Original Article

Journal of General Internal Medicine

, Volume 23, Issue 5, pp 561-566

Validation of Screening Questions for Limited Health Literacy in a Large VA Outpatient Population

  • Lisa D. ChewAffiliated withDepartment of Medicine, Division of General Internal Medicine, University of Washington, Harborview Medical Center Email author 
  • , Joan M. GriffinAffiliated withCenter for Chronic Disease Outcomes Research (CCDOR), Minneapolis VA Medical CenterDepartment of Medicine, Division of General Internal Medicine, University of Minnesota
  • , Melissa R. PartinAffiliated withCenter for Chronic Disease Outcomes Research (CCDOR), Minneapolis VA Medical CenterDepartment of Medicine, Division of General Internal Medicine, University of Minnesota
  • , Siamak NoorbaloochiAffiliated withCenter for Chronic Disease Outcomes Research (CCDOR), Minneapolis VA Medical CenterDepartment of Medicine, Division of General Internal Medicine, University of Minnesota
  • , Joseph P. GrillAffiliated withCenter for Chronic Disease Outcomes Research (CCDOR), Minneapolis VA Medical Center
  • , Annamay SnyderAffiliated withCenter for Chronic Disease Outcomes Research (CCDOR), Minneapolis VA Medical Center
  • , Katharine A. BradleyAffiliated withHealth Services Research & Development, Primary and Specialty Medical Care, and Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Health Care SystemDepartment of Medicine and Health Services, University of Washington
  • , Sean M. NugentAffiliated withCenter for Chronic Disease Outcomes Research (CCDOR), Minneapolis VA Medical Center
  • , Alisha D. BainesAffiliated withCenter for Chronic Disease Outcomes Research (CCDOR), Minneapolis VA Medical Center
    • , Michelle VanRynAffiliated withDepartment of Family Medicine and Community Health, University of Minnesota

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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.

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.

Conclusion

A single question may be useful for detecting patients with inadequate health literacy in a VA population.

KEY WORDS

health literacy screening validation questions