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PubMedDate not supplied

Quick assessment of literacy in primary care: the newest vital sign.

PURPOSE: Current health literacy screening instruments for health care settings are either too long for routine use or available only in English. Our objective was to develop a quick and accurate screening test for limited literacy available in English and Spanish. METHODS: We administered candidate items for the new instrument and also the Test of Functional Health Literacy in Adults (TOFHLA) to English-speaking and Spanish-speaking primary care patients. We measured internal consistency with Cronbach's alpha and assessed criterion validity by measuring correlations with TOFHLA scores. Using TOFLHA scores <75 to define limited literacy, we plotted receiver-operating characteristics (ROC) curves and calculated likelihood ratios for cutoff scores on the new instrument. RESULTS: The final instrument, the Newest Vital Sign (NVS), is a nutrition label that is accompanied by 6 questions and requires 3 minutes for administration. It is reliable (Cronbach alpha >0.76 in English and 0.69 in Spanish) and correlates with the TOFHLA. Area under the ROC curve is 0.88 for English and 0.72 for Spanish versions. Patients with more than 4 correct responses are unlikely to have low literacy, whereas fewer than 4 correct answers indicate the possibility of limited literacy. CONCLUSION: NVS is suitable for use as a quick screening test for limited literacy in primary health care settings.

Arizona↗
PubMed2002

Functional health literacy and the risk of hospital admission among Medicare managed care enrollees.

OBJECTIVES: This study analyzed whether inadequate functional health literacy is an independent risk factor for hospital admission. METHODS: We studied a prospective cohort of 3260 Medicare managed care enrollees. RESULTS: Of the participants, 29.5% were hospitalized. The crude relative risk (RR) of hospitalization was higher for individuals with inadequate literacy (n = 800; RR = 1.43; 95% confidence interval [CI] = 1.24, 1.65) and marginal literacy (n = 366; RR = 1.33; 95% CI = 1.09, 1.61) than for those with adequate literacy (n = 2094). In multivariate analysis, the adjusted relative risk of hospital admission was 1.29 (95% CI = 1.07, 1.55) for individuals with inadequate literacy and 1.21 (95% CI = 0.97, 1.50) for those with marginal literacy. CONCLUSIONS: Inadequate literacy was an independent risk factor for hospital admission among elderly managed care enrollees.

Aged↗
PubMed2004

Health literacy and pregnancy preparedness in pregestational diabetes.

OBJECTIVE: We investigated the association between functional health literacy and markers of pregnancy preparedness in women with pregestational diabetes. RESEARCH DESIGN AND METHODS: English- and Spanish-speaking pregnant women with pregestational diabetes were recruited. Women completed the Test of Functional Health Literacy in Adults (TOFHLA) short form and a questionnaire. A TOFHLA score of < or =30 was defined as low functional health literacy. RESULTS: Of 74 women participating in the study, 16 (22%) were classified as having low functional health literacy. Compared with women with adequate health literacy, those with low health literacy were significantly more likely to have an unplanned pregnancy (P = 0.02) and significantly less likely to have either discussed pregnancy ahead of time with an endocrinologist or obstetrician (P = 0.01) or taken folic acid (P = 0.001). CONCLUSIONS: The results of this study suggest that low functional health literacy among women with pregestational diabetes is associated with several factors that may adversely impact birth outcomes.

Adult↗
PubMed2006

Home and community literacy experiences of individuals with Down syndrome.

