Screening Hospitalized Patients for Low Health Literacy: Beyond the REALM of Possibility?

Abstract

As patient-centered education efforts increase, assessing health literacy (HL) becomes more salient. The verbal Brief Health Literacy Screen (BHLS) may have clinical and feasibility advantages over written tools, including the Rapid Estimate of Adult Literacy in Medicine–Revised (REALM-R) and Short Test of Functional Health Literacy in Adults (S-TOFHLA); however, the BHLS’s utility among inpatients remains unresolved. Hospitalized adults were enrolled; HL was assessed using three tools. Categorical comparisons used chi-square; area under the receiver operating characteristic curve was calculated (reference: REALM-R). The prevalence of low HL among participants (n = 260) was higher for the BHLS than S-TOFHLA (29% vs. 17%, p < .001) and higher for the REALM-R than both the BHLS (44% vs. 29%, p = .004) and S-TOFHLA (44% vs. 17%, p < .001). The areas under the receiver operating characteristic curve were .58 for BHLS and .66 for S-TOFHLA. The different prevalence of low HL among the participants based on each tool likely reflects the complexity of measuring HL and differing domains captured by each tool. The BHLS can be considered a viable inpatient HL screening tool, given its increased feasibility and verbal administration.