Validation of a Short Form for Health Literacy Assessment Using Talking Touchscreen Technology

Abstract

Background: Health literacy is an area of growing research and clinical interest, necessitating short, accurate measures of this complex construct. Health Literacy Assessment Using Talking Touchscreen Technology (Health LiTT) measures prose, document, and quantitative literacy by self-administration on a touchscreen computer. Objective: The objective of this study was to assess the validity of a short form of Health LiTT and to identify a meaningful cutoff score for adequate health literacy. Methods: A subsample of 137 participants from the Literacy and Cognitive Function among Older Adults study completed a 10-item Health LiTT short form and three interviewer-administered health literacy measures: Test of Functional Health Literacy in Adults (TOFHLA), Rapid Estimate of Adult Literacy in Medicine (REALM), and Newest Vital Sign (NVS). Convergent validity was assessed by correlating scores for all measures, and known-groups validity was assessed by comparing mean Health LITT scores across TOFHLA levels (inadequate, marginal, adequate). Internal consistency reliability was estimated with Cronbach's alpha. A cutoff score for adequate health literacy was established using the TOFHLA cutoff for adequate versus inadequate/marginal health literacy. Key Results: Spearman correlations between Health LiTT scores and total TOFHLA, REALM, and NVS scores were 0.65, 0.69, and 0.56, respectively (all p < .001). Mean Health LiTT scores were significantly and meaningfully different across inadequate (40.4), marginal (50.1), and adequate (57.1) TOFHLA categories (F = 60.6; p < .001). Cronbach's alpha for the Health LiTT short form was .73. A cutoff score of 55 on Health LiTT showed acceptable sensitivity and specificity to identify adequate health literacy. Conclusions: This 10-item Health LiTT short form demonstrated excellent convergent and known-groups validity and acceptable internal consistency reliability in older adults. The established cutoff also showed excellent sensitivity and specificity. Validation of other custom Health LiTT short forms with varying items from the bank and computer adaptive test-generated Health LiTT scores is ongoing. [HLRP: Health Literacy Research and Practice. 2020;4(4):e200-e207.] Plain Language Summary: This article provides evidence of the need for and psychometric properties of a valid and reliable short form of the flexible, technologically advanced Health Literacy Assessment Using Talking Touchscreen Technology measure, as well as a cutoff score to note adequate versus marginal/inadequate health literacy.

Characterizing Health Literacy and Its Correlates Among Individuals With Traumatic Brain Injury (TBI): A TBI Model Systems Study

“…Developers of the short-form HealthLiTT survey recommended a cutoff T-score of 55 to designate adequate health literacy, based on maximizing sensitivity and specificity relative to a gold standard measure of health literacy. 21 On the basis of this cutoff score, 69% of our sample demonstrated adequate health literacy, while 31% scored in the range of marginal/inadequate health literacy.…”

“…T-scores for the HealthLiTT survey were calculated and were used to divide the sample into marginal/inadequate and adequate health literacy groups, with a T-score of 55+ indicating adequate health literacy based on comparison with gold standard measures of health literacy. 21 Chi-square tests were used to compare the proportion of individuals in adequate versus marginal/inadequate health literacy groups by age (<45 years vs 45+ years), sex (male vs female), education (less than high school, high school/GED, more than high school), race/ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic), urbanicity (rural, urban, suburban), and injury severity (complicated mild/moderate vs severe). BTACT scores were compared between health literacy groups using t tests.…”

Validity of Patient-Reported Outcomes Measurement Information System Physical, Mental, and Social Health Measures After Left Ventricular Assist Device Implantation and Implications for Patient Care

“…The 12 PROMIS measures evaluated for validity included physical health (Fatigue, 32,33 Physical Function, 34,35 Sleep Disturbance, 36,37 Sleep-Related Impairment 36,37 ), mental health (Depression, 38,39 Anxiety, 38 Cognitive Function 40,41 ), and social health (Social Function: Ability to Participate in Social Roles, 42 Satisfaction With Social Roles and Activities 42 ; Social Relationships: Emotional, Informational, and Instrumental Social Support 42 ). The PROs, clinician ratings, performance tests, and clinical adverse events that were used as validity indicators included KCCQ-12, 14,15 EQ-5D-3L, 12,13 Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being 12-item scale, 43,44 PROMIS Overall Quality of Life item, 20 New York Heart Association functional classification, 45 Health Literacy Assessment Using Touchscreen Technology, 46,47 6-minute walk test, [48][49][50][51] trail making test, part B, [52][53][54] and neurological dysfunction. 11…”

The Relationship of Health Literacy to Health Outcomes Among Individuals With Traumatic Brain Injury: A Traumatic Brain Injury Model Systems Study

“…Health literacy level, based on the Health LiTT T-score, was dichotomized into marginal/inadequate (Tscore <55) and adequate health literacy (T-score ≥55), which provides acceptable sensitivity and specificity to identify adequate health literacy. 43 The PROMIS Global Physical Health (PH) T-scores were dichotomized into fair-to-poor physical health (T-score <42) and good-toexcellent physical health (T-score ≥ 42). 44 The PROMIS Global Mental Health (MH) T-scores were also dichotomized into fair-to-poor mental health (T-score <40) and good-to-excellent mental health (≥40).…”