This exploratory survey was conducted to gain a detailed understanding of the home and community literacy experiences of children, adolescents and adults with Down syndrome. The data were collected from 224 parents/guardians across Canada who were asked to indicate literacy goals and priorities for their children with Down syndrome, the literacy resources they and their children utilised at home and in the community, perceived barriers to their children's literacy attainment, and solutions for alleviating the barriers. The results were analysed according to age when appropriate, in order to better understand the course of literacy development. Overall, the number of respondents who indicated their children with Down syndrome could read and write appeared to be consistent with previously published estimates, including the number reporting advanced reading levels. The wide range of reading and writing materials observed in use at home appeared to be greater than the range of materials actually used by children with Down syndrome. Relatively few of the parents who read storybooks to their children reported asking higher-level questions, suggesting that some parents might benefit from support in this activity. Many respondents reported using the library, and many expressed concerns about the quality and scarcity of literacy programs. The results are discussed with regard to their implications for how parents, caregivers, teachers, and program providers can encourage literacy development in persons with Down syndrome, and suggestions for future research.

Adolescent↗
PubMedDate not supplied

Health literacy and cancer communication.

Health literacy is increasingly recognized as a critical factor affecting communication across the continuum of cancer care. We reviewed research on health literacy and examined its impact on cancer outcomes and communication. According to the National Adult Literacy Survey (NALS), considered the most accurate portrait of literacy in our society, about one in five American adults may lack the necessary literacy skills to function adequately in our society. As patients, such individuals are at a disadvantage in their capacity to obtain, process, and understand cancer information and services needed to make appropriate health care decisions. Patients with poor health literacy have a complex array of difficulties with written and oral communication that may limit their understanding of cancer screening and of symptoms of cancer, adversely affecting their stage at diagnosis. In addition, these barriers impair communication and discussion about risks and benefits of treatment options, and patient understanding of informed consent for routine procedures and clinical trials. More research is needed to identify successful methods for educating and communicating with patients who have limited health literacy. Based on our own experience, we offer practical communication aids that can help bridge the cancer communication gap.

Communication Barriers↗
PubMed2001

Genetic influences on language impairment and literacy problems in children: same or different?

Data from two twin studies are examined to assess genetic and environmental influences on literacy, and the etiological relationship between language and literacy. Study 1 used children from 86 families previously recruited for a study of the genetics of specific language impairment (see Bishop, North, & Donlan, 1995), who completed tests of single-word reading and spelling. Literacy problems in this sample were common, were strongly heritable, and showed a close genetic relationship with poor nonword repetition. Study 2 included two subsets of children: 37 twin pairs who had taken part in study 1, 3 to 4 years earlier, and 100 twin pairs recruited from the general population by Bishop et al. (1999). All children were given a standardised test of nonword reading. There was no genetic influence on nonword reading ability, either across the normal range, or at the lower extreme, though there were significant associations with some social variables. However, bivariate DeFries Fulker analysis suggested that in this study, as in study 1, there was shared genetic variance between poor nonword repetition and literacy deficits. It is concluded that poor nonword repetition, which is known to be highly heritable, puts the child at risk for literacy problems. However, in a general population sample, such as that included in study 2, poor nonword repetition is a relatively rare correlate of literacy problems, which are more likely to have an environmental origin. Thus the different pattern of results in the two studies can be explained if one assumes that genetic influences are substantial only when literacy problems are severe and/or accompanied by oral language difficulties.

Child↗
PubMed2002

Health literacy, cervical cancer risk factors, and distress in low-income African-American women seeking colposcopy.

OBJECTIVES: To describe the relationship between health literacy, distress, and cervical cancer risk factors in women at high risk for developing cervical cancer. DESIGN: Cross-sectional, prospective cohort design. SETTING: Two university-based gynecological oncology colposcopy clinics and 3 Planned Parenthood community dinics. PATIENTS/PARTICIPANTS: One hundred-thirty English-speaking African-American women > or = 18 years referred for colposcopy following abnormal Pap testing. MAIN OUTCOME MEASURES: Avoidance and Intrusion subscales of the Impact of Events Scale (IES), Rapid Estimate of Adult Literacy in Medicine (REALM), and demographics. RESULTS: Forty-five percent of women had a low level of health literacy (< 9th grade). Low health literacy was related to fewer risk factors (P < .01) and higher levels of distress on the Impact of Events avoidance subscale (P < .05) after controlling for covariates. Forty-three percent of women with low literacy had excessive levels of distress as compared to 25% in women with high literacy (P < .05). CONCLUSIONS: A low level of health literacy is associated with increased levels of distress among women at high risk for developing cervical cancer. To the extent that distress serves as a barrier to treatment, culturally informed, effective interventions are needed.

Adolescent↗
PubMed2004

Functional health literacy: an issue in African-American and other ethnic and racial communities.

The purpose of this study was two-fold: to identify and assess the functional health literacy level among a group of African-American adults and to determine the feasibility of conducting a functional health literacy assessment in community-based settings, primary, and acute care settings. This was an exploratory descriptive study done to ascertain the degree of health literacy among a sample of respondents from vulnerable populations including African-Americans and Hispanics. The total sample was comprised of 190 (N = 190) men and women in Los Angeles and New York. This included a sample of 81 (n = 81) African-American participants and 16 (n = 16) Hispanic participants. The average age of the total sample was 43 years of age, and 47% of the total sample was male, while 53% were female. The average age of the African-American sample was 41 years Conversely, 53% of the African-American sample was male, while 47% of the sample was female. The Modified Test of Functional Health Literacy in Adults (TOFHLA) survey instrument, developed by Williams and Colleagues (1995), was administered to participants to assess health literacy. The TOFHLA consisted of a Reading Comprehension component that contained 39 multiple-choice questions. Findings from this study suggest that patients who have marginal or inadequate functional health literacy will have difficulty reading, understanding, and interpreting most written health texts and instructions In addition, patients with marginal or inadequatefunctional health literacy scores are more likely to misunderstand directions for health care. Consequently, these patients are also more likely to take medications incorrectly and more likely to fail to follow a prescribed diet or treatment regimen.

Adult↗
PubMedDate not supplied

Health literacy is a predictor of HIV/AIDS knowledge.

BACKGROUND AND OBJECTIVES: This study's objective was to evaluate the association between health literacy and human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) knowledge among patients seen at an inner-city, public hospital urgent care center (UCC). METHODS: We used a prospective survey of patients offered an HIV test by their providers during a UCC visit. We measured patients' health literacy level using the Rapid Estimate of Adult Literacy in Medicine (REALM) scale and assessed their HIV/AIDS knowledge using a 22-item questionnaire. RESULTS: A total of 372 patients were enrolled. Among participants in this relatively young sample (55% were under the age of 40), 92 (25%) had a REALM score at or below a sixth-grade level, and 122 (33%) did not have a high school diploma. Patients' mean HIV/AIDS knowledge scores differed significantly between patients with inadequate health literacy and those with marginal or adequate health literacy. In multivariate analyses, patients' REALM scores were positively associated with patients' HIV/AIDS knowledge even after adjusting for income, education, and risk perception. CONCLUSIONS: These findings demonstrate that HIV/AIDS knowledge is strongly associated with patients' health literacy in this inner-city population. These findings reiterate the need to target HIV prevention strategies toward populations with inadequate health literacy levels and to dispel misconceptions regarding HIV/AIDS that directly influence risk-taking behaviors and health care utilization.

Acquired Immunodeficiency Syndrome↗
PubMed2006

Literacy, consumer informatics, and health care outcomes: Interrelations and implications.

Health care outcomes are clearly impacted by the ability of clients to participate in their health care. Nurses have always used education to empower their patients. With the advent of the Internet the concept of patient education has been transformed to the much broader concept of consumer informatics. For increasing numbers of clients the Internet has become a primary source of health information and a major factor influencing their knowledge and decisions related to their health. Successful use of the Internet depends on several different levels and types of literacies. This paper explores the interrelations between the concepts of basic literacy, computer literacy, information literacy, health information literacy and health literacy. It demonstrates the need for client assessment tools that are sensitive to each of these literacies and their interrelations. In concludes by challenging consumer informatics specialists to develop these assessment tools as well as teaching tools for empowering consumers using the Internet.

