Screening Questions to Predict Limited Health Literacy: A Cross-Sectional Study of Patients With Diabetes Mellitus
Screening Questions to Predict Limited Health Literacy: A Cross-Sectional Study of Patients With Diabetes Mellitus
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DOI：
10.1370/afm.919
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发表时间：
2009-01-01
影响因子：
4.4
通讯作者：
Miser, William F.
中科院分区：
文献类型：
--
作者：
Jeppesen, Kelly Marvin;Coyle, James D.;Miser, William F.
有限的健康知识越来越被认为是获得足够医疗保健的障碍。目前，临床医生的责任是识别继发于有限健康素养的不良健康结果风险的患者。我们的目标是确定筛选问题和人口统计独立预测有限的健康素养，从而可以帮助临床医生个性化他们的病人education.METHODS之间的2006年8月和2007年7月，我们问了225例患者正在接受治疗的糖尿病在学术初级保健办公室几个问题，他们的阅读能力的一部分，一个更大的研究（57%的应答率）。我们建立了一个逻辑回归模型，预测有限的健康素养，以确定这些问题和人口统计学变量的独立预测属性。如果患者的成人功能性健康素养短期测试（S-TOFHLA）评分低于23分，则将其归类为健康素养有限。评估的潜在预测因素是自评阅读能力，达到的最高教育水平，单项识字筛选（锡尔斯）的结果，患者的阅读享受，年龄，性别和race.RESULTS总体而言，15.1%的患者有有限的健康素养。在最终的模型中，5个潜在的预测因素与健康素养有限的几率增加独立相关。具体来说，如果患者的自评阅读能力较差，则他们的健康素养更有可能受到限制（模型中每增加一点的比值比[OR]= 3.37; 95%置信区间[CI]，1.71-6.63），更频繁地需要帮助阅读书面健康材料（由锡尔斯评估）（OR = 2.03，95%CI，1.26-3.26），文化程度低（OR = 1.89; 95%CI，1.12-3.18），男性（OR = 4.46; 95%CI，1.53-12.99），非白人（OR = 3.73; 95%CI，1.04-13.40）。这些关联并不受年龄的影响。受试者工作特征曲线下面积为0.9212。结论自测阅读能力、锡尔斯结果、最高教育程度、性别和种族独立预测患者是否具有有限的健康素养。临床医生应该意识到这些相关性，并提出问题以识别有风险的患者。我们提出了一个“SOS”助记符的基础上，这些研究结果，以帮助临床医生希望个性化的病人教育。
PURPOSE Limited health literacy is increasingly recognized as a barrier to receiving adequate health care. Identifying patients at risk of poor health outcomes secondary to limited health literacy is currently the responsibility of clinicians. Our objective was to identify which screening questions and demographics independently predict limited health literacy and could thus help clinicians individualize their patient education.METHODS Between August 2006 and July 2007, we asked 225 patients being treated for diabetes at an academic primary care office several questions regarding their reading ability as part of a larger study (57% response rate). We built a logistic regression model predicting limited health literacy to determine the independent predictive properties of these questions and demographic variables. Patients were classified as having limited health literacy if they had a Short Test of Functional Health Literacy in Adults (S-TOFHLA) score of less than 23. The potential predictors evaluated were self-rated reading ability, highest education level attained, Single-Item Literacy Screener (SILS) result, patients' reading enjoyment, age, sex, and race.RESULTS Overall, 15.1% of the patients had limited health literacy. In the final model, 5 of the potential predictors were independently associated with increased odds of having limited health literacy. Specifically, patients were more likely to have limited health literacy if they had a poorer self-rated reading ability (odds ratio [OR] per point increase in the model = 3.37; 95% confidence interval [CI], 1.71-6.63), more frequently needed help reading written health materials (assessed by the SILS) (OR = 2.03; 95% CI, 1.26-3.26), had a lower education level (OR = 1.89; 95% CI, 1.12-3.18), were male (OR = 4.46; 95% CI, 1.53-12.99), and were of nonwhite race (OR = 3.73; 95% CI, 1.04-13.40). These associations were not confounded by age. The area under the receiver operating characteristic curve was 0.9212.CONCLUSIONS Self-rated reading ability, SILS result, highest education level attained, sex, and race independently predict whether a patient has limited health literacy. Clinicians should be aware of these associations and ask questions to identify patients at risk. We propose an "SOS" mnemonic based on these findings to help clinicians wishing to individualize patient education.