adults.

Publication Type

Journal Article. Research Support, Non-U.S. Gov*****'t.

Link to the Ovid Full Text or citation

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Result <5. >

Unique Identifier

20010182

Status

MEDLINE

Authors

Walker J. Pepa C. Gerard PS.

Authors Full Name

Walker, *****. Pepa, Carole. Gerard, Peggy S.

Institution

School of Nursing, Purdue University Calumet, Hammond, Indiana, USA. walkerj@calumet.purdue.edu

Title

Assessing the health literacy levels of patients using selected hospital services.

Source

Clinical Nurse Specialist. 24(1):31-7, 2010 Jan-Feb.

Abstract

PURPOSE: The aim of this study was to assess the health literacy abilities of patients in an urban and suburban hospital. BACKGROUND: Inadequate health literacy is a widespread problem that is associated with insufficient self-care knowledge and behavior, inappropriate use of emergency services, higher rates of hospitalization, and increased healthcare costs. Knowledge of patients*****' reading ability is necessary to ensure that appropriately leveled printed health education materials are available. METHODS: The health literacy of a convenience sample of 21 inpatients and 34 outpatients from an urban and suburban hospital was measured using the Test of Functional Health Literacy in Adults and the Rapid Estimate of Adult Literacy in Medicine. Variables for analysis included demographic characteristics, perceived health status, highest grade of school completed, socioeconomic status, healthcare costs, and number of inpatient and outpatient admissions over the previous year. RESU!

LTS: Based on the Rapid Estimate of Adult Literacy in Medicine, 33% of patients had health literacy levels that were eighth grade or below, whereas according to the Test of Functional Health Literacy in Adults, 23% had marginal or inadequate functional health literacy. Literacy was significantly related to socioeconomic status (P < .001) and education (P < .001), although 30% of participants had a reading level below the highest grade completed. No other significant correlations were found. IMPLICATIONS: Clinical nurse specialists should ensure that health information materials are written at appropriate levels and educate nurses and other healthcare professionals to use effective communication and teaching strategies.

Publication Type

Journal Article.

Link to the Ovid Full Text or citation

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Result <6. >

Unique Identifier

19531559

Status

MEDLINE

Authors

Barber MN. Staples M. Osborne RH. Clerehan R. Elder C. Buchbinder R.

Authors Full Name

Barber, Melissa N. Staples, Margaret. Osborne, Richard H. Clerehan, Rosemary. Elder, Catherine. Buchbinder, Rachelle.

Institution

Monash Department of Clinical Epidemiology, Cabrini Hospital, Melbourne, Australia. rachelle.buchbinder@med.monash.edu.au

Title

Up to a quarter of the Australian population may have suboptimal health literacy depending upon the measurement tool: results from a population-based survey.

Source

Health Promotion International. 24(3):252-61, 2009 Sep.

Abstract

The objective of this paper is to measure health literacy in a representative sample of the Australian general population using three health literacy tools; to consider the congruency of results; and to determine whether these assessments were associated with socio-demographic characteristics. Face-to-face interviews were conducted in a stratified random sample of the adult Victorian population identified from the 2004 Australian Government Electoral Roll. Participants were invited to participate by mail and follow-up telephone call. Health literacy was measured using the Rapid Estimate of Adult Literacy in Medicine (REALM), Test of Functional Health Literacy in Adults (TOFHLA) and Newest Vital Sign (NVS). Of 1680 people invited to participate, 89 (5.3%) were ineligible, 750 (44.6%) were not contactable by phone, 531 (32%) refused and 310 (response rate 310/1591, 19.5%) agreed to participate. Compared with the general population, participants were slightly older, better ed!

ucated and had a higher annual income. The proportion of participants with less than adequate health literacy levels varied: 26.0% (80/308) for the NVS, 10.6% (51 33/310) for the REALM and 6.8% (21/309) for the TOFHLA. A varying but significant proportion of the general population was found to have limited health literacy. The health literacy measures we used, while moderately correlated, appear to measure different but related constructs and use different cut offs to indicate poor health literacy.

Publication Type

Journal Article. Research Support, Non-U.S. Gov*****'t.

Link to the Ovid Full Text or citation

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Result <7. >

Unique Identifier

19051972

Status

MEDLINE

Authors

Reeves K.

Authors Full Name

Reeves, Kath*****.

Title

Health literacy: the newest vital sign.

Source

MEDSURG Nursing. 17(5):288, 296, 2008 Oct.

Publication Type

Journal Article.

Link to the Ovid Full Text or citation

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Result <8. >

Unique Identifier

18660507

Status

MEDLINE

Authors

Ibrahim SY. Reid F. Shaw A. Rowlands G. Gomez GB. Chesnokov M. Ussher M.

