title: Single-item or two-item literacy screener to predict the S-TOFHLA among adult hemodialysis patients.
abstract: OBJECTIVE
  We compared single-item (SILS) and two-item (TILS) literacy screeners in predicting Short Test of Functional Health Literacy in Adults (S-TOFHLA) scores.
  
  
  METHODS
  Adult hemodialysis patients completed SILS, which determines need for assistance when reading written medical information; TILS (last grade completed and self-reported reading ability); and S-TOFHLA. Receiver operator characteristic curves (ROC) and stratum specific likelihoods were calculated.
  
  
  RESULTS
  Of 227 participants, median S-TOFHLA was 24 (IQR 15-34). 129 (55%) participants had adequate, 70 (30%) inadequate, and 37 (16%) marginal health literacy. SILS and TILS predicted S-TOFHLA scores equivalently. Test characteristics predicting inadequate health literacy were: SILS sensitivity for threshold >1, 54% (95%CI: 44, 64), for >2, 39% (29, 49) and specificity for >1, 73% (64, 80), for >2, 93% (87, 97), area under the ROC of 0.67 (0.60-0.74); TILS sensitivity for threshold >1, 72% (62, 80), for >2, 30% (21, 40) and specificity for >1, 54% (45, 63), for >2, 86% (79, 92), area under the ROC of 0.66 (0.59-0.73).
  
  
  CONCLUSIONS
  SILS and TILS had similar test characteristics in predicting S-TOFHLA.
  
  
  CONCLUSIONS
  While a positive result on either test increases the likelihood that a patient has low health literacy, the SILS is easier to administer and score.
authors.affiliation: Department of Emergency Medicine, University of North Carolina, Chapel Hill, USA. Electronic address: brice@med.unc.edu.
authors.forename: Jane H
authors.initials: JH
authors.lastname: Brice
authors.affiliation: University of North Carolina, Chapel Hill, USA.
authors.forename: Mark B
authors.initials: MB
authors.lastname: Foster
authors.affiliation: Davidson University, Davidson, USA.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Principe
authors.affiliation: University of North Carolina, Chapel Hill, USA.
authors.forename: Chailee
authors.initials: C
authors.lastname: Moss
authors.affiliation: Department of Emergency Medicine, University of Pennsylvania, Philadelphia, USA.
authors.forename: Frances S
authors.initials: FS
authors.lastname: Shofer
authors.affiliation: Department of Medicine, University of North Carolina, Chapel Hill, USA.
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Falk
authors.affiliation: Department of Medicine, University of North Carolina, Chapel Hill, USA.
authors.forename: Maria E
authors.initials: ME
authors.lastname: Ferris
authors.affiliation: Department of Medicine, University of North Carolina, Chapel Hill, USA.
authors.forename: Darren A
authors.initials: DA
authors.lastname: DeWalt
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D004521:Educational Measurement; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D057220:Health Literacy; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D009657:North Carolina; D011237:Predictive Value of Tests; D012372:ROC Curve; D011932:Reading; D006435:Renal Dialysis; D015203:Reproducibility of Results; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires
keywords: Health literacy; Renal dialysis