title: Health literacy among Spanish-speaking patients in the emergency department.
abstract: OBJECTIVE
  Health literacy influences a patient's ability to read and understand labels on medicine containers, appointment slips, informed-consent documents and medical instructions--all of which are considered basic health documents that a patient encounters in healthcare settings. Previous research suggests Spanish-speaking patients have low levels of health literacy. This study compares the functional health literacy (FHL) of Spanish- and English-speaking adult patients in a suburban emergency department (ED).
  
  
  METHODS
  Through a prospective, matched cohort design, Spanish-speaking adult patients and pediatric guardians presenting to the ED were matched with English-speaking patients by age, gender and treatment area. Demographic information, including total years of school completed and self-assessed reading ability, was collected. The Test of Functional Health Literacy in Adults (TOFHLA) was administered in the subject's primary language. A score of <60 indicated inadequate FHL, 60-74 marginally adequate FHL, and >74 adequate literacy.
  
  
  RESULTS
  Eighty-six matched pairs were enrolled. The median age was 30.5 years, and 56% were male. Spanish speakers averaged a TOFHLA score of 59.72, and English speakers 90.78. Only 7% of English speakers had less-than-adequate FHL compared to 74% of Spanish speakers. The average years of school completed were 10.59 (7.95 Spanish; 13.19 English), and 55% of English speakers reported "excellent" reading ability compared to 13% of Spanish speakers. Last grade completed (p=0.004) and self-assessed reading ability (p=0.0007) are predictors of TOFHLA scores. Those subjects who completed less than the eighth grade had inadequate FHL.
  
  
  CONCLUSIONS
  The majority of Spanish-speaking subjects have less-than-adequate FHL. Self-reported reading ability and years of school completed appear to predict FHL and may be clinically useful. Due to the disproportionately low level of health literacy among Spanish-speaking patients demonstrated in this and previous studies, future efforts should focus on developing programs that improve health literacy by providing this population with oral translations and pictorial and video instructions.
authors.affiliation: Department of Emergency Medicine, University of North Carolina, Chapel Hill, NC 27599, USA. brice@med.unc.edu
authors.forename: Jane H
authors.initials: JH
authors.lastname: Brice
authors.forename: Debbie
authors.initials: D
authors.lastname: Travers
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Cowden
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Young
authors.forename: Antonio
authors.initials: A
authors.lastname: Sanhueza
authors.forename: Yolanda
authors.initials: Y
authors.lastname: Dunston
mesh_terms: D000328:Adult; D054521:Cultural Competency; D004522:Educational Status; D004636:Emergency Service, Hospital; D005260:Female; D006630:Hispanic or Latino; D006801:Humans; D008297:Male; D011446:Prospective Studies; D011932:Reading