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. Author manuscript; available in PMC: 2015 Sep 1.
Published in final edited form as: Diabetes Educ. 2014 Jun 19;40(5):581–604. doi: 10.1177/0145721714540220

Table 1. Measures of Health Literacy and Numeracy in Diabetes.

Measure Items Measurement Description Sample Findings
Internal Consistency Reliability Construct Validity Predictive Validity
General
Brief Health Literacy Screen (BHLSa)17 3 Respondents are asked to rate their confidence completing medical forms, state how often they have problems learning, and if they need help completing medical forms. 296 English and Spanish-speaking adults with T2DMb 17 N/A Each BHLS item and the BHLS summative score were associated health literacy (STOFHLAc) 17 N/A
Brief Measures of Print Literacy and Numeracy18 3 (HLd), 4 (HNe) 3 item HL screener adapted from Chew et al.19
4 item HN items adapted from Lipkus20 and STOFHLAc 21
3,033 American Indian and Alaska Natives18 α = 0.67 for HLd items18 Both HLd and HNe associated with key demographics (age, education level, income) and diabetes and other disease related knowledge18 N/A
Newest Vital Sign (NVSf) 22 6 Respondents are asked to read and interpret a nutritional label. 205 adults with diabetes22 N/A NVS associated with educational attainment and health literacy (STOFHLAc, r =.54)22 N/A
Rapid Estimate of Adult Literacy in Medicine (REALMg)23 66 Respondents read medical words, and a correct response is given for each correct pronunciation. 240 adults with diabetes23 N/A REALM associated with health literacy (SKILLDh)23 N/A
Rapid Estimate of Adult Literacy in Medicine - revised (REALM-Ri)24 8 Respondents read medical words, and a correct response is given for each correct pronunciation. 125 adults with T2DMb; 71% AA; 68% less than HS24 α=0.95; item-test correlations, r=0.78-0.9124 N/A REALM-Ri associated with diabetes knowledge, but not A1C24
Rapid Estimate of Adult Literacy in Medicine - short form (REALM-SFj)22 7 Respondents read medical words, and a correct response is given for each correct pronunciation. 243 adults with diabetes22 N/A REALM-SF associated with educational attainment and health literacy (STOFHLAc, r =.48)22 N/A
Single-Item Literacy Screener (SILSk)25 1 Respondents rate how often they need to have someone help them read instructions, pamphlets, or other written material from their doctor or pharmacy.26 225 adults with diabetes25 N/A SILS was associated with health literacy (STOFHLAc) 25 N/A
Short Estimate of Functional Health Literacy in Adults (STOFHLAc)17,22,25,27,28 41 Respondents read two health-related passages, and complete 37 Cloze items and 4 numeracy items. 180 adolescents with asthma and diabetes27 N/A N/A STOFHLAc associated with intent to use online health resources27
225 adults with diabetes25 N/A Low scores on the STOFHLAc associated with black race, lower self-rated reading ability, lower educational attainment, and health literacy (SILSk)25 N/A
490 adults with diabetes22 N/A STOFHLAc associated with educational attainment and health literacy (NVSf [n=205, r=.54] and REALM-SFj [n=240, r =.48])22 N/A
296 English and Spanish-speaking adults with T2DMb 17 N/A STOFHLAc categories associated with health literacy (each BHLSa item and the BHLSa summative score)17 N/A
144 Latino adults with diabetes28 N/A STOFHLAc associated with the DNT-15l Latino28 N/A
Diabetes-specific
Diabetes Numeracy Test-15 (DNT-15l)28 15 Latino version of the original DNT.16,29 Items require respondents to perform addition, subtraction, understand fractions, divide, understand number hierarchy and perform calculations. 144 Latino adults with diabetes28 KR-20=0.7828 DNT-15 Latino associated with educational attainment, general numeracy (WRATm), and health literacy (STOFHLAc)28 DNT-15 Latino was associated with acculturation, but not self-care or A1Cn 28
DNT-Adolescent and DNT-14 Adolescent30 39 (DNT-Ao), (DNT-14p) Adolescent versions of the original DNT.16,29 Items require respondents to perform addition, subtraction, understand fractions, divide, understand number hierarchy and perform calculations related to common diabetes tasks. Sample 1=61 adolescents; Sample 2=72 adolescents30 Sample 1: KR-20=0.93
Sample 2: KR-20=0.83
Combined Sample (DNT-14p), KR-20=0.8230
In Sample 1, DNT-39q and DNT-14 associated with parent education, and adolescent reading skills (WRATm) 30
In Sample 2, DNT-14 associated with diabetes problem solving skills.
In Sample 1, DNT-39q and DNT-14p associated with insulin pump use.
In combined sample analysis, DNT-14p associated with A1Cn.30
Diabetes-specific Health Literacy Index (DHLIr)31 10 An index of diabetes specific health literacy was constructed from responses to 10 diabetes self-care regimen items. 1318 adults with diabetes31 α=0.9331 Compared to patients with the lowest DHLIs literacy level, patients with the highest DHLIr literacy level were more likely to be younger, White, have more education, but modestly less income31 DHLI associated with self-graded diabetes self-care, but was not associated with the average number of days performing five self-management behaviors or A1Cn 31
Literacy Assessment for Diabetes33 60 Respondents read words related to diabetes management and care, and a correct response is given for each correct pronunciation. 203 adults High test-retest reliability; ICC=.86 LAD had high concurrent validity with WRAT3 (r=.81) and REALM (r=.90) N/A
Spoken Knowledge in Low Literacy in Diabetes Scale (SKILLDh)23 10 Further validation of the original SKILLDh.32 Respondents answer open-ended questions about behaviors to manage diabetes. 240 adults with diabetes23 α=0.5423
Inter-rater reliability on 23 interviews; all kappas p<.001, Spearman's rho= 0.79% (95% CI 0.56 to 0.91, p<0.001)23
SKILLD associated with higher education, health literacy (REALMg), and diabetes knowledge (DKTs)23 N/A
a

BHLS = Brief Health Literacy Screen

b

T2DM = Type 2 Diabetes Mellitus

c

STOFHLA = Short Test of Functional Health Literacy in Adults

d

HL = Health Literacy

e

HN = Health Numeracy

f

NVS = Newest Vital Sign

g

REALM = Rapid Estimate of Adult Literacy in Medicine

h

SKILLD = Spoken Knowledge in Low Literacy in Diabetes Scale

i

REALM-R = Rapid Estimate of Adult Literacy in Medicine – Revised

j

REALM-SF = Rapid Estimate of Adult Literacy in Medicine – Short Form

k

SILS = Single-Item Literacy Screener

l

DNT-15 = Diabetes Numeracy Test – 15

m

WRAT = Wide Range Achievement Test

n

A1C = Hemoglobin A1C

o

DNT-A = Diabetes Numeracy Test - Adolescent

p

DNT-14 = Diabetes Numeracy Test 14

q

DNT-39 = Diabetes Numeracy Test 39

r

DHLI = Diabetes Specific Health Literