Objective:
To examine the measurement properties of the 16 screening questions (16-sq) of inadequate health literacy (hl) and their briefer version (3-sq), and identify the best screen for inadequate hl in non-white populations.
Methods:
Sample included 378 individuals with type-2 diabetes. we computed sensitivity, specificity, positive and negative likelihood ratios, and c-indices, using the s-tofhla as a reference measure. we also conducted exploratory factor analysis, and used structural equation modeling (sem) for confirmatory purposes.
Results:
Mean age was 56.1 years, 69% were female, and 83% were african-american. 10% had limited hl (s-tohfla scores <23). six questions (6-sq) were identified and included in the final item-reduced factor analysis, which showed good fit in confirmatory sem (chi-square=9.5; p=0.305; rmsea=0.023). weighted summative score of the 6-sq and the item "difficulty understanding written information" performed better than the 3-sq in identifying patients with inadequate hl (c-indices 0.67 versus 0.75).
Conclusion:
The weighted summative score of the 6-sq and the item "difficulty understanding written information" performed better than the other items or combinations of these items in identifying individuals with inadequate hl.
Practice implications:
The proposed weighting of scores could be applied in studies using these screening questions for better classification of inadequate hl.