None of the authors have any conflicts of interest to report.
BRIEF REPORT: Screening Items to Identify Patients with Limited Health Literacy Skills
Article first published online: 12 JUL 2006
Journal of General Internal Medicine
Volume 21, Issue 8, pages 874–877, August 2006
How to Cite
Wallace, L. S., Rogers, E. S., Roskos, S. E., Holiday, D. B. and Weiss, B. D. (2006), BRIEF REPORT: Screening Items to Identify Patients with Limited Health Literacy Skills. Journal of General Internal Medicine, 21: 874–877. doi: 10.1111/j.1525-1497.2006.00532.x
- Issue published online: 12 JUL 2006
- Article first published online: 12 JUL 2006
- health literacy;
BACKGROUND: Patients with limited literacy skills are routinely encountered in clinical practice, but they are not always identified by clinicians.
OBJECTIVE: To evaluate 3 candidate questions to determine their accuracy in identifying patients with limited or marginal health literacy skills.
METHODS: We studied 305 English-speaking adults attending a university-based primary care clinic. Demographic items, health literacy screening questions, and the Rapid Estimate of Adult Literacy in Medicine (REALM) were administered to patients. To determine the accuracy of the candidate questions for identifying limited or marginal health literacy skills, we plotted area under the receiver operating characteristic (AUROC) curves for each item, using REALM scores as a reference standard.
RESULTS: The mean age of subjects was 49.5; 67.5% were female, 85.2% Caucasian, and 81.3% insured by TennCare and/or Medicare. Fifty-four (17.7%) had limited and 52 (17.0%) had marginal health literacy skills. One screening question, “How confident are you filling out medical forms by yourself?” was accurate in detecting limited (AUROC of 0.82; 95% confidence interval [CI]=0.77 to 0.86) and limited/marginal (AUROC of 0.79; 95% CI=0.74 to 0.83) health literacy skills. This question had significantly greater AUROC than either of the other questions (P<.01) and also a greater AUROC than questions based on demographic characteristics.
CONCLUSIONS: One screening question may be sufficient for detecting limited and marginal health literacy skills in clinic populations.