Original Research

Journal of General Internal Medicine

, Volume 26, Issue 3, pp 265-271

Open Access This content is freely available online to anyone, anywhere at any time.

Validation of Self-Reported Health Literacy Questions Among Diverse English and Spanish-Speaking Populations

  • Urmimala SarkarAffiliated withSan Francisco Center for Vulnerable Populations, San Francisco General Hospital, University of CaliforniaDepartment of Medicine, Division of General Internal Medicine, University of California Email author 
  • , Dean SchillingerAffiliated withSan Francisco Center for Vulnerable Populations, San Francisco General Hospital, University of CaliforniaDepartment of Medicine, Division of General Internal Medicine, University of California
  • , Andrea LópezAffiliated withSan Francisco Center for Vulnerable Populations, San Francisco General Hospital, University of CaliforniaDepartment of Medicine, Division of General Internal Medicine, University of California
  • , Rebecca SudoreAffiliated withSan Francisco VA Medical CenterDivision of Geriatrics, San Francisco Veterans Affairs Medical Center, University of California

Abstract

Background

Limited health literacy (HL) contributes to poor health outcomes and disparities, and direct measurement is often time-intensive. Self-reported HL questions have not been validated among Spanish-speaking and diverse English-speaking populations.

Objective

To evaluate three self-reported questions:1 “How confident are you filling out medical forms?”;2 “How often do you have problems learning about your medical condition because of difficulty understanding written information?”; and3 “How often do you have someone help you read hospital materials?” Answers were based on a 5-point Likert scale.

Design

This was a validation study nested within a trial of diabetes self-management support in the San Francisco Department of Public Health.

Participants

English and Spanish-speaking adults with type 2 diabetes receiving primary care.

Methods

Using the Test of Functional Health Literacy in Adults (s-TOFHLA) in English and Spanish as the reference, we classified HL as inadequate, marginal, or adequate. We calculated the C-index and test characteristics of the three questions and summative scale compared to the s-TOFHLA and assessed variations in performance by language, race/ethnicity, age, and education.

Key Results

Of 296 participants, 48% were Spanish-speaking; 9% were White, non-Hispanic; 47% had inadequate HL and 12% had marginal HL. Overall, 57% reported being confident with forms “somewhat” or less. The “confident with forms” question performed best for detecting inadequate (C-index = 0.82, (0.77-0.87)) and inadequate plus marginal HL (C index = 0.81, (0.76-0.86); p < 0.01 for differences from other questions), and performed comparably to the summative scale. The “confident with forms” question and scale also performed best across language, race/ethnicity, educational attainment, and age.

Conclusions

A single self-reported HL question about confidence with forms and a summative scale of three questions discriminated between Spanish and English speakers with adequate HL and those with inadequate and/or inadequate plus marginal HL. The “confident with forms” question or the summative scale may be useful for estimating HL in clinical research involving Spanish-speaking and English-speaking, chronically-ill, diverse populations.

KEY WORDS

health literacy limited English proficiency Hispanic American validation studies