Psychometric Properties of the Brief Health Literacy Screen in Clinical Practice
Psychometric Properties of the Brief Health Literacy Screen in Clinical Practice
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DOI：
10.1007/s11606-013-2568-0
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发表时间：
2014-01-01
影响因子：
5.7
通讯作者：
Kripalani, Sunil
中科院分区：
文献类型：
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作者：
Wallston, Kenneth A.;Cawthon, Courtney;Kripalani, Sunil
三项简要健康素养筛查（BHLS）已在研究环境中得到验证，但未在临床人员管理的常规实践中得到验证。作为健康素养筛查（HEALS）研究的一部分，我们评估了BHLS的心理测量特性，以验证临床护士在诊所和医院环境中的管理。从2010年10月开始，诊所和学术医疗中心医院的护士在病人入院期间管理BHLS，并将反应记录在电子健康记录中。训练有素的研究助理（RAs）进行成人功能健康素养短测试（S-TOFHLA），并对医院和诊所的方便样本患者重新进行BHLS测试。分析包括内部一致性信度、管理员间信度和并发效度的测试，通过比较护士管理和护士管理的BHLS分数（分别为BHLS- rn和BHLS- ra）与S-TOFHLA。在医院患者（N = 498）和临床患者（N = 295）中，BHLS-RN的Cronbach's alpha值分别为0.80和0.76，具有较高的内部一致性信度。临床患者BHLS-RN和BHLS-RA的类内相关性为0.77 (95% CI 0.71 ~ 0.82)，住院患者为0.49 （95% CI 0.40 ~ 0.58）。BHLS-RN评分与BHLS-RA评分显著相关（住院患者r = 0.33，临床患者r = 0.62），与S-TOFHLA评分显著相关（医院和临床患者r = 0.35），提供了管理者间信度和并发效度的证据。在回归模型中，调整年龄、教育程度、性别和种族后，BHLS-RN评分是S-TOFHLA评分的显著预测因子。BHLS-RN预测S-TOFHLA足够健康素养的受试者工作特征曲线下面积在医院为0.71，在诊所为0.76。由护士在常规临床护理期间进行的BHLS显示出足够的可靠性和有效性，可以用作健康素养措施。
The three-item Brief Health Literacy Screen (BHLS) has been validated in research settings, but not in routine practice, administered by clinical personnel.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.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.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.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.The BHLS, administered by nurses during routine clinical care, demonstrates adequate reliability and validity to be used as a health literacy measure.