Limited Ability of Three Health Literacy Screening Items to Identify Adult English- and Spanish-Speaking Emergency Department Patients With Lower Health Literacy

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

“…Inter‐rater agreement for the scores on the COSMIN checklist items was high with a kappa score of 0.84. None of the three diagnostic studies assessed with the QUADAS‐2 31,32,37 scored "low risk of bias" on all four domains. All three showed high risk of bias in the patient selection: i.e., patients were sampled consecutively 31,32 and inappropriate exclusions were not avoided because second‐grade reading level patients were excluded, which may have influenced accuracy findings 37 .…”

“…None of the three diagnostic studies assessed with the QUADAS‐2 31,32,37 scored "low risk of bias" on all four domains. All three showed high risk of bias in the patient selection: i.e., patients were sampled consecutively 31,32 and inappropriate exclusions were not avoided because second‐grade reading level patients were excluded, which may have influenced accuracy findings 37 . Only one study showed sufficient information to determine appropriate conduct and interpretation of the index tests 37 .…”

“…32,34,37 The Brief Health Literacy Screen (BHLS) are the three SILS-questions combined in one instrument. 31,32,34,37 The two Subjective Numeracy Scale (SNS) versions are measures of individuals' perceived ability to perform various mathematical tasks and preference for the use of numerical versus prose information.…”

Factors Associated with Lack of HIV Testing among Latino Immigrant and Black Patients at 4 Geographically and Demographically Diverse Emergency Departments

“…The RCT involved testing an intervention designed to increase HIV/AIDS and HIV testing knowledge and HIV testing motivation and behavioral skills. 21 , 23 At the terminal portion of their involvement in the ED portion of the trial, these participants completed an audio-assisted self-interview about whether they had engaged in any HIV risk-taking behaviors in the prior 3 months. These HIV risk-taking behaviors included: (1) two or more main partners, (2) casual partners, (3) exchange partners, (4) condomless anal intercourse (CAI), and (5) intravenous drug use.…”

“…There were more Latino immigrants (n ¼ 641) than Black participants (n ¼ 500) who reported any past 3-month HIV risk-taking behavior (28% vs 17%; p < 0.0001). The Providence site (n ¼ 334) had the highest proportion of participants with any previous 3-month HIV risk-taking behaviors (31%, 95% CI 26-37), followed by Los Angeles (n ¼ 307) (23%, 95% CI 19-29), Birmingham (n ¼ 218) (14%, 95% CI 10-20) and Cincinnati (n ¼ 282) (20%, 95% CI [15][16][17][18][19][20][21][22][23][24][25]. Table 3 provides the demographic characteristics of participants according to any versus no reported past 3-month risk-taking behaviors by race/ethnicity and ED.…”