Feasibility of Health Literacy Tools for Older Patients in the Emergency Department

Abstract

Introduction: This study evaluates the feasibility of using a volunteer research associate (RA) to administer two separate health literacy assessment tools in the emergency department (ED), specifically in an older population of patients. The outcomes measured were administration time and interruptions. Methods: Using a prospective, cross-sectional study with a convenience sample, adult patients over the age of 55 presenting between June-August 2018 to one urban, academic ED were evaluated by a volunteer RA using either the Newest Vital Sign (NVS) or the Short Assessment of Health Literacy (SAHL). All patients 55 years of age or older who consented to participate were included. We excluded from this study the following: patients with dementia or other disability involving reading, speech, or cognitive function, as noted in their medical record or by their attending physician; prisoners; and those subjectively deemed in extremis or too ill to participate by their attending physician. Results: Health literacy was assessed in 202 patients using either the NVS or SAHL. Mean time of administration was 214.0 seconds for the NVS, and 206.8 for the SAHL. The maximum time of administration for the NVS was 563 seconds, compared to 607 seconds for the SAHL. We found that 95.2% of NVS and 93.9% of SAHL tests incurred no interruptions during administration. Conclusion: No significant difference was found between the length of time needed to administer the NVS or SAHL to older patients in the ED. Both tools averaged an administration time of around three to four minutes, and neither incurred regular interruptions to its administration by a volunteer RA. Further study is needed to assess validity of these tools in an ED setting. [West J Emerg Med. 2020;21(5)1270-1274.] protocols and seeking proper follow-up. Adequate health literacy is key to achieving proper compliance to medication use and has been shown to improve healthcare outcomes. 2,3 Health literacy is complex, and often described as consisting of a variety of components, including literacy and numeracy. The term "literacy" is used to explain aspects of language involving reading, writing, speaking, or listening, while

A systematic review of instruments to measure health literacy of patients in emergency departments

“…All studies consisted of English‐speaking participants. Three studies also included Spanish‐speaking participants 33,36,37 . Sample sizes varied from 202 to 2,770 participants.…”

“…Each item contains a medical term printed in boldface and two association words (i.e., the key and the distracter). Correct answers are determined by both correct pronunciation and accurate association 36,38 …”

“…All instruments were administered in English. In three studies, the NVS, the SAHL, the BHLS, and the three SILS questions were also administered in Spanish 33,36,37 …”

“…All studies were published between 2011 and 2020 and performed in the United States. The vast majority were single center, [31][32][33][34]36 prospective observational cohort studies, [31][32][33][34][35][36][37] conducted in urban academic EDs. 31,32,34,36 One study was conducted in four urban academic EDs.…”

“…The vast majority were single center, [31][32][33][34]36 prospective observational cohort studies, [31][32][33][34][35][36][37] conducted in urban academic EDs. 31,32,34,36 One study was conducted in four urban academic EDs. 37 Another study was performed in one pediatric ED.…”