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 BHLS may have clinical and feasibility advantages over written tools, including the REALM-R and S-TOFHLA, however the BHLS’ utility among inpatients remains unresolved. Hospitalized adults were enrolled; HL was assessed using three tools. Categorical comparisons used Chi-square; AUROC 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<0.001) and higher for the REALM-R than both the BHLS (44% vs. 29%, p=0.004) and S-TOFHLA (44% vs. 17%, p<0.001). The AUROCs were 0.58 for BHLS and 0.66 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.

Provider and patient perception of psychiatry patient health literacy

“…Using previously validated studies, if a patient or provider answered ‘always’, ‘often’, or ‘sometimes’ to either ‘How often do you have someone help you read hospital materials?’ or ‘How often do you have problems learning about your mental health or medical condition?’ that was considered to be inadequate health literacy. 13 , 14 , 15 , 16 , 17 , 18 , 19 …”

“…These 3 questions, also known as the Short Literacy Survey (SLS) and the Brief Health Literacy Screen (BHLS) in other studies, have since been validated against the S-TOFHLA and Rapid Estimate of Adult Literacy in Medicine (REALM), another validated health literacy tool, in various other inpatient and outpatient populations. 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 The BHLS questions take 1.5 minutes to administer and can be administered verbally by a nurse without training. The BHLS could be used to develop a practical method for identifying patients with inadequate health literacy in a busy clinical setting.…”

Pharmacists in Home/Hospice/Palliative Care Settings

“…Patients particularly those with limited health literacyfound a hospital pharmacist-based intervention to be very helpful and empowering. The PILL-CVD study consisting of pharmacist-assisted medication reconciliation, inpatient pharmacist counseling, low-literacy adherence aids, and individualized telephone follow-up, on the number of clinically important medication errors after hospital discharge suggested more involvement of pharmacists and opportunities for better outcome [65][66][67][68][69].…”

Inpatient vision screening: A needs assessment

“…Since poor vision among inpatients has been found to increase the risk of falls and delirium, among other risk factors, recent guidelines by the Agency for Healthcare Research and Quality (AHRQ) recommend that inpatients have their glasses within reach and that poor inpatient vision should be identified as a modifiable risk factor in inpatient care (Fong, Tulebaev, & Inouye, 2009; “Preventing Falls in Hospitals,” 2013; Jaffee et al, 2016). Previous research has found that up to one-half of general medicine inpatients fail a basic bedside vision screen (Louis, Arora, Matthiesen, Meltzer, & Press, 2017; Press et al, 2015; Press, Shapiro, Mayo, Meltzer, & Arora, 2013). Therefore, a simple vision screening test utilized in the hospital inpatient setting may be an important link in improving vision and reducing risks related to poor vision.…”