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Quick identification of adults with limited health literacy

Clinical Question:
Is there a practical method for rapidly identifying adults with limited health literacy?

Bottom Line:
Three single-item questions (see the synopsis) are practical and useful for quickly identifying adults with limited health literacy. (LOE = 1a)

Powers BJ, Trinh JV, Bosworth HB. Can this patient read and understand written health information? JAMA 2010;304(1):76-84.  [PMID:20606152]

Study Design:
Systematic review


Not applicable

More than 90 million adults in the United States lack the necessary literacy skills to adequately function in the current health care system. These investigators thoroughly searched multiple databases for English language-only studies that evaluated instruments for identifying limited literacy in health care settings. Quality criteria included: (1) prospective sample size of at least 100 participants; (2) independent interpretation of acceptable reference standard and screening instrument; and (3) evaluation of the screening instrument in a sample representing a wide spectrum of adults in a community setting. Only studies meeting all 3 criteria, or those meeting at least 2 criteria but not considered invalid, were included. Two individuals independently reviewed all potential studies for inclusion and methodological quality. Disagreements were resolved by consensus with a third reviewer. Ten studies evaluating 6 unique tests for limited literacy were included. Useful single-item questions for identifying limited literacy in the busy office setting included:(1) "Do you usually ask someone to help you read materials you receive from the hospital?" (positive likelihood ratio [LR+] for "yes" = 4.5; 95% CI, 3.8-5.1; negative likelihood ratio [LR-] for "no" = 0.55; 0.51- 0.59); (2) "How confident are you filling out medical forms by yourself?" (LR+ for "little bit or not at all" = 5.0; 3.8-6.4; LR- for "extremely or quite a bit" = 0.44; 0.24-0.82); and (3) "How would you rate your ability to read?" (LR+ for "okay or poor/very poor" = 5.1; 3.2-8.3; LR- for "very good or excellent" = 0.16; 0.05-0.46).


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