期刊
JOURNAL OF GENERAL INTERNAL MEDICINE
卷 26, 期 3, 页码 265-271出版社
SPRINGER
DOI: 10.1007/s11606-010-1552-1
关键词
health literacy; limited English proficiency; Hispanic American; validation studies
资金
- San Francisco Veterans' Affairs Medical Center
- National Center for Research Resources [KL2RR024130]
- Agency for Healthcare Research and Quality [R18 HS01726101, K08 HS017594]
- NIH [ULRR024131]
- Veterans Affairs
- Pfizer
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. 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. This was a validation study nested within a trial of diabetes self-management support in the San Francisco Department of Public Health. English and Spanish-speaking adults with type 2 diabetes receiving primary care. 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. 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. 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.
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