Development of an Easy-to-Use Spanish Health Literacy Assessment Tool

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Development of an Easy-to-Use Spanish Health
Literacy Assessment Tool

• Shoou-Yih D. Lee, PhD 1
• Deborah E. Bender, PhD 1
• Rafael Ruiz, ScM 1
• Young Ik Cho, PhD 2
• 1 University of North Carolina at Chapel Hill
• 2 University of Illinois at Chicago

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Problems of Low Health Literacy

• Health literacy means the degree to which
  individuals have the capacity to obtain, process,
  and understand basic health information and
  services needed to make appropriate health
  decisions.
• Inadequate health literacy may reduce health
  status, and possibly threaten health care quality
  and increase the use of unnecessary high-cost
  services.
• Inadequate health literacy may cost 30 billion
  to 73 billion in 1998 U.S. dollars, or about 3.2
  to 7.6 percent of personal health care
  expenditures

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Health Literacy Among Latinos

• Latinos are the fastest growing ethnic group in
  the U.S. In 2003, they surpassed African
  Americans to become the nations largest minority
  group. Their share of the U.S. population is
  expected to rise to more than 21 in the
  mid-2000s.
• The growth of the Latino population has created
  new demands on our health care system.
• Low health literacy may be a particularly salient
  problem among Latinos. What is the extent of the
  problem? What is its health impact?... NOT MUCH
  IS KNOWN!

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Assessment of Spanish Health Literacy

• One existing instrument Spanish Test of
  Functional Health Literacy in Adults (S-TOFHLA)-
  a comprehension test, containing sections on
  reading comprehension and a numeracy.- lengthy,
  cumbersome to administer and score
• Rapid Estimate of Adult Literacy in Medicine
  (REALM)- a word recognition test (if examinees
  have trouble pronouncing words, which is a
  beginning-level reading skills, they are likely
  to have difficulty with comprehension, which is a
  higher order skill)- short, easy to use-
  construction of a Spanish version failed because
  of regular phoneme-grapheme correspondence in the
  Spanish language- lack of a correspondence
  between the reading and comprehension abilities
  in Spanish-speaking Latinos

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Rapid Estimate of Adult Literacy in Medicine
(REALM)
ASK THE RESPONDENT TO READ ALOUD THE FOLLOWING
WORDS, STARTING FROM LIST 1 AND THEN LIST 2 AND
LIST 3.   Here are three lists of words. Please
read them aloud to me. (GIVE EACH LIST TO
RESPONDENT. CHECK WORDS HE/SHE CAN
READ/PRONOUNCE CORRECTLY.)   List 1 List
2 List 3 fat ________ fatigue ________
allergic ________ flu ________
pelvic ________ menstrual ________
pill ________ jaundice ________
testicle ________ dose ________
infection ________ colitis ________
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Short Assessment of Health Literacy for Spanish
Adults (SAHLSA)

• A modification of REALM by incorporating
  questions that test the examinees understanding
  of the meanings of the words.
• The test is analogous to multiple-choice
  questions. It consists of a stem (in the form of
  a question or command) and choices (in the form
  of an answer to the question or command)- Stem
  question or command- Key correct choice-
  Distractor incorrect but plausible choice

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SAHLSA
Im going to show you cards with 3 words on them.
First I would like you to read the word on the
top out loud. Then I will read the two words on
the bottom to you and I would like you to tell me
which on of the two words is more similar to the
word on the top. If you do not know the answer,
please say, dont know. Do not guess. fat
_________ ___orange ___butter ___dont
know flu _________ ___well ___sick ___dont
know pill _________ ___tablet ___cookie ___dont
know dose _________ ___sleep ___amount ___dont
know eye _________ ___listen ___see ___dont
know stress _________ ___worry ___happy ___dont
know pap smear _________ ___test
___vaccine ___dont know nerves _________ ___bore
d ___anxiety ___dont know germs _________ ___bact
eria ___mood ___dont know meals _________ ___dinn
er ___walk ___dont know disease _________ ___diab
etes ___exercise ___dont know cancer _________ __
_tumor ___fracture ___dont know
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Procedures for the Development of SAHLSA

• Instrument development the Delphi process-
  Translation of the 66 medical terms in REALM-
  Selection of the appropriate key and distractor
  for each of the 66 medical terms in English-
  Translation and back translation of the selected
  keys and distractors
• Validation of the instrument- Pilot-testing with
  10 English-speaking and 10 Spanish-speaking
  patients at the UNC Ambulatory Care Center-
  Interviewing 202 English-speaking and 201
  Spanish-speaking patients to test the
  instruments validity and reliability

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Results

•  

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Results (cont.)

• Item response analysis and OLS were used to
  reduce the number of items while increasing the
  discriminatory power of SAHLSA
• Reduced to 37 items
• Correlated with TOFHLA at r0.72
• Significantly correlated with health status at
  r0.17 (correlation between TOFHLA and health
  status is r0.15)
• Correlated with education at r0.53 (correlation
  between TOFHLA and education is r0.52 in Spanish
  speakers and r0.40 in English speakers)
• Test-retest reliability is r0.80

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Discussion

• Healthy People 2010 Objectives Draft for the
  Public Comment notes that health literacy is
  "increasingly vital to help people critically
  evaluate health information"
• Rapid growth of Hispanic residents in the nation
  makes the development of a reliable and
  easy-to-use health literacy assessment tool in
  Spanish an important task
• Results suggest SAHLSA is valid and reliable
• Further improvement will make SAHLSA an
  easy-to-use screening tool in clinical and
  community settings