Validation of Screening Questions for Limited Health Literacy in a Large VA Outpatient Population
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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.
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.
Measurements 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.
A single question may be useful for detecting patients with inadequate health literacy in a VA population.
- Validation of Screening Questions for Limited Health Literacy in a Large VA Outpatient Population
Journal of General Internal Medicine
Volume 23, Issue 5 , pp 561-566
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- Author Affiliations
- 1. Department of Medicine, Division of General Internal Medicine, University of Washington, Harborview Medical Center, Seattle, WA, USA
- 2. Center for Chronic Disease Outcomes Research (CCDOR), Minneapolis VA Medical Center, Minneapolis, MN, USA
- 3. Department of Medicine, Division of General Internal Medicine, University of Minnesota, Minneapolis, MN, USA
- 4. Health Services Research & Development, Primary and Specialty Medical Care, and Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Health Care System, Seattle, WA, USA
- 5. Department of Medicine and Health Services, University of Washington, Seattle, WA, USA
- 6. Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN, USA