Authors Full Name

Ibrahim, S Y. Reid, F. Shaw, A. Rowlands, G. Gomez, G B. Chesnokov, M. Ussher, M.

Institution

Faculty of Health and Social Care, Institute of Primary Care and Public Health, London South Bank University, London, UK. ibrahis5@lsbu.ac.uk

Title

Validation of a health literacy screening tool (REALM) in a UK population with coronary heart disease.

Source

Journal of Public Health. 30(4):449-55, 2008 Dec.

Abstract

BACKGROUND: Health literacy (HL) has been recognized as an important public health issue in other developed countries such as the US. There is currently no HL screening tool valid for use in the UK. This study aimed to validate a US-developed HL screening tool (the Rapid Estimate for Adult Literacy in Medicine; REALM) for use in the UK against the UK*****'s general literacy screening tool (the Basic Skills Agency Initial Assessment Test, BSAIT). METHODS: A cross-sectional survey involving 300 adult patients admitted to hospital for investigation of coronary heart disease were given the REALM and BSAIT tools to complete as well as specific questions considered likely to predict HL. These questions relate to the difficulty in understanding medical information, medical forms or instructions on tablets, frequency of reading books and whether the participant*****'s job involves reading. RESULTS: The REALM was significantly correlated with the BSAIT (r = 0.70; P < 0.001), and significantl!

y related to seven of the eight questions likely to be predictive of HL. CONCLUSIONS: This study has shown that the REALM has face, criterion and construct validity for use as an HL screening tool in the UK, in research and in everyday clinical practice. Further studies are needed to assess the prevalence of low HL in a wider population and to explore the links that may exist between low HL and poor health in the UK.

Publication Type

Journal Article. Research Support, Non-U.S. Gov*****'t. Validation Studies.

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Result <9. >

Unique Identifier

18588408

Status

MEDLINE

Authors

Volandes AE. Paasche-Orlow M. Gillick MR. Cook EF. Shaykevich S. Abbo ED. Lehmann L.

Authors Full Name

Volandes, Angelo E. Paasche-Orlow, Michael. Gillick, Muriel R. Cook, E F. Shaykevich, Shimon. Abbo, Elmer D. Lehmann, Lisa.

Institution

General Medicine Unit, Massachusetts General Hospital, Boston, Massachusetts 02114, USA. avolandes@partners.org

Title

Health literacy not race predicts end-of-life care preferences.

Source

Journal of Palliative Medicine. 11(5):754-62, 2008 Jun.

Abstract

BACKGROUND: Several studies have reported that African Americans are more likely than whites to prefer aggressive treatments at the end of life. OBJECTIVE: Since the medical information presented to subjects is frequently complex, we hypothesized that apparent differences in end-of-life preferences and decision making may be due to disparities in health literacy. A video of a patient with advanced dementia may overcome communication barriers associated with low health literacy. DESIGN: Before and after oral survey. PARTICIPANTS: Subjects presenting to their primary care doctors. METHODS: Subjects were asked their preferences for end-of-life care after they heard a verbal description of advanced dementia. Subjects then viewed a 2-minute video of a patient with advanced dementia and were asked again about their preferences. For the analysis, preferences were dichotomized into comfort care and aggressive care. Health literacy was measured using the Rapid Estimate of Adult Lit!

eracy in Medicine (REALM) and subjects were divided into three literacy categories: low (0-45, sixth grade and below), marginal (46-60, seventh to eighth grade) and adequate (61-66, ninth grade and above). Unadjusted and adjusted logistic regression models were fit using stepwise algorithms to examine factors related to initial preferences before the video. RESULTS: A total of 80 African Americans and 64 whites completed the interview. In unadjusted an*****s, African Americans were more likely than whites to have preferences for aggressive care after the verbal description, odds ratio (OR) 4.8 (95% confidence interval [CI] 2.1-10.9). Subjects with low or marginal health literacy were also more likely than subjects with adequate health literacy to have preferences for aggressive care after the verbal description, OR 17.3 (95% CI 6.0-49.9) and OR 11.3 (95% CI 4.2-30.8) respectively. In adjusted an*****s, health literacy (low health literacy: OR 7.1, 95% CI 2.1-24.2; marginal !

health literacy OR 5.1, 95% CI 1.6-16.3) but not race (OR 1.1, 95% CI

0.3-3.2) was an independent predictor of preferences after the verbal description. After watching a video of advanced dementia, there were no significant differences in the distribution of preferences by race or health literacy. CONCLUSIONS: Health literacy and not race was an independent predictor of end-of-life preferences after hearing a verbal description of advanced dementia. In addition, after viewing a video of a patient with advanced dementia there were no longer any differences in the distribution of preferences according to race and health literacy. These findings suggest that clinical practice and research relating to end-of-life preferences may need to focus on a patient education model incorporating the use of decision aids such as video to ensure informed decision-making.

