Health Literacy Estimation of English and Spanish Language Caregivers

Abstract

Background: Provider ability to estimate caregiver health literacy (HL) in English-speaking caregivers has been shown to be poor, but estimation of HL in Spanish-speaking caregivers by physicians and staff has yet to be studied. Linguistic differences can further hinder communication in medical care. Objective: This study evaluated how well pediatric providers and staff predict caregiver HL as measured by two HL tools in a bilingual (English/Spanish) population. Method: For this study, we obtained a convenience sample of caregivers, evaluating one group with the Newest Vital Sign (NVS) and the second group with the Short Assessment of Health Literacy (SAHL). Physicians/nurse practitioners (NPs), and medical assistants (MAs) estimated caregiver scores for each tool. We dichotomized estimated and actual scores for each tool using published standards. We used McNemar's test and Cohen's Kappa to evaluate agreement between dichotomized predicted and actual scores. We used log binomial regression to examine how caregiver's language affected agreement between dichotomized caregiver scores and provider estimates. All physicians/NPs were native English speakers only and all MAs were native bilingual English/Spanish speakers. Physicians/NPs used interpretation services when appropriate. Key Results: Fifty caregivers were evaluated using the NVS and 50 using the SAHL. There was no overall association between dichotomized physician/NP or MA estimation and caregiver score for either tool. However, providers' estimates were less likely to match caregiver scores when the caregiver's language was Spanish (NVS: relative risk [RR] = 0.57 [95% CI 0.37, 0.87], SAHL: RR = 0.37 [95% CI 0.23,0.6]). Conclusion: Physician/NP and MA ability to estimate caregiver HL in English proficient and limited English proficiency caregivers is poor. The physician/NP group was less likely to estimate HL correctly if the caregivers spoke Spanish. Providers must use additional caution when providing cross-language care. [ HLRP: Health Literacy Research and Practice . 2018;2(2):e107–e114.] Plain Language Summary: This study examined estimation of health literacy of English- and Spanish-speaking caregivers by pediatric providers and medical assistants. We found that both providers and staff estimate caregiver health literacy poorly, and that primary language discordance may be a factor. The results support the institution of universal health literacy precautions for all caregivers of pediatric patients.

Health Literacy Perceptions and Knowledge in Pediatric Continuity Practices

“…There are ample data demonstrating that clinician assessment of health literacy of both patients and caregivers is poor ( Bass et al, 2002 ; Cooper et al, 2018 ; Kelly & Haidet, 2007 ), yet most physicians and especially residents felt they could adequately assess health literacy. Universal health literacy precautions were designed to reduce reliance on physician assessment or health literacy assessment tools to stratify the types of information given to patients and to ensure that all patients and caregivers received adequate information.…”

“…Unfortunately, studies have also shown that not only do physicians have difficulty identifying caregivers or patients with limited health literacy, but pediatricians feel they have inadequate communication skills and time to meet the needs of these caregivers ( Bass et al, 2002 ; Chesser et al, 2012 ; Cooper et al, 2018 ; Kelly & Haidet, 2007 ; Turner et al, 2009 ). Additionally, research shows that residents overestimate the clarity with which they communicate and instead often use medical jargon and rarely use clear communication strategies such as Teach-Back techniques ( Howard et al, 2013 ).…”

Diagnostic error experiences of patients and families with limited English-language health literacy or disadvantaged socioeconomic position in a cross-sectional US population-based survey

“…"24–28 Health literacy is widely recognised as a factor influenced by multiple social determinants of health including English proficiency, race, ethnicity, income and educational attainment 17 20. Its measurement may be particularly affected by language,18 29 30 such as whether health literacy is assessed in the predominant language of the healthcare organisation or in the patient’s native language. To overcome this challenge, some studies recommend assessing "confidence completing medical forms in English by yourself" 18.…”

“…In addition, patients may be reluctant to reveal limited health literacy 31 32. Studies suggest that some patients—especially those with language preferences other than English— may poorly estimate health literacy 29 33. Low health literacy is associated with poor health outcomes in various populations,17 18 29 and may be exacerbated by limited English proficiency 18 30 34.…”

“…Studies suggest that some patients—especially those with language preferences other than English— may poorly estimate health literacy 29 33. Low health literacy is associated with poor health outcomes in various populations,17 18 29 and may be exacerbated by limited English proficiency 18 30 34. We therefore defined limited LEHL using the validated item regarding confidence completing medical forms alone and the recommended "somewhat confident" cut-off 24; or Spanish-preference, as indicated by request to complete the survey in Spanish.…”