Validation of three health literacy screening questions compared with S-TOFHLA in a low-income diverse English- and Spanish-Speaking population.

Background Clinicians need a tool to gauge patients' ability to understand health conditions and treatment options. The Short-form Test of Functional Health Literacy in Adults (S-TOFHLA) is the gold standard for this, but its length is prohibitive for use in clinical settings. This study seeks to va...

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Published in:Journal of Public Health Vol. 46; no. 3; pp. 383 - 392
Main Authors: Kincaid, Hope, Coyne, Cathy A, Hamadani, Roya, Friel, Timothy
Format: research tables/charts Journal Article
Published: Oxford University Press / USA Sep2024
Online Access:View this record in EBSCOhost
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      dt: Sep2024
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      pub: Oxford University Press / USA
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        10.1093/pubmed/fdae035
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        atl: Validation of three health literacy screening questions compared with S-TOFHLA in a low-income diverse English- and Spanish-Speaking population.
      aug:
        au:
          Kincaid, Hope
          Coyne, Cathy A
          Hamadani, Roya
          Friel, Timothy
        affil: Network Office of Research and Innovation, Lehigh Valley Health Network , Allentown, PA 18103 , USA
      sug:
        subj:
          Health Literacy
          Health Screening
          Socioeconomic Factors
          Instrument Validation
          Cultural Diversity
          Human
          Cross Sectional Studies
          English Language
          Spanish Language
          Pennsylvania
          Hispanic Americans
          ROC Curve
          Coefficient alpha
          Descriptive Statistics
          Sensitivity and Specificity
          Data Analysis Software
          Funding Source
      ab: Background Clinicians need a tool to gauge patients' ability to understand health conditions and treatment options. The Short-form Test of Functional Health Literacy in Adults (S-TOFHLA) is the gold standard for this, but its length is prohibitive for use in clinical settings. This study seeks to validate a novel three-item question set for predicting health literacy. Methods This cross-sectional study utilized an in-person questionnaire alongside the S-TOFHLA. The sample included 2027 English- and Spanish-speaking adults (≥18 years) recruited from primary care practices serving a low-income eastern Pennsylvania community. Most patients (57.7%) identified as Hispanic. Diagnostic accuracy of each question and aggregated scores were assessed against the validated survey by calculating the area under the receiver operating characteristic (AUROC) curve. Results Questions in the 'Problems Learning' and 'Help Reading' domains (AUROC 0.66 for each) performed better than the 'Confident Forms' question (AUROC 0.64). Summing all three scores resulted in an even higher AUROC curve (0.71). Cronbach's alpha of the combined items was 0.696. Conclusions Study results suggest that any of the three questions are viable options for screening health literacy levels of diverse patients in primary care clinical settings. However, they perform better as a summed score than when used individually.
      pubtype: Academic Journal
      doctype:
        research
        tables/charts
        Journal Article
      ougenre: Article
    language: English
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