Time to sign: The relationship between health literacy and signature time

Sharp, Lisa K.; Ureste, Peter; Torres, Leianne; Bailey, Lauren; Gordon, Howard S.; Gerber, Ben S.

doi:10.1016/j.pec.2012.10.012

Cited by 7 publications

(7 citation statements)

References 24 publications

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“…Similarly, patients with signature time > 9 s were more likely to be at inadequate HL level. Our findings are consistent with a previous study by Sharp and colleagues reporting high accuracy of signature time in predicting REALM HL levels in a population of inner city internal medicine patients [ 21 ]. This study expands the evidence base for the accuracy of signature time in predicting S-TOFHLA HL levels and in a population receiving specialized anticoagulation management.…”

Section: Discussionsupporting

confidence: 93%

“…Signature time was operationally defined as the time between the pen touching the paper to provide a signature and the pen being lifted off of the paper at the end of the signature [ 21 ]. Signature time was measured by RAs using a stopwatch in the large pocket of a white laboratory coat.…”

Section: Methodsmentioning

confidence: 99%

“…To overcome barriers for widespread screening, there is a need for quick, objective, less-stigmatizing and easy-to-administer HL measure [ 20 ]. Emerging evidence suggests that signature time may be a reliable, alternative option for HL screening [ 21 ]. Signature time is defined as the amount of time a person requires to sign their name on health-related documents [ 21 ].…”

Section: Introductionmentioning

confidence: 99%

“…Emerging evidence suggests that signature time may be a reliable, alternative option for HL screening [ 21 ]. Signature time is defined as the amount of time a person requires to sign their name on health-related documents [ 21 ]. To our knowledge, evidence evaluating signature time as a measure of HL has not been replicated to date in a population receiving long-term anticoagulation management.…”

Section: Introductionmentioning

confidence: 99%

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The Relationship Between Signature Time and Functional Health Literacy: Results from a Prospective Study of an Urban Low-Income Population Receiving Long-Term Anticoagulation

et al. 2023

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Introduction Low health literacy (HL) is consistently associated with worse health outcomes. Routine clinical screening with available instruments is impractical because of added time and effort. Prior findings suggested that signature time may be a reliable alternative measure of HL among general medicine patients. Methods Our aim was to assess the screening performance of signature time and explore optimal thresholds for identifying patients with limited HL in a chronically anticoagulated population. English-speaking patients receiving long-term anticoagulation therapy were recruited. HL was assessed using the Short Test of Functional Health Literacy in Adults (STOFHLA). Signature time was measured using a stopwatch. Logistic regression models and receiver-operating characteristic (ROC) curves were used to evaluate the association and accuracy of signature time compared to HL, respectively. Results Of 139 enrolled patients, mean age was 60.1 years, 70.5% were African-American, 48.9% reported < $25,000 income, and 27.3% had marginal or inadequate HL. Overall, median time to sign was 6.1 s. Signature time was longest with inadequate HL (median 9.5 s) compared to adequate HL (5.7 s; p < 0.01). Longer signature time was significantly associated with lower HL after adjusting for age and education (aOR 0.77, 95% CI: 0.68–0.88, p < 0.01). Signature time demonstrated high accuracy (area under the curve [AUC] > 0.8) in identifying HL levels. Thresholds of 5.1 s and 9.0 s showed appropriate screening performance in distinguishing patients with adequate vs. marginal and marginal vs. inadequate HL, respectively. Conclusion Signature time demonstrated strong screening performance and may offer a quick and practical approach to assessing HL among patients receiving long-term anticoagulation management.

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Section: Discussionsupporting

confidence: 93%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The Relationship Between Signature Time and Functional Health Literacy: Results from a Prospective Study of an Urban Low-Income Population Receiving Long-Term Anticoagulation

et al. 2023

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“…However, there have been substantial differences noted in gender and ethnicity, despite stratification for education [10,11]. There has been an increase in the development of new screening tools, particularly instruments that can be administered in under 15 min; however, many of them have not been extensively studied and tested [7,[12][13][14][15][16]. In terms of multiitem screening tools, the Newest Vital Sign (NVS) has been tested multiple times [17][18][19][20][21].…”

Section: Introductionmentioning

confidence: 99%

Hospital pharmacists understanding of available health literacy assessment tools and their perceived barriers for incorporation in patient education – a survey study

Chan

Spina

Zuk

et al. 2020

BMC Health Serv Res

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Background: Patients with low health literacy experience difficulty in understanding their medications leading to worse health outcomes. Pharmacists need to use formal assessment tools to be able to identify these patients, so they can better tailor their patient education. The objective of the study was to characterize hospital pharmacists understanding of health literacy and their use of screening and counselling strategies before and after completion of an educational module and to identify barriers that hospital pharmacists perceive to exist that prevent them from using health literacy tools. Methods: Pharmacists in three health authorities were administered a pre-survey and then given access to an online 11 min educational video. The post-survey was distributed 1 month later. Descriptive statistics were used to quantify survey responses with comparisons made between pre and post responses. The main outcome measure was pharmacists' understanding of health literacy and their current practice related to health literacy. Results: There were 131 respondents for the pre-survey and 39 for the post-survey. In the pre-module survey, 84% of pharmacists felt they understood what health literacy was, but only 53% currently assessed patients for their health literacy status and 40% were aware of what strategies to use in low health literacy patients. Lack of time (74%) was the biggest barrier in assessing patients' health literacy. In the post-module survey, 87% felt they understood what health literacy was and 64% incorporated health literacy status evaluation into their clinical practice. The educational module was helpful to the clinical practice of 74% of respondents. Conclusion: As health literacy can affect a patient's ability to adhere to their medications it is important for pharmacists to assess this in their patients. While pharmacists self-reported a high degree of understanding of health literacy, they are not regularly assessing their patients' health literacy status and are unaware of what strategies to use for low literacy patients.

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Growing evidence for ‘time to sign’

Lindau

2013

Patient Education and Counseling

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Time to sign: The relationship between health literacy and signature time

Cited by 7 publications

References 24 publications

The Relationship Between Signature Time and Functional Health Literacy: Results from a Prospective Study of an Urban Low-Income Population Receiving Long-Term Anticoagulation

The Relationship Between Signature Time and Functional Health Literacy: Results from a Prospective Study of an Urban Low-Income Population Receiving Long-Term Anticoagulation

Hospital pharmacists understanding of available health literacy assessment tools and their perceived barriers for incorporation in patient education – a survey study

Growing evidence for ‘time to sign’

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