Health literacy: The validation of a short form health literacy screening assessment in an ambulatory care setting

Adverse health outcomes associated with low health literacy affect one in three Americans. Low literacy also consumes health care resources equivalent to billions of dollars annually. Many variables are associated with inadequate health literacy yet the exact relationships between patient variables and health literacy outcomes are unclear. Understanding patient variables associated with inadequate health literacy can provide insight into disparities in healthcare and identify priority populations. To prevent personal and system loss, healthcare providers need an efficient means of identifying patients' literacy skills. My research validated a brief screening tool in an ambulatory clinical setting against two previously validated health literacy measures. My study also identified patient variables associated with health literacy level. Finally my study identified the stage of readiness for the sample participants related to their awareness of health literacy and their utilization of patient health education.;My study was conducted with 378 veteran participants presenting in eight acute ambulatory care clinics. The proposed BRIEF screening tool and two previously validated assessments were significantly correlated with moderate positive correlations, suggesting the BRIEF is clinically valid. A Principal Component Analysis suggests the BRIEF screen measures one distinct construct "health literacy" accounting for 60% of score variance. The receiving operator characteristic curve (ROC) analysis also suggests the BRIEF is a more sensitive measure of inadequate health literacy than the individual BRIEF items. Findings suggest clinicians can ask four brief questions to screen patients' health literacy needs and provide as a valid indicator to alert ambulatory healthcare team members of their patients' health literacy needs. Upon screening, clinicians can refer patients to an official evaluation and/or patient education intervention and tailor their clinical practice to meet the individual needs of patients. A multivariate analysis indicated demographic variables were jointly associated with 34% of the STOFHLA score variance. Univariate statistics suggest the majority of participants were knowledgeable about health literacy and health education; confident in their ability to seek support; and had received support related to health literacy and patient health education. My findings and their implications for research and practice are discussed.