A single question may be useful for detecting patients with inadequate health literacy in a VA population.

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OBJECTIVES: This paper compares estimates of poor health literacy using two widely used assessment tools and assesses the effect of non-response on these estimates. STUDY DESIGN AND SETTING: A total of 4,868 veterans receiving care at four VA medical facilities between 2004 and 2005 were stratified by age and facility and randomly selected for recruitment. Interviewers collected demographic information and conducted assessments of health literacy (both REALM and S-TOFHLA) from 1,796 participants. Prevalence estimates for each assessment were computed. Nonrespondents received a brief proxy questionnaire with demographic and self-report literacy questions to assess non-response bias. Available administrative data for non-participants were also used to assess nonresponse bias. RESULTS: Among the 1,796 patients assessed using the S-TOFHLA, 8% had inadequate and 7% had marginal skills. For the REALM, 4% were categorized with 6th grade skills and 17% with 7-8th grade skills. Adjusting for non-response bias increased the S-TOFHLA prevalence estimates for inadequate and marginal skills to 9.3% and 11.8%, respectively, and the REALM estimates for≤6th and 7-8th grade skills to 5.4% and 33.8%, respectively. CONCLUSIONS: Estimates of poor health literacy varied by the assessment used, especially after adjusting for non-response bias. Researchers and clinicians should consider the possible limitations of each assessment when considering the most suitable tool for their purposes.

We applied emerging evidence in simulation science to create a curriculum in emergency response for health science students and professionals. Our research project was designed to (1) test the effectiveness of specific immersive simulations, (2) create reliable assessment tools for emergency response and team communication skills, and (3) assess participants' retention and transfer of skills over time. We collected both quantitative and qualitative data about individual and team knowledge, skills, and attitudes. Content experts designed and pilot-tested scaled quantitative tools. Qualitative evaluations administered immediately after simulations and longitudinal surveys administered 6-12 months later measured student participants' individual perceptions of their confidence, readiness for emergency response, and transfer of skills to their day-to-day experience. Results from 312 participants enrolled in nine workshops during a 24-month period indicated that the 10-hour curriculum is efficient (compared with larger-scale or longer training programs) and effective in improving skills. The curriculum may be useful for public health practitioners interested in addressing public health emergency preparedness competencies and Institute of Medicine research priority areas.

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