Comprehension↗
PubMed2026

The musculoskeletal pain literacy questionnaire (MSK-PLq) - Part 1: Development of a preliminary version through a systematic review and Delphi consensus.

OBJECTIVE: Chronic musculoskeletal (MSK) pain is a leading cause of disability worldwide, and self-management is a first-line approach recommended by international clinical guidelines. Access to evidence-based information that enhances health literacy may support patients' engagement in their self-management and treatment decision-making, potentially reducing disease burden and pain. However, no tool currently exists to assess health literacy specifically in MSK pain. This study aimed to develop and describe the preliminary version of a knowledge-based questionnaire to evaluate MSK pain literacy, the Musculoskeletal Pain-Literacy questionnaire (MSK-PLq). METHODS: A systematic literature review identified existing health literacy instruments and generated a preliminary list of domains. A two-round Delphi study with 22 panellists (19 experts and three people living with chronic MSK pain), followed by consensus meetings, was used to refine domains and items (&#x2265;70% agreement). Readability was assessed using the Flesch Reading Ease (FRE) score and three stakeholders were consulted to review the questionnaire for comprehensibility, clarity, and face validity. RESULTS: Six domains were retained (Understand, Access, Appraise, Apply, Digital, Beliefs), comprising 20 items in the preliminary version of MSK-PLq. Readability was acceptable (mean FRE 74, indicating fairly easy reading), and subject feedback supported the questionnaire's clarity and face validity. CONCLUSIONS: The preliminary version of the MSK-PLq is proposed as the first knowledge-based tool to assess functional, interactive, and critical aspects of MSK pain literacy. It may have applications in clinical practice, research, education, and digital health, by informing tailored patient education and supporting self-management strategies, although further psychometric validation is required.

Humans↗
PubMedDate not supplied

Information literacy as the foundation for evidence-based practice in graduate nursing education: a curriculum-integrated approach.

As part of a system-wide initiative to advance evidence-based practice among clinicians, graduate students, and educators, the New York University Division of Nursing embarked on a curricular initiative to integrate components of information literacy in all core courses of the master's program. Increasing competency in information literacy is the foundation for evidence-based practice and provides nursing professionals with the skills to be literate consumers of information in an electronic environment. Competency in information literacy includes an understanding of the architecture of information and the scholarly process; the ability to navigate among a variety of print and electronic tools to effectively access, search, and critically evaluate appropriate resources; synthesize accumulated information into an existing body of knowledge; communicate research results clearly and effectively; and appreciate the social issues and ethical concerns related to the provision, dissemination, and sharing of information. In collaboration with the New York University Division of Libraries' Health Sciences Librarian, instructional modules in information literacy relevant to each of the 5 core nursing master's courses were developed, complemented by a Web-based tutorial: http://library.nyu.edu/research/health/tutorial. The Web site is multifaceted, with fundamentals for the beginner, as well as more complex content for the advanced user. Course assignments were designed to promote specific competencies in information literacy and strategies for evaluating the strength of the evidence found. A survey of information literacy competencies, which assessed students' knowledge, misconceptions, and use of electronic information resources, was administered when students entered the program and at 1-year intervals thereafter.

Computer Literacy↗
PubMed2004

Internet usage by low-literacy adults seeking health information: an observational analysis.

