title: Psychometric properties of the brief health literacy screen in clinical practice.
abstract: BACKGROUND
  The three-item Brief Health Literacy Screen (BHLS) has been validated in research settings, but not in routine practice, administered by clinical personnel.
  
  
  OBJECTIVE
  As part of the Health Literacy Screening (HEALS) study, we evaluated psychometric properties of the BHLS to validate its administration by clinical nurses in both clinic and hospital settings.
  
  
  METHODS
  Beginning in October 2010, nurses in clinics and the hospital at an academic medical center have administered the BHLS during patient intake and recorded responses in the electronic health record.
  
  
  METHODS
  Trained research assistants (RAs) administered the short Test of Functional Health Literacy in Adults (S-TOFHLA) and re-administered the BHLS to convenience samples of hospital and clinic patients. Analyses included tests of internal consistency reliability, inter-administrator reliability, and concurrent validity by comparing the nurse-administered versus RA-administered BHLS scores (BHLS-RN and BHLS-RA, respectively) to the S-TOFHLA.
  
  
  RESULTS
  Cronbach's alpha for the BHLS-RN was 0.80 among hospital patients (N = 498) and 0.76 among clinic patients (N = 295), indicating high internal consistency reliability. Intraclass correlation between the BHLS-RN and BHLS-RA among clinic patients was 0.77 (95 % CI 0.71-0.82) and 0.49 (95 % CI 0.40-0.58) among hospital patients. BHLS-RN scores correlated significantly with BHLS-RA scores (r = 0.33 among hospital patients; r = 0.62 among clinic patients), and with S-TOFHLA scores (r = 0.35 among both hospital and clinic patients), providing evidence of inter-administrator reliability and concurrent validity. In regression models, BHLS-RN scores were significant predictors of S-TOFHLA scores after adjustment for age, education, gender, and race. Area under the receiver operating characteristic curve for BHLS-RN to predict adequate health literacy on the S-TOFHLA was 0.71 in the hospital and 0.76 in the clinic.
  
  
  CONCLUSIONS
  The BHLS, administered by nurses during routine clinical care, demonstrates adequate reliability and validity to be used as a health literacy measure.
authors.affiliation: School of Nursing, Vanderbilt University, Nashville, TN, USA.
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Wallston
authors.forename: Courtney
authors.initials: C
authors.lastname: Cawthon
authors.forename: Candace D
authors.initials: CD
authors.lastname: McNaughton
authors.forename: Russell L
authors.initials: RL
authors.lastname: Rothman
authors.forename: Chandra Y
authors.initials: CY
authors.lastname: Osborn
authors.forename: Sunil
authors.initials: S
authors.lastname: Kripalani
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D000554:Ambulatory Care Facilities; D004521:Educational Measurement / Q000379:methods; D005260:Female; D057220:Health Literacy; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods* / Q000592:standards; D008875:Middle Aged; D009738:Nursing Service, Hospital; D010343:Patient Admission; D059017:Primary Care Nursing; D011594:Psychometrics; D012372:ROC Curve; D015203:Reproducibility of Results; D013714:Tennessee
references.citation: J Biomed Inform. 2009 Apr;42(2):377-81
references.pmid: 18929686
references.citation: J Gen Intern Med. 2006 Aug;21(8):874-7
references.pmid: 16881950
references.citation: Jt Comm J Qual Patient Saf. 2014 Feb;40(2):68-76
references.pmid: 24716329
references.citation: Acad Emerg Med. 2011 Nov;18(11):1148-55
references.pmid: 22092896
references.citation: Patient Educ Couns. 1999 Sep;38(1):33-42
references.pmid: 14528569
references.citation: J Gen Intern Med. 2008 May;23(5):561-6
references.pmid: 18335281
references.citation: Fam Med. 1991 Aug;23(6):433-5
references.pmid: 1936717
references.citation: J Gen Intern Med. 2006 Aug;21(8):878-83
references.pmid: 16881951
references.citation: Am J Med. 2005 Apr;118(4):371-7
references.pmid: 15808134
references.citation: J Gen Intern Med. 2005 Nov;20(11):1042-4
references.pmid: 16307631
references.citation: J Am Geriatr Soc. 2006 May;54(5):770-6
references.pmid: 16696742
references.citation: J Gen Intern Med. 2006 Aug;21(8):884-7
references.pmid: 16881952
references.citation: Int J Public Health. 2009;54(5):313-24
references.pmid: 19644651
references.citation: JAMA. 2010 Jul 7;304(1):76-84
references.pmid: 20606152
references.citation: J Gen Intern Med. 1995 Oct;10(10):537-41
references.pmid: 8576769
references.citation: Fam Med. 1993 Jun;25(6):391-5
references.pmid: 8349060
references.citation: J Gen Intern Med. 2011 Mar;26(3):265-71
references.pmid: 21057882
references.citation: Fam Med. 2004 Sep;36(8):588-94
references.pmid: 15343421
references.citation: Ann Intern Med. 2011 Jul 19;155(2):97-107
references.pmid: 21768583
references.citation: J Surg Res. 2007 Jun 15;140(2):208-13
references.pmid: 17509266
references.citation: Acad Med. 2002 Oct;77(10):1039-41
references.pmid: 12377684
references.citation: J Gen Intern Med. 2008 Jan;23(1):100-2
references.pmid: 17992564
references.citation: Patient Educ Couns. 2007 Apr;66(1):119-22
references.pmid: 17140758