title: Can screening items identify surgery patients at risk of limited health literacy?
abstract: BACKGROUND
  Health literacy skills (HLS) have been shown to have a major impact on patient outcomes. To identify patients with limited or marginal HLS, the accuracy of three established screening items were examined.
  
  
  METHODS
  We studied English-speaking adults (>or=21 years) attending a university-based vascular surgery clinic. Structured interviews were conducted to assess sociodemographic characteristics, screening items, and HLS. Area under the receiver operating characteristic (AUROC) curves were plotted to assess the discriminatory capacity of each screening item in detecting patients with limited/marginal HLS.
  
  
  RESULTS
  One hundred patients agreed to enter the study and met inclusion criteria. The mean age was 62.0 +/- 12.9; 65 were female; 96 were Caucasian; and 32 had not completed high school. The three screening items were effective in detecting patients with limited (n=18) or marginal (n=21) HLS. "How often do you have someone (like a family member, friend, or hospital worker) help you read hospital materials?" (AUROC of 0.83; 95% confidence interval [CI]=0.73, 0.92), "How often do you have problems learning about your medical condition because of difficulty understanding written information?" (AUROC of 0.77; 95% CI=0.67, 0.86), and "How confident are you filling out medical forms by yourself?" (AUROC of 0.76; 95% CI=0.66, 0.86) were effective in detecting those with limited/marginal HLS skills.
  
  
  CONCLUSIONS
  Our findings provide further evidence of the clinical usefulness of these screening items for detecting inadequate HLS in this patient population. Surgeons should consider administering these easy screening items to identify patients at greatest risk of limited or marginal HLS.
authors.affiliation: Department of Family Medicine, University of Tennessee Graduate School of Medicine, Knoxville, Tennessee 37920, USA. lwallace@mc.tumck.edu
authors.forename: Lorraine S
authors.initials: LS
authors.lastname: Wallace
authors.forename: David C
authors.initials: DC
authors.lastname: Cassada
authors.forename: Edwin S
authors.initials: ES
authors.lastname: Rogers
authors.forename: Michael B
authors.initials: MB
authors.lastname: Freeman
authors.forename: Oscar H
authors.initials: OH
authors.lastname: Grandas
authors.forename: Scott L
authors.initials: SL
authors.lastname: Stevens
authors.forename: Mitchell H
authors.initials: MH
authors.lastname: Goldman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000554:Ambulatory Care Facilities; D019540:Area Under Curve; D003142:Communication; D032882:Comprehension; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods* / Q000706:statistics & numerical data; D010817:Physician-Patient Relations; D012308:Risk Management / Q000379:methods*; D011795:Surveys and Questionnaires; D014656:Vascular Surgical Procedures