What Patient Characteristics Influence Nurses’ Assessment of Health Literacy?

Abstract

Overestimation of patients’ health literacy skills is common among nurses and physicians. At Vanderbilt University Hospital (VUH), nurses routinely ask patients the three Brief Health Literacy Screening (BHLS) questions. Data from two studies that recruited patients at VUH, the Health Literacy Screening (HEALS) study and the Vanderbilt Inpatient Cohort Study (VICS), were analyzed to compare the BHLS score recorded by nurses during clinical care with the score recorded by trained research assistants (RAs) during the same hospitalization. Logistic regression models determined which patient characteristics were associated with nurses documenting higher health literacy scores than RAs. Overall, the majority (60%) of health literacy scores were accurate, though nurses recorded meaningfully higher health literacy scores in 28.4% of HEALS patients and 35.6% of VICS patients. In the HEALS cohort, patients who were male and had less education were more likely to have higher health literacy scores recorded by nurses (OR=1.93, 95% CI=1.24-3.00 and OR=0.80, 95% CI=0.74-0.88, respectively). In the VICS cohort, patients who were older, male, and had less education were more likely to have higher health literacy scores recorded by nurses (OR=1.01, 95% CI=1.003-1.02; OR=1.49, 95% CI=1.20-1.84; and OR=0.87, 95% CI=0.83-0.90, respectively). These findings suggest that health literacy scores recorded by nurses for male patients and patients with less education could be overestimated. Thus, healthcare professionals should be aware of this tendency and should verify the results of routine health literacy screening tests, especially in certain patient groups.

Acute care nurses' views on family participation and collaboration in fundamental care

“…Furthermore, nurses in our study showed limited awareness of how to assess the health literacy in their patients and families, and therefore did not tailor information to enhance understanding. Other researchers have reported similar findings that nurses routinely overestimate patients' health literacy skills (Goggins, Wallston, Mion, Cawthon, & Kripalani, ). If patients and their families in the acute care setting do not comprehend the information provided to them by healthcare staff, they are unable to effectively exercise an informed choice when making healthcare decisions.…”

“…First, acute care nurses should be aware that the delivery of fundamental care is underpinned by the establishment of a relationship with patients and their family (Kitson et al., ). Caring relationships are underpinned by effective communication (Collins, ); therefore, nurses must be aware that people with lower individual health literacy may be less likely to ask questions, or to ask for clarification if they do not understand their care (Australian Commission on Safety and Quality in Health Care (ACSQHC), ; Goggins et al., ). If low health literacy is suspected, nurses should implement evidence‐based strategies such as (i) teach‐back (The Joint Commission, ); (ii) ask‐tell‐ask (Martino, ); or (iii) teach to a goal (Baker et al., ), to enhance patients' and families' understanding.…”

Low Health Literacy Is Associated with Increased Transitional Care Needs in Hospitalized Patients

“…Third, for the measure of health literacy, we relied on data collected by nurses as part of their normal workflow. As is often the case with data collected during routine care, the scores are imperfect, 45 but they have proven to be a valuable and valid indicator of health literacy in our previous research. 18,24,25,46 Fourth, we chose to declare a domain as positive if any item in that domain was positive and to perform a domain-level analysis (for greater clarity).…”

Quitting smoking before surgical interventions and its relationship to health literacy

“…Health literacy (HL) is the degree to which people have the ability to understand and access basic health services information, prevent disease, and make and implement decisions during treatment in the process of acquiring health information [2,[8][9][10][11]. Low levels of HL indicate that health information is difficult to understand and that the instructions given are difficult and lead to adverse health outcomes [8,12,13].…”