The Single Item Literacy Screener: evaluation of a brief instrument to identify limited reading ability.
BACKGROUND
Reading skills are important for accessing health information, using health care services, managing one's health and achieving desirable health outcomes. Our objective was to assess the diagnostic accuracy of the Single Item Literacy Screener (SILS) to identify limited reading ability, one component of health literacy, as measured by the S-TOFHLA.


METHODS
Cross-sectional interview with 999 adults with diabetes residing in Vermont and bordering states. Participants were randomly recruited from Primary Care practices in the Vermont Diabetes Information System June 2003-December 2004. The main outcome was limited reading ability. The primary predictor was the SILS.


RESULTS
Of the 999 persons screened, 169 (17%) had limited reading ability. The sensitivity of the SILS in detecting limited reading ability was 54% [95% CI: 47%, 61%] and the specificity was 83% [95% CI: 81%, 86%] with an area under the Receiver Operating Characteristics Curve (ROC) of 0.73 [95% CI: 0.69, 0.78]. Seven hundred seventy (77%) screened negative on the SILS and 692 of these subjects had adequate reading skills (negative predictive value = 0.90 [95% CI: 0.88, 0.92]). Of the 229 who scored positive on the SILS, 92 had limited reading ability (positive predictive value = 0.4 [95% CI: 0.34, 0.47]).


CONCLUSIONS
The SILS is a simple instrument designed to identify patients with limited reading ability who need help reading health-related materials. The SILS performs moderately well at ruling out limited reading ability in adults and allows providers to target additional assessment of health literacy skills to those most in need. Further study of the use of the SILS in clinical settings and with more diverse populations is warranted.
Morris
Nancy S
NS
College of Nursing and Health Sciences, University of Vermont, Burlington, Vermont, USA. nancy.morris@uvm.edu
MacLean
Charles D
CD
Chew
Lisa D
LD
Littenberg
Benjamin
B
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D032882:Comprehension; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus; D004521:Educational Measurement / Q000379:methods*; D004522:Educational Status; D005194:Family Practice; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology; D010353:Patient Education as Topic; D011320:Primary Health Care; D011932:Reading; D011795:Surveys and Questionnaires; D014707:Vermont