Publication Type

Comparative Study. Journal Article.

Link to the Ovid Full Text or citation

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Result <10. >

Unique Identifier

18467532

Status

MEDLINE

Authors

Johnson K. Weiss BD.

Authors Full Name

Johnson, Kristen. Weiss, Barry D.

Institution

Polyclinic Family Medicine Northgate, North Seattle, Washington, USA.

Title

How long does it take to assess literacy skills in clinical practice?.

Source

Journal of the American Board of Family Medicine: JABFM. 21(3):211-4, 2008 May-Jun.

Abstract

BACKGROUND: Health literacy screening is often not performed in clinical settings. One possible reason is the concern about the time involved in performing such assessments. Our objective was to measure the time required to administer the Newest Vital Sign (NVS) literacy assessment instrument to English-speaking primary care patients. METHODS: The NVS was administered to 78 consecutive English-speaking patients in an outpatient primary care clinic. The length of time to complete the NVS was timed with a stopwatch. RESULTS: The average time to complete the NVS was 2.9 minutes (95% confidence limit, 2.6-3.1 min). CONCLUSION: The NVS is a health literacy screening tool of sufficient brevity to be considered for use in primary care practices.

Publication Type

Journal Article.

Link to the Ovid Full Text or citation

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Result <11. >

Unique Identifier

18335281

Status

MEDLINE

Authors

Chew LD. Griffin JM. Partin MR. Noorbaloochi S. Grill JP. Snyder A. Bradley KA. Nugent SM. Baines AD. Vanryn M.

Authors Full Name

Chew, Lisa D. Griffin, Joan M. Partin, Melissa R. Noorbaloochi, Siamak. Grill, Joseph P. Snyder, Annamay. Bradley, Katharine A. Nugent, ***** M. Baines, Alisha D. Vanryn, *****.

Institution

Department of Medicine, Division of General Internal Medicine, University of Washington, Harborview Medical Center, Seattle, WA, USA. lchew@u.washington.edu

Title

Validation of screening questions for limited health literacy in a large VA outpatient population.

Comments

Comment in: J Gen Intern Med. 2008 Sep;23(9):1545; PMID: 18636297]

Source

Journal of General Internal Medicine. 23(5):561-6, 2008 May.

Other ID

Source: NLM. PMC2324160

Abstract

OBJECTIVES: Previous studies have shown that a single question may identify individuals with inadequate health literacy. We evaluated and compared the performance of 3 health literacy screening questions for detecting patients with inadequate or marginal health literacy in a large VA population. METHODS: We conducted in-person interviews among a random sample of patients from 4 VA medical centers that included 3 health literacy screening questions and 2 validated health literacy measures. Patients were classified as having inadequate, marginal, or adequate health literacy based on the Short Test of Functional Health Literacy in Adults (S-TOFHLA) and the Rapid Estimate of Adult Literacy in Medicine (REALM). We evaluated the ability of each of 3 questions to detect: 1) inadequate and the combination of *****"inadequate or marginal*****" health literacy based on the S-TOFHLA and 2) inadequate and the combination of *****"inadequate or marginal*****" health literacy based on the REALM. MEASUREMEN!

TS AND MAIN RESULTS: Of 4,384 patients, 1,796 (41%) completed interviews. The prevalences of inadequate health literacy were 6.8% and 4.2%, based on the S-TOHFLA and REALM, respectively. Comparable prevalences for marginal health literacy were 7.4% and 17%, respectively. For detecting inadequate health literacy, *****"How confident are you filling out medical forms by yourself?*****" had the largest area under the Receiver Operating Characteristic Curve (AUROC) of 0.74 (95% CI: 0.69-0.79) and 0.84 (95% CI: 0.79-0.89) based on the S-TOFHLA and REALM, respectively. AUROCs were lower for detecting *****"inadequate or marginal*****" health literacy than for detecting inadequate health literacy for each of the 3 questions. CONCLUSION: A single question may be useful for detecting patients with inadequate health literacy in a VA population.

Publication Type

Journal Article. Multicenter Study. Research Support, U.S. Gov*****'t, Non-P.H.S.. Validation Studies.

Link to the Ovid Full Text or citation

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Result <12. >

Unique Identifier

17557682

Status

MEDLINE

Authors

Gong DA. Lee JY. Rozier RG. Pahel BT. Richman JA. Vann WF Jr.

