title: Estimating health literacy in family medicine clinics in metropolitan Detroit: a MetroNet study.
abstract: OBJECTIVE
  Assessing health literacy during the clinical encounter is difficult. Many established instruments are lengthy and not practical for use in a busy practice setting. Our objective was to compare the performance of 3 health literacy screening questions against the Short Test of Functional Health Literacy for Adults (S-TOFHLA) in an urban, ethnically diverse primary care practice-based research network.
  
  
  METHODS
  A convenience sample of patients in clinics in the Detroit area were recruited to complete a questionnaire that included the S-TOFHLA and 3 items similar to the Chew screening questions. Area under the receiver operating characteristic (AUROC) curves compared the test characteristics of the screening questions to the S-TOFHLA.
  
  
  RESULTS
  The participation rate was 92% (N = 599). Most participants were women (65%) and African American (51%); 51.8% had a household annual income of <$20,000. Almost all (96.7%) had an adequate score on the S-TOFHLA. The screening question with the largest AUROC (0.83; 95% CI, 0.70-0.95) was "How often do you have someone help you read instructions, pamphlets or other written materials from your doctor or pharmacy?"; the AUROC for all 3 questions was 0.90 (95% CI, 0.85-0.95).
  
  
  CONCLUSIONS
  Self-administration of the 3 screening questions demonstrated high performance compared with the 36-item S-TOFHLA interview instrument. These screening questions should help providers identify patients who may need extra support to follow health prescriptions.
authors.affiliation: Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, MI 48201, USA.
authors.forename: Kendra L
authors.initials: KL
authors.lastname: Schwartz
authors.forename: Monina
authors.initials: M
authors.lastname: Bartoces
authors.forename: Kimberly
authors.initials: K
authors.lastname: Campbell-Voytal
authors.forename: Patricia
authors.initials: P
authors.lastname: West
authors.forename: Joseph
authors.initials: J
authors.lastname: Monsur
authors.forename: Ashleigh
authors.initials: A
authors.lastname: Sartor
authors.forename: Anne Victoria
authors.initials: AV
authors.lastname: Neale
mesh_terms: D000554:Ambulatory Care Facilities; D004522:Educational Status; D005194:Family Practice; D005260:Female; D057220:Health Literacy; D006801:Humans; D008297:Male; D008824:Michigan; D008875:Middle Aged; D011320:Primary Health Care; D012372:ROC Curve; D012494:Sampling Studies; D011795:Surveys and Questionnaires; D014505:Urban Population
keywords: Health Literacy; Primary Health Care; Urban Health Services