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Measurement properties and comparative performance of health literacy screening questions in a predominantly low income African American population with diabetes. Patient Educ Couns 2014 Oct;97(1):88-95

Date

08/02/2014

Pubmed ID

25082723

DOI

10.1016/j.pec.2014.07.008

Scopus ID

2-s2.0-84926245208 (requires institutional sign-in at Scopus site)   12 Citations

Abstract

OBJECTIVE: To examine the measurement properties of the 16 screening questions (16-SQ) of inadequate health literacy (HL) and their briefer version (3-SQ), and identify the best screen for inadequate HL in non-white populations.

METHODS: Sample included 378 individuals with type-2 diabetes. We computed sensitivity, specificity, positive and negative likelihood ratios, and C-indices, using the s-TOFHLA as a reference measure. We also conducted exploratory factor analysis, and used structural equation modeling (SEM) for confirmatory purposes.

RESULTS: Mean age was 56.1 years, 69% were female, and 83% were African-American. 10% had limited HL (s-TOHFLA scores <23). Six questions (6-SQ) were identified and included in the final item-reduced factor analysis, which showed good fit in confirmatory SEM (chi-square=9.5; P=0.305; RMSEA=0.023). Weighted summative score of the 6-SQ and the item "difficulty understanding written information" performed better than the 3-SQ in identifying patients with inadequate HL (C-indices 0.67 versus 0.75).

CONCLUSION: The weighted summative score of the 6-SQ and the item "difficulty understanding written information" performed better than the other items or combinations of these items in identifying individuals with inadequate HL.

PRACTICE IMPLICATIONS: The proposed weighting of scores could be applied in studies using these screening questions for better classification of inadequate HL.

Author List

Al Sayah F, Majumdar SR, Egede LE, Johnson JA

Author

Leonard E. Egede MD Center Director, Chief, Professor in the Medicine department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adult
Aged
Cross-Sectional Studies
Diabetes Mellitus, Type 2
Educational Measurement
Factor Analysis, Statistical
Female
Health Knowledge, Attitudes, Practice
Health Literacy
Humans
Male
Mass Screening
Middle Aged
Poverty
ROC Curve
Sensitivity and Specificity
Surveys and Questionnaires