Estimating health literacy in family medicine clinics in metropolitan Detroit: A metronet study

Objective: assessing health literacy during the clinical encounter is difficult. many established instruments are lengthy and not practical for use in a busy practice setting. our objective was to compare the performance of 3 health literacy screening questions against the short test of functional health literacy for adults (s-tofhla) in an urban,ethnically diverse primary care practice-based research network. methods: a convenience sample of patients in clinics in the detroit area were recruited to complete a questionnaire that included the s-tofhla and 3 items similar to the chew screening questions. area under the receiver operating characteristic (auroc) curves compared the test characteristics of the screening questions to the s-tofhla. results: the participation rate was 92% (n = 599). most participants were women (65%) and african american (51%); 51.8% had a household annual income of <$20,000. almost all (96.7%) had an adequate score on the s-tofhla. the screening question with the largest auroc (0.83; 95% ci,0.70-0.95) was how often do you have someone help you read instructions,pamphlets or other written materials from your doctor or pharmacy?; the auroc for all 3 questions was 0.90 (95% ci,0.85- 0.95). conclusions: self-administration of the 3 screening questions demonstrated high performance compared with the 36-item s-tofhla interview instrument. these screening questions should help providers identify patients who may need extra support to follow health prescriptions.