摘要：Objectives. To evaluate 3 single-item screening measures for limited health literacy in a community-based population of English and Spanish speakers. Methods. We recruited 324 English and 314 Spanish speakers from a community research registry in Dallas, Texas, enrolled between 2009 and 2012. We used 3 screening measures: (1) How would you rate your ability to read?; (2) How confident are you filling out medical forms by yourself?; and (3) How often do you have someone help you read hospital materials? In analyses stratified by language, we used area under the receiver operating characteristic (AUROC) curves to compare each item with the validated 40-item Short Test of Functional Health Literacy in Adults. Results. For English speakers, no difference was seen among the items. For Spanish speakers, “ability to read” identified inadequate literacy better than “help reading hospital materials” (AUROC curve = 0.76 vs 0.65; P = .019). Conclusions. The “ability to read” item performed the best, supporting use as a screening tool in safety-net systems caring for diverse populations. Future studies should investigate how to implement brief measures in safety-net settings and whether highlighting health literacy level influences providers’ communication practices and patient outcomes. Health literacy—ability to obtain, process, and understand basic health information and services needed to make health decisions—is a key health determinant, particularly for Hispanic immigrants. 1,2 Recent reforms following the Affordable Care Act ask health care systems to identify low health literacy patients, provide special assistance, and incorporate health literacy into quality metrics. 3 Administration of validated measures such as the Short Test of Functional Health Literacy in Adults (STOFHLA) takes 3 to 8 minutes. 4 Brief single-item measures that indirectly assess literacy and are documented in electronic health records are needed. However, these measures have been studied mostly among English speakers 5–7 who are chronically ill. 8–10 Safety-net systems are willing to conduct literacy screening 1 but need valid measures for their diverse population, particularly Spanish-speaking patients (40% of US Hispanic individuals are foreign-born, and fewer than 25% of them report speaking English very well 11 ). We evaluated 3 single items against the STOFHLA, a well-accepted, commonly used measure, in a community-based population of English and Spanish speakers.
