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

Authors

    • Department of Medicine, Division of General Internal MedicineUniversity of Washington, Harborview Medical Center
  • Joan M. Griffin
    • Center for Chronic Disease Outcomes Research (CCDOR)Minneapolis VA Medical Center
    • Department of Medicine, Division of General Internal MedicineUniversity of Minnesota
  • Melissa R. Partin
    • Center for Chronic Disease Outcomes Research (CCDOR)Minneapolis VA Medical Center
    • Department of Medicine, Division of General Internal MedicineUniversity of Minnesota
  • Siamak Noorbaloochi
    • Center for Chronic Disease Outcomes Research (CCDOR)Minneapolis VA Medical Center
    • Department of Medicine, Division of General Internal MedicineUniversity of Minnesota
  • Joseph P. Grill
    • Center for Chronic Disease Outcomes Research (CCDOR)Minneapolis VA Medical Center
  • Annamay Snyder
    • Center for Chronic Disease Outcomes Research (CCDOR)Minneapolis VA Medical Center
  • Katharine A. Bradley
    • Health Services Research & Development, Primary and Specialty Medical Care, and Center of Excellence in Substance Abuse Treatment and EducationVA Puget Sound Health Care System
    • Department of Medicine and Health ServicesUniversity of Washington
  • Sean M. Nugent
    • Center for Chronic Disease Outcomes Research (CCDOR)Minneapolis VA Medical Center
  • Alisha D. Baines
    • Center for Chronic Disease Outcomes Research (CCDOR)Minneapolis VA Medical Center
  • Michelle VanRyn
    • Department of Family Medicine and Community HealthUniversity of Minnesota
Original Article

DOI: 10.1007/s11606-008-0520-5

Cite this article as:
Chew, L.D., Griffin, J.M., Partin, M.R. et al. J GEN INTERN MED (2008) 23: 561. doi:10.1007/s11606-008-0520-5

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 literacyscreeningvalidationquestions

Copyright information

© Society of General Internal Medicine 2008