Authors Full Name

Gong, Debra A. Lee, *****ica Y. Rozier, R Gary. Pahel, Bhavna T. Richman, Julia A. Vann, William F Jr.

Institution

Department of Pediatric Dentistry CB 7450, University of North Carolina, Chapel Hill, NC 27599-7450, USA.

Title

Development and testing of the Test of Functional Health Literacy in Dentistry (TOFHLiD).

Source

Journal of Public Health Dentistry. 67(2):105-12, 2007.

Abstract

OBJECTIVE: This study aims to evaluate the reliability and validity of the Test of Functional Health Literacy in Dentistry (TOFHLiD), a new instrument to measure functional oral health literacy. METHODS: TOFHLiD uses text passages and prompts related to fluoride use and access to care to assess reading comprehension and numerical ability. Parents of pediatric dental patients (n = 102) were administered TOFHLiD, a medical literacy comprehension test (TOFHLA), and two word recognition tests [Rapid Estimate of Adult Literacy in Dentistry (REALD), Rapid Estimate of Adult Literacy in Medicine (REALM)]. This design provided assessments of dental and medical health literacy by all subjects, both measured with two different methods (reading/numeracy ability and word recognition). Construct validity of TOFHLiD was assessed by entering the correlation coefficients for all pairwise comparisons of literacy instruments into a multitrait-multimethod matrix. Internal reliability of TOFHL!

iD was assessed with Cronbach*****'s alpha. Criterion-related predictive validity was tested by associations between the TOFHLiD scores and the three measures of oral health in multivariate regression an*****s. RESULTS: The correlation coefficient for TOFHLiD and REALD-99 scores (monotrait-heteromethod) was high (r = 0.82, P < 0.05). Coefficients between TOFHLiD and TOFHLA (heterotrait-monomethod: r = 0.52) and REALM (heterotrait-heteromethod: r = 0.53) were smaller than coefficients for convergent validity Cronbach*****'s alpha for TOFHLiD was 0.63. TOFHLiD was positively correlated with OHIP-14 (P < 0.05), but not with parent or child oral health. TOFHLA was not related to dental outcomes. CONCLUSIONS: TOFHLiD demonstrates good convergent validity but only moderate ability to discriminate between dental and medical health literacy. Its predictive validity is only partially established, and internal consistency just meets the threshold for acceptability. Results provide solid suppor!

t for more research, but not widespread use in clinical or public heal

th practice.

Publication Type

Evaluation Studies. Journal Article. Research Support, N.I.H., Extramural. Research Support, Non-U.S. Gov*****'t. Validation Studies.

Link to the Ovid Full Text or citation

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Result <13. >

Unique Identifier

17557681

Status

MEDLINE

Authors

Richman JA. Lee JY. Rozier RG. Gong DA. Pahel BT. Vann WF Jr.

Authors Full Name

Richman, Julia A. Lee, *****ica Y. Rozier, R Gary. Gong, Debra A. Pahel, Bhavna T. Vann, William F Jr.

Institution

Department of Pediatric Dentistry CB 7450, University of North Carolina, Chapel Hill, NC 27599-7450, USA.

Title

Evaluation of a word recognition instrument to test health literacy in dentistry: the REALD-99.

Source

Journal of Public Health Dentistry. 67(2):99-104, 2007.

Abstract

OBJECTIVE: This study aims to evaluate a dental health literacy word recognition instrument. METHODS: Based on a reading recognition test used in medicine, the Rapid Estimate of Adult Literacy in Medicine (REALM), we developed the Rapid Estimate of Adult Literacy in Dentistry (REALD-99). Parents of pediatric dental patients were recruited from local dental clinics and asked to read aloud words in both REALM and REALD-99. REALD-99 scores had a possible range of 0 (low literacy) to 99 (high literacy); REALM scores ranged from 0 to 66. Outcome measures included parents*****' perceived oral health for themselves and of their children, and oral health-related quality of life of the parent as measured by the short-form Oral Health Impact Profile (OHIP-14). To determine the validity, we tested bivariate correlations between REALM and REALD-99, REALM and perceived dental outcomes, and REALD-99 and perceived dental outcomes. We used ordinary least squares regression and logit models to !

further examine the relationship between REALD-99 and dental outcomes. We determined internal reliability using Cronbach*****'s alpha. RESULTS: One hundred two parents of children were interviewed. The average REALD-99 and REALM-66 scores were high (84 and 62, respectively). REALD-99 was positively correlated with REALM (PCC = 0.80). REALM was not related to dental outcomes. REALD-99 was associated with parents*****' OHIP-14 score in multivariate analysis. REALD-99 had good reliability (Cronbach*****'s alpha = 0.86). CONCLUSIONS: REALD-99 has promise for measuring dental health literacy because it demonstrated good reliability and is quick and easy to administer. Additional studies are needed to examine the validity of REALD-99 using objective clinical oral health measures and more proximal outcomes such as behavior and compliance to specific health instructions.

