Health Literacy among Spanish-Speaking Patients in the Emergency Department

Brice, Jane H.; Travers, Debbie; Cowden, Christopher S.; Young, Matthew D.; Sanhueza, Antonio; Dunston, Yolanda

doi:10.1016/s0027-9684(15)31512-1

Cited by 54 publications

(35 citation statements)

References 12 publications

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“…In the past, emergency department literacy or numeracy studies generally focused on content, or disease-specific knowledge, making comparisons among studies very difficult. 16,17,39–50 The lack of a simple, concise bedside tool has been a significant barrier to identifying and measuring individual patient numeracy and general health literacy in the emergency department setting.…”

Section: Discussionmentioning

confidence: 99%

Short, Subjective Measures of Numeracy and General Health Literacy in an Adult Emergency Department

McNaughton

Wallston

Rothman

et al. 2011

Academic Emergency Medicine

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Objectives To evaluate the reliability and validity of brief subjective measures of numeracy and general health literacy in the adult emergency department setting. Methods A convenience sample of adult emergency department patients completed subjective measures of general health literacy (Short Literacy Screening questions, SLS) and numeracy (Subjective Numeracy Scale, SNS). These patients also completed two objective tests of literacy (the Short Test of Functional Health Literacy in Adults, S-TOFHLA; and the Rapid Estimate of Adult Literacy in Medicine, REALM) and an objective test of numeracy (WRAT4). Internal reliability of the subjective measures was assessed using Cronbach’s alpha. Construct validity of the subjective measures was assessed by correlating them against the S-TOFHLA, REALM, and WRAT4, using Spearman’s rank correlation coefficients, receiver operating characteristics (ROC) curves, and hierarchical, multiple linear regression with adjustment for patient age, gender, race, and education. Results The median age of the 207 patients surveyed was 46 (interquartile range 32, 59); twenty-seven percent were African American. Sixty-one percent of patients reported their highest level of education was high school or below. As measured by the S-TOFHLA and REALM, most patients had adequate literacy levels (89% and 80%, respectively), while 44% of patients had below average numeracy skills on the WRAT4. Median SLS was 14 (IQR 12, 15) on a scale of 3 to 15; median SNS was 36 (IQR 30, 42) on a scale of 6 to 48. The SLS and SNS had good internal reliability, with Cronbach’s alphas of 0.74 and 0.82, respectively. The SLS Spearman’s rank order correlation coefficient was 0.33 (95% confidence interval 0.20, 0.45) for the S-TOFHLA, with a standardized beta coefficient of 0.36 (p<0.05) after adjustment for patient demographics. The SLS correlation coefficient was 0.26 (95% CI 0.13, 0.38) for the REALM, with a standardized beta coefficient of 0.38 (p<0.05) after adjustment for patient demographics. The area under the curve (AUC) for the SLS ROC curves was 0.74 (95% CI 0.68, 0.80) when compared to the S-TOFHLA and 0.72 (95% CI 0.65, 0.78) when compared to the REALM. The SNS predicted numeracy well, with a correlation coefficient of 0.57 (95% CI 0.47,0.65) for the WRAT4, a standardized beta coefficient of 0.30(p<0.05) after adjustment for patient demographics, and an ROC AUC of 0.77 (95% CI of 0.70, 0.82). Conclusions The SNS and SLS are reliable, valid tests that can be used to rapidly estimate general health literacy and numeracy skill levels in adult emergency department patients. Continuing work is needed to establish their ability to predict clinical outcomes.