BACKGROUND: Adults with low literacy may encounter informational obstacles on the Internet when searching for health information, in part because most health Web sites require at least a high-school reading proficiency for optimal access. OBJECTIVE: The purpose of this study was to 1) determine how low-literacy adults independently access and evaluate health information on the Internet, 2) identify challenges and areas of proficiency in the Internet-searching skills of low-literacy adults. METHODS: Subjects (n=8) were enrolled in a reading assistance program at Bidwell Training Center in Pittsburgh, PA, and read at a 3rd to 8th grade level. Subjects conducted self-directed Internet searches for designated health topics while utilizing a think-aloud protocol. Subjects' keystrokes and comments were recorded using Camtasia Studio screen-capture software. The search terms used to find health information, the amount of time spent on each Web site, the number of Web sites accessed, the reading level of Web sites accessed, and the responses of subjects to questionnaires were assessed. RESULTS: Subjects collectively answered 8 out of 24 questions correctly. Seven out of 8 subjects selected "sponsored sites"-paid Web advertisements-over search engine-generated links when answering health questions. On average, subjects accessed health Web sites written at or above a 10th grade reading level. Standard methodologies used for measuring health literacy and for promoting subjects to verbalize responses to Web-site form and content had limited utility in this population. CONCLUSION: This study demonstrates that Web health information requires a reading level that prohibits optimal access by some low-literacy adults. These results highlight the low-literacy adult population as a potential audience for Web health information, and indicate some areas of difficulty that these individuals face when using the Internet and health Web sites to find information on specific health topics.

Adult↗
PubMed2006

eHEALS: The eHealth Literacy Scale.

BACKGROUND: Electronic health resources are helpful only when people are able to use them, yet there remain few tools available to assess consumers' capacity for engaging in eHealth. Over 40% of US and Canadian adults have low basic literacy levels, suggesting that eHealth resources are likely to be inaccessible to large segments of the population. Using information technology for health requires eHealth literacy-the ability to read, use computers, search for information, understand health information, and put it into context. The eHealth Literacy Scale (eHEALS) was designed (1) to assess consumers' perceived skills at using information technology for health and (2) to aid in determining the fit between eHealth programs and consumers. OBJECTIVES: The eHEALS is an 8-item measure of eHealth literacy developed to measure consumers' combined knowledge, comfort, and perceived skills at finding, evaluating, and applying electronic health information to health problems. The objective of the study was to psychometrically evaluate the properties of the eHEALS within a population context. A youth population was chosen as the focus for the initial development primarily because they have high levels of eHealth use and familiarity with information technology tools. METHODS: Data were collected at baseline, post-intervention, and 3- and 6-month follow-up using control group data as part of a single session, randomized intervention trial evaluating Web-based eHealth programs. Scale reliability was tested using item analysis for internal consistency (coefficient alpha) and test-retest reliability estimates. Principal components factor analysis was used to determine the theoretical fit of the measures with the data. RESULTS: A total of 664 participants (370 boys; 294 girls) aged 13 to 21 (mean = 14.95; SD = 1.24) completed the eHEALS at four time points over 6 months. Item analysis was performed on the 8-item scale at baseline, producing a tight fitting scale with alpha = .88. Item-scale correlations ranged from r = .51 to .76. Test-retest reliability showed modest stability over time from baseline to 6-month follow-up (r = .68 to .40). Principal components analysis produced a single factor solution (56% of variance). Factor loadings ranged from .60 to .84 among the 8 items. CONCLUSIONS: The eHEALS reliably and consistently captures the eHealth literacy concept in repeated administrations, showing promise as tool for assessing consumer comfort and skill in using information technology for health. Within a clinical environment, the eHEALS has the potential to serve as a means of identifying those who may or may not benefit from referrals to an eHealth intervention or resource. Further research needs to examine the applicability of the eHEALS to other populations and settings while exploring the relationship between eHealth literacy and health care outcomes.

Adolescent↗
PubMed1988

Decree No. 013/PRG concerning creation of a National Guinean Commission of Literacy and Adult Education, 21 January 1987.