Publication Type

Evaluation Studies. Journal Article. Research Support, N.I.H., Extramural. Research Support, Non-U.S. Gov*****'t. Validation Studies.

Link to the Ovid Full Text or citation

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Result <14. >

Unique Identifier

17557680

Status

MEDLINE

Authors

Lee JY. Rozier RG. Lee SY. Bender D. Ruiz RE.

Authors Full Name

Lee, *****ica Y. Rozier, R Gary. Lee, Shoou-Yih Daniel. Bender, Deborah. Ruiz, Rafael E.

Institution

Department of Pediatric Dentistry, CB 7450 Brauer Hall, Carolina Campus, Chapel Hill, NC 27599-7450, USA. leej@dentistry.unc.edu

Title

Development of a word recognition instrument to test health literacy in dentistry: the REALD-30--a brief communication.

Source

Journal of Public Health Dentistry. 67(2):94-8, 2007.

Abstract

OBJECTIVE: This study aims to develop and pilot test a dental word recognition instrument. METHODS: The development of our instrument was based on the Rapid Estimate of Adult Literacy in Medicine (REALM), an efficient word recognition instrument used to assess health literacy in the medical arena. Our instrument, Rapid Estimate of Adult Literacy in Dentistry (REALD-30), consisted of 30 common dental words with various degrees of difficulty. It was administered to 202 English-speaking adults recruited from outpatient medical clinics. We examined the instrument*****'s internal reliability using Cronbach*****'s alpha and its validity by correlating the REALD-30 score to two dental outcomes (perceived dental health status and oral health-related quality of life) and medical health literacy. RESULTS: REALD-30 scores were significantly correlated with REALM scores. REALD-30 was significantly related to perceived dental health status in the bivariate analysis. It also was significantly rel!

ated to oral health-related quality of life in a multivariate analysis. In contrast, medical health literacy was not related to either of the dental outcome measures. CONCLUSIONS: The new REALD-30 instrument displays good reliability but only partial validity. Results suggest that dental health literacy may be distinct from medical health literacy and may have an independent effect on dental health outcomes.

Publication Type

Journal Article. Research Support, N.I.H., Extramural. Research Support, U.S. Gov*****'t, P.H.S..

Link to the Ovid Full Text or citation

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Result <15. >

Unique Identifier

17178765

Status

MEDLINE

Authors

Shea JA. Guerra CE. Ravenell KL. McDonald VJ. Henry CA. Asch DA.

Authors Full Name

Shea, Judy A. Guerra, Carmen E. Ravenell, Karima L. McDonald, Vanessa J. Henry, Camille A N. Asch, ***** A.

Institution

Center for Health Equity Research and Promotion, Philadelphia Vetrans Affairs Medical Center, Philadelphia, PA, USA. sheaja@mail.med.upenn.edu

Title

Health literacy weakly but consistently predicts primary care patient dissatisfaction.

Source

International Journal for Quality in Health Care. 19(1):45-9, 2007 Feb.

Abstract

OBJECTIVES: To study relationships between health literacy and multiple satisfaction domains. Health literacy is related to some domains of patient satisfaction such as communication and understanding, but little is known about relationships of health literacy with other satisfaction domains. Moreover, the importance of health literacy in predicting satisfaction compared with other patient sociodemographics is underexplored. DESIGN: Cross-sectional survey. SETTING: Primary care waiting areas with a Veterans Administration Medical Center and a university health system. PARTICIPANTS: One thousand five hundred and twenty-eight primary care patients. MAIN OUTCOME MEASURES: A brief demographics questionnaire, the Rapid Estimate of Adult Literacy in Medicine, the Veterans Affairs ambulatory care patient satisfaction survey, and an adaptation of the Charlson Comorbidity Index. RESULTS: In unadjusted regression an*****s, lower health literacy level was a significant predictor of w!

orse satisfaction in 7 of 10 domains (P < 0.01). When adjusting for patient sociodemographics, predicted relationships remained significant in six of the seven domains (P < 0.05), with each unit change in the 4-stage literacy classification associated with a 3-6 point decrease in dissatisfaction scores (0-100 scale). Health literacy did not predict overall dissatisfaction (P = 0.55). CONCLUSIONS: These results suggest that health literacy, as assessed through a pronunciation exercise that is closely related to more comprehensive measures of literacy, has a consistent, albeit weak relationship with patient satisfaction. Future work is needed to clarify if patients with lower literacy are really receiving different care than those with higher literacy and to pinpoint the sources of their more negative responses.