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Section: Discussionmentioning

confidence: 99%

Short, Subjective Measures of Numeracy and General Health Literacy in an Adult Emergency Department

McNaughton

Wallston

Rothman

et al. 2011

Academic Emergency Medicine

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“…This is less than what is reported among the emergency department (ED) and primary care patient populations. Limited health literacy rates in ED populations range from 7% to 74% (Brice et al., ; Ginde, Weiner, Pallin, & Camargo, ; Olives, Patel, Patel, Hottinger, & Miner, ; Schumacher et al., ). Limited health literacy among adults seen in EDs is associated with increasing age (Downey & Zun, ; Ginde et al., ; Olives et al., ), male sex (Olives et al., ; Schumacher et al., ), lower education level (Ginde et al., ), and lower income (Ginde et al., ).…”

Section: Introductionmentioning

confidence: 99%

Health literacy in the urgent care setting

Alberti

Morris

2017

Journal of the American Association of Nurse Practitioners

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Background An increasing number of Americans are using urgent care (UC) clinics due to: improved health insurance coverage, the need to decrease cost, primary care offices with limited appointment availability, and a desire for convenient care. Patients are treated by providers they may not know for episodic illness or injuries while in pain or not feeling well. Treatment instructions and follow‐up directions are provided quickly. Purpose To examine health literacy in the adult UC population and identify patient characteristics associated with health literacy risk. Methods As part of a larger cross‐sectional study, UC patients seen between October 2013 and January 2014 completed a demographic questionnaire and the Newest Vital Sign. Descriptive, nonparametric analyses, and a multinomial logistic regression were done to assess health literacy, associated and predictive factors. Results A total of 57.5% of 285 participants had adequate health literacy. The likelihood of limited health literacy was associated with increased age (p < .001), less education (p < .001), and lower income (p = .006). Conclusions/implications Limited health literacy is common in a suburban UC setting, increasing the risk that consumers may not understand vital health information. Clear provider communication and confirmation of comprehension of discharge instructions for self‐management is essential to optimize outcomes for UC patients.

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“…Using these measures, higher proportions of Spanish-speaking individuals have been found to have lower health literacy than English speakers (Williams et al, 1995; Brice et al, 2008). Spanish-speaking individuals with low health literacy have been found to have a poorer understanding of health information than those with higher health literacy (Bennett et al, 2007; Fang et al, 2009; Leyva et al, 2005) as well as lower utilization of cancer screening (Garbers & Chiasson, 2004).…”

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confidence: 99%

Low Health Literacy, Limited English Proficiency, and Health Status in Asians, Latinos, and Other Racial/Ethnic Groups in California

Sentell

Braun

2012

Journal of Health Communication

384

280

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We estimated health status by low health literacy and limited-English proficiency alone and in combination for Latinos, Chinese, Korean, Vietnamese, and Whites in a population-based sample: 48,427 adults from the 2007 California Health Interview Survey, including 3,715 with limited-English proficiency, were studied. Multivariate logistic models examined self-reported health by health literacy and English proficiency in the full sample and racial/ethnic subgroups. Overall, 44.9% with limited-English proficiency reported low health literacy versus 13.8% of English speakers. Among the limited-English proficient, Chinese respondents had the highest prevalence of low health literacy (68.3%), followed by Latinos (45.3%), Koreans (35.6%), Vietnamese (29.7%), and Whites (18.8%). In the full sample, respondents with both limited-English proficiency/low health literacy reported the highest prevalence of poor health (45.1%), followed by limited-English proficiency-only (41.1%), low health literacy-only (22.2%), and neither (13.8%), a hierarchy that remained significant in multivariate models. However, sub-analyses revealed limited-English proficient Latinos, Vietnamese, and Whites had equal or greater odds of poor health compared with low health literate/limited-English proficient respondents. Individuals with both limited-English proficiency and low health literacy are at high risk for poor health. Limited-English proficiency may carry greater health risk than low health literacy, though important racial/ethnic variations exist.

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Health Literacy among Spanish-Speaking Patients in the Emergency Department

Cited by 54 publications

References 12 publications

Short, Subjective Measures of Numeracy and General Health Literacy in an Adult Emergency Department

Short, Subjective Measures of Numeracy and General Health Literacy in an Adult Emergency Department

Health literacy in the urgent care setting

Low Health Literacy, Limited English Proficiency, and Health Status in Asians, Latinos, and Other Racial/Ethnic Groups in California

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