This Decree creates a National Guinean Commission of Literacy and Adult Education under the Minister of National Education. The following are among the goals of the Commission: 1) to regroup the organizations, both public and private, that are engaged in adult education and literacy, with the goal of making their activities more useful; 2) to formulate adult education programs and strategies to combat illiteracy, keeping in mind the policy of human advancement; 3) to harmonize and coordinate all literacy programs and adult education activities; 4) to further the development and implementation of programs relating to literacy, adult education, and continuing and professional education; 5) to undertake studies and research relating to literacy, national languages, and adult education; and 6) to collect and disseminate information, documents, and studies in the area of literacy and adult education in Guinea and elsewhere. Further provisions of the Decree deal with the composition, organization, and resources of the Commission, among other things.

Adult↗
PubMed2004

Readiness for evidence-based practice: information literacy needs of nurses in the United States.

In this paper U.S. nurses' readiness to provide Evidence-Based Practice (EBP) as measured by their information literacy knowledge and skills is described. The Institute of Medicine directed health care providers to use EBP as a means to improve patient safety, efficiency and effectiveness of health care services. Information literacy has been identified as a nursing informatics competency for the basic nurse. As such, information literacy is an essential component in the application of EBP. The importance of developing information literacy skills is enhancement of the nurse's ability to use current best available research literature in the conduct of EBP with subsequent improvement in nursing sensitive patient outcomes. This study describes the level of nurses' information literacy knowledge and gaps in their skills for identifying, accessing, retrieving, evaluating and utilizing research evidence to provide best care for patients. The value of this study is to increase awareness among nurse administrators, educators, and clinicians of the need for information literacy education to enable evidence-based nursing practice and to guide development of supportive curricula and professional continuing education.

Biomedical Research↗
PubMed1996

The health care experience of patients with low literacy.

OBJECTIVES: To understand the difficulties that patients with poor reading ability have interacting with the health care system and to identify the coping mechanisms they use to deal with these problems. DESIGN: Focus groups and individual interviews with patients who are illiterate and patients with low literacy. SETTING: Two large, urban public hospitals. PARTICIPANTS: Sixty patients with marginal to poor reading abilities as measured by the Rapid Estimate of Adult Literacy in Medicine were interviewed in focus groups or individual interviews. MEASUREMENTS AND MAIN RESULTS: Patients with low literacy harbor a deep sense of shame, which is reinforced by hospital staff who become frustrated or angry when someone cannot complete a form or read instructions. Seeking medical care is intimidating for patients with low literacy because they cannot understand signs and registration forms. Many patients recounted serious medication errors resulting from their inability to read labels. To cope with these problems, the patients with low literacy rely heavily on oral explanations, visual clues, and demonstrations of tasks to learn new material. Most also use a friend or family member as a surrogate reader. CONCLUSIONS: Patients with poor reading ability have important problems accessing the health care system, understanding recommended treatments, and following the instructions of providers. Because of their shame, patients with low literacy may be unwilling to disclose their problem to health care providers, and screening tests of reading ability may be necessary to identify those who need special assistance. Patients' coping mechanisms give insight into possible interventions that may improve their interactions with the health care system.

Adult↗
PubMedDate not supplied

On the relationship between dynamic visual and auditory processing and literacy skills; results from a large primary-school study.

Three hundred and fifty randomly selected primary school children completed a psychometric and psychophysical test battery to ascertain relationships between reading ability and sensitivity to dynamic visual and auditory stimuli. The first analysis examined whether sensitivity to visual coherent motion and auditory frequency resolution differed between groups of children with different literacy and cognitive skills. For both tasks, a main effect of literacy group was found in the absence of a main effect for intelligence or an interaction between these factors. To assess the potential confounding effects of attention, a second analysis of the frequency discrimination data was conducted with performance on catch trials entered as a covariate. Significant effects for both the covariate and literacy skill was found, but again there was no main effect of intelligence, nor was there an interaction between intelligence and literacy skill. Regression analyses were conducted to determine the magnitude of the relationship between sensory and literacy skills in the entire sample. Both visual motion sensitivity and auditory sensitivity to frequency differences were robust predictors of children's literacy skills and their orthographic and phonological skills.

Auditory Perception↗