Publication Type

Journal Article. Research Support, U.S. Gov*****'t, Non-P.H.S..

Link to the Ovid Full Text or citation

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Result <16. >

Unique Identifier

16881950

Status

MEDLINE

Authors

Wallace LS. Rogers ES. Roskos SE. Holiday DB. Weiss BD.

Authors Full Name

Wallace, Lorraine S. Rogers, Edwin S. Roskos, Steven E. Holiday, ***** B. Weiss, Barry D.

Institution

Department of Family Medicine, University of Tennessee Graduate School of Medicine, Knoxville, TN 37920, USA. lwallace@mc.utmck.edu

Title

Brief report: screening items to identify patients with limited health literacy skills.

Source

Journal of General Internal Medicine. 21(8):874-7, 2006 Aug.

Other ID

Source: NLM. PMC1831582

Abstract

BACKGROUND: Patients with limited literacy skills are routinely encountered in clinical practice, but they are not always identified by clinicians. OBJECTIVE: To evaluate 3 candidate questions to determine their accuracy in identifying patients with limited or marginal health literacy skills. METHODS: We studied 305 English-speaking adults attending a university-based primary care clinic. Demographic items, health literacy screening questions, and the Rapid Estimate of Adult Literacy in Medicine (REALM) were administered to patients. To determine the accuracy of the candidate questions for identifying limited or marginal health literacy skills, we plotted area under the receiver operating characteristic (AUROC) curves for each item, using REALM scores as a reference standard. RESULTS: The mean age of subjects was 49.5; 67.5% were female, 85.2% Caucasian, and 81.3% insured by TennCare and/or Medicare. Fifty-four (17.7%) had limited and 52 (17.0%) had marginal health literac!

y skills. One screening question, *****"How confident are you filling out medical forms by yourself?*****" was accurate in detecting limited (AUROC of 0.82; 95% confidence interval [CI]=0.77 to 0.86) and limited/marginal (AUROC of 0.79; 95% CI=0.74 to 0.83) health literacy skills. This question had significantly greater AUROC than either of the other questions (P<.01) and also a greater AUROC than questions based on demographic characteristics. CONCLUSIONS: One screening question may be sufficient for detecting limited and marginal health literacy skills in clinic populations.

Publication Type

Comparative Study. Journal Article.

Link to the Ovid Full Text or citation

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Result <17. >

Unique Identifier

19531559

Status

MEDLINE

Authors

Barber MN. Staples M. Osborne RH. Clerehan R. Elder C. Buchbinder R.

Authors Full Name

Barber, Melissa N. Staples, Margaret. Osborne, Richard H. Clerehan, Rosemary. Elder, Catherine. Buchbinder, Rachelle.

Institution

Monash Department of Clinical Epidemiology, Cabrini Hospital, Melbourne, Australia. rachelle.buchbinder@med.monash.edu.au

Title

Up to a quarter of the Australian population may have suboptimal health literacy depending upon the measurement tool: results from a population-based survey.[Erratum appears in Health Promot Int. 2009 Dec;24(4):445]

Source

Health Promotion International. 24(3):252-61, 2009 Sep.

Abstract

The objective of this paper is to measure health literacy in a representative sample of the Australian general population using three health literacy tools; to consider the congruency of results; and to determine whether these assessments were associated with socio-demographic characteristics. Face-to-face interviews were conducted in a stratified random sample of the adult Victorian population identified from the 2004 Australian Government Electoral Roll. Participants were invited to participate by mail and follow-up telephone call. Health literacy was measured using the Rapid Estimate of Adult Literacy in Medicine (REALM), Test of Functional Health Literacy in Adults (TOFHLA) and Newest Vital Sign (NVS). Of 1680 people invited to participate, 89 (5.3%) were ineligible, 750 (44.6%) were not contactable by phone, 531 (32%) refused and 310 (response rate 310/1591, 19.5%) agreed to participate. Compared with the general population, participants were slightly older, better ed!

ucated and had a higher annual income. The proportion of participants with less than adequate health literacy levels varied: 26.0% (80/308) for the NVS, 10.6% (51 33/310) for the REALM and 6.8% (21/309) for the TOFHLA. A varying but significant proportion of the general population was found to have limited health literacy. The health literacy measures we used, while moderately correlated, appear to measure different but related constructs and use different cut offs to indicate poor health literacy.

