title: The relationship between functional health literacy and adherence to emergency department discharge instructions among Spanish-speaking patients.
abstract: BACKGROUND
  Adherence to emergency department (ED) discharge instructions among immigrant Spanish-speaking populations in the United States is suboptimal. Our objectives were to: (1) investigate associations between functional health literacy (FHL) and ED discharge instruction adherence in Spanish-speaking populations, and (2) compare the ED adherence rates of Spanish speakersto English speakers.
  
  
  METHODS
  Using a matched cohort design, the FHL of adult native Spanish speakers in a tertiary care ED was assessed using the Test of Functional Health Literacy of Adults in Spanish (TOHFLA-S). Gender-matched and age-matched native English speakers were assessed using TOHFLA. TOFHLA scores range from 1 to 100 with adequate FHL cutoff at 74. Excluded patients were those aged less than 19 years, unwilling, prisoners, institutionalized, extremely ill, with a psychiatric complaint, in receipt of nonspecific instructions for follow-up, or with poor vision. A second interview assessed adherence with follow-up appointments and filling prescriptions.
  
  
  RESULTS
  Fifty matched pairs were enrolled. Spanish speakers were less likely to understand discharge instructions (Spanish speakers, 78%; English speakers, 94%; p < .0001) or to keep follow-up appointments (Spanish speakers, 46%; English speakers, 83%; p <.0001). TOFHLA for Spanish speakers averaged 62 vs 93 for English speakers (p < .0001). FHL was associated with understanding of and adherence to discharge instructions for Spanish speakers. Further, Spanish speakers reported lack of understanding as a primary reason for nonadherence.
  
  
  CONCLUSIONS
  Spanish-speaking patients were less likely to comply with discharge instructions and scored lower on a test of FHL than English-speaking patients. Poor adherence to ED discharge instructions was associated with lower FHL scores for our Spanish-speaking population. Alternative methods of providing discharge instructions to this population of patients should be explored.
authors.affiliation: Swedish Family Medicine Residency, Littleton, Colorado, USA.
authors.forename: Patrick Carlsen
authors.initials: PC
authors.lastname: Smith
authors.forename: Jane H
authors.initials: JH
authors.lastname: Brice
authors.forename: James
authors.initials: J
authors.lastname: Lee
mesh_terms: D000328:Adult; D004636:Emergency Service, Hospital; D005260:Female; D057220:Health Literacy; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D007802:Language; D008297:Male; D010349:Patient Compliance / Q000208:ethnology*; D010351:Patient Discharge