Publication Type

Journal Article. Research Support, Non-U.S. Gov*****'t.

Link to the Ovid Full Text or citation

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Result <18. >

Unique Identifier

16338915

Status

MEDLINE

Authors

Weiss BD. Mays MZ. Martz W. Castro KM. DeWalt DA. Pignone MP. Mockbee J. Hale FA.

Authors Full Name

Weiss, Barry D. Mays, Mary Z. Martz, William. Castro, Kelley Merriam. DeWalt, Darren A. Pignone, Michael P. Mockbee, Joy. Hale, Frank A.

Institution

University of Arizona College of Medicine, Department of Family and Community Medicine, Tucson 85719, USA. bdweiss@u.arizona.edu

Title

Quick assessment of literacy in primary care: the newest vital sign.[Erratum appears in Ann Fam Med. 2006 Jan-Feb;4(1):83]

Source

Annals of Family Medicine. 3(6):514-22, 2005 Nov-Dec.

Other ID

Source: NLM. PMC1466931

Abstract

PURPOSE: Current health literacy screening instruments for health care settings are either too long for routine use or available only in English. Our objective was to develop a quick and accurate screening test for limited literacy available in English and Spanish. METHODS: We administered candidate items for the new instrument and also the Test of Functional Health Literacy in Adults (TOFHLA) to English-speaking and Spanish-speaking primary care patients. We measured internal consistency with Cronbach*****'s alpha and assessed criterion validity by measuring correlations with TOFHLA scores. Using TOFLHA scores <75 to define limited literacy, we plotted receiver-operating characteristics (ROC) curves and calculated likelihood ratios for cutoff scores on the new instrument. RESULTS: The final instrument, the Newest Vital Sign (NVS), is a nutrition label that is accompanied by 6 questions and requires 3 minutes for administration. It is reliable (Cronbach alpha >0.76 in English a!

nd 0.69 in Spanish) and correlates with the TOFHLA. Area under the ROC curve is 0.88 for English and 0.72 for Spanish versions. Patients with more than 4 correct responses are unlikely to have low literacy, whereas fewer than 4 correct answers indicate the possibility of limited literacy. CONCLUSION: NVS is suitable for use as a quick screening test for limited literacy in primary health care settings.

Publication Type

Journal Article. Research Support, Non-U.S. Gov*****'t.

Link to the Ovid Full Text or citation

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Result <19. >

Unique Identifier

15343422

Status

MEDLINE

Authors

Davis TC. Wolf MS.

Authors Full Name

Davis, Terry C. Wolf, Michael S.

Title

Health literacy: implications for family medicine. [Review] [17 refs]

Source

Family Medicine. 36(8):595-8, 2004 Sep.

Abstract

As many as 90 million Americans have difficulty understanding and acting on health information. This health literacy epidemic is increasingly recognized as a problem that influences health care quality and cost. Yet many physicians do not recognize the problem or lack the skills and confidence to approach the subject with patients. In this issue of Family Medicine, several articles address health literacy in family medicine. Wallace and Lennon examined the readability of American Academy of Family Physicians patient education materials available via the Internet. They found that three of four handouts were written above the average reading level of American adults. Rosenthal and colleagues surveyed residents and found they lacked the confidence to screen and counsel adults about literacy. They used a Reach Out and Read program with accompanying resident education sessions to provide a practical and effective means for incorporating literacy assessment and counseling into p!

rimary care. Chew and colleagues presented an alternative to existing health literacy screening tests by asking three questions to detect inadequate health literacy. Likewise, Shea and colleagues reviewed the prospect of shortening the Rapid Estimate of Adult Literacy in Medicine (REALM), a commonly used health literacy screening tool. Both the Chew and Shea articles highlight the need for improved methods for recognizing literacy problems in the clinical setting. Further research is required to identify effective interventions that will strengthen the skills and coping strategies of both patients and providers and also prevent and limit poor reading and numeracy ability in the next generation. [References: 17]

Publication Type

Editorial. Review.

Link to the Ovid Full Text or citation

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Result <20. >

Unique Identifier

15343419

Status

MEDLINE

Authors

Shea JA. Beers BB. McDonald VJ. Quistberg DA. Ravenell KL. Asch DA.

Authors Full Name

Shea, Judy A. Beers, Benjamin B. McDonald, Vanessa J. Quistberg, D Alex. Ravenell, Karima L. Asch, ***** A.

Institution

Center for Health Equity Research and Promotion (CHERP), Philadelphia Veterans Affairs Medical Center, PA 19104-6021, USA. sheaja@mail.med.upenn.edu

Title

Assessing health literacy in African American and Caucasian adults: disparities in rapid estimate of adult literacy in medicine (REALM) scores.

Comments

Comment in: Fam Med. 2005 Apr;37(4):234; PMID: 15812684]

Source

Family Medicine. 36(8):575-81, 2004 Sep.

Abstract

BACKGROUND AND OBJECTIVES: The influence of literacy on health and health care is an important area of investigation. Studies with a literacy focus are most valuable when literacy is assessed with psychometrically sound instruments. METHODS: This study used a prospective cohort sample of 1,610 primary care patients. Patients provided sociodemographics and took the Rapid Estimate of Adult Literacy in Medicine (REALM), a 66-item word pronunciation literacy test. RESULTS: The sample was 65% African American; 66% were men; 51% had a high school education or less. REALM scores were significantly related to education, age, and race but not gender. When stratified by education, differences between African Americans and Caucasians remained significant. Using 19 different strategies to shorten the 66-item instrument, reliability coefficients above.80 were maintained. CONCLUSIONS: The REALM is a robust assessment of health literacy. However, the discordance in scores between African!

Americans and Caucasians with similar educational attainment needs to be further addressed. A much shorter instrument would still have internally consistent scores and potentially be more useful in clinical settings.

Publication Type

Comparative Study. Journal Article. Research Support, U.S. Gov*****'t, Non-P.H.S..

Link to the Ovid Full Text or citation

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Result <21. >

Unique Identifier

14528569

Status

MEDLINE

Authors

Baker DW. Williams MV. Parker RM. Gazmararian JA. Nurss J.

Authors Full Name

Baker, D W. Williams, M V. Parker, R M. Gazmararian, J A. Nurss, J.

Institution

Department of Medicine, Department of Epidemiology and Biostatistics, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH 44109-1998, USA. dwb@po.cwru.edu

Title

Development of a brief test to measure functional health literacy.

Source

Patient Education & Counseling. 38(1):33-42, 1999 Sep.

Abstract

We describe the development of an abbreviated version of the Test of Functional Health Literacy in Adults (TOFHLA) to measure patients*****' ability to read and understand health-related materials. The TOFHLA was reduced from 17 Numeracy items and 3 prose passages to 4 Numeracy items and 2 prose passages (S-TOFHLA). The maximum time for administration was reduced from 22 minutes to 12. In a group of 211 patients given the S-TOFHLA, Cronbach*****'s alpha was 0.68 for the 4 Numeracy items and 0.97 for the 36 items in the 2 prose passages. The correlation (Spearman) between the S-TOFHLA and the Rapid Estimate of Adult Literacy in Medicine (REALM) was 0.80, although there were important disagreements between the two tests. The S-TOFHLA is a practical measure of functional health literacy with good reliability and validity that can be used by health educators to identify individuals who require special assistance to achieve learning goals.

Publication Type

Comparative Study. Journal Article. Validation Studies.

Link to the Ovid Full Text or citation

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Result <22. >

Unique Identifier

9768381

Status

MEDLINE

Authors

Davis TC. Michielutte R. Askov EN. Williams MV. Weiss BD.

Authors Full Name

Davis, T C. Michielutte, R. Askov, E N. Williams, M V. Weiss, B D.

Institution

Department of Internal Medicine and Pediatrics, Louisiana State University Medical Center, School of Medicine, LA 71130-3932, USA. tdavis@mail-sh.lsumc.edu

Title

Practical assessment of adult literacy in health care. [Review] [58 refs]

Source

Health Education & Behavior. 25(5):613-24, 1998 Oct.

Abstract

Low literacy is a pervasive and underrecognized problem in health care Approximately 21% of American adults are functionally illiterate, and another 27% have marginal literacy skills. Such patients may have difficulty reading and understanding discharge instructions, medication labels, patient education materials, consent forms, or health surveys. Properly assessing the literacy level of individual patients or groups may avoid problems in clinical care and research. This article reviews the use of literacy assessments, discusses their application in a variety of health care settings, and cites issues providers need to consider before testing. The authors describe informal and formal methods of screening for reading and comprehension in English and Spanish including the Rapid Estimate of Adult Literacy in Medicine, the Wide Range Achievement Test-3, the Cloze procedure, the Test of Functional Health Literacy in Adults, and others. Practical implications and recommendations !

for specific use are made. [References: 58]

Publication Type

Journal Article. Review.

Link to the Ovid Full Text or citation

http://webp*****.ouhsc.edu/login?url=http://ovidsp.ovid.com/ovidweb.cgi?T=JS&NEWS=N&PAGE=fulltext&D=med4&AN=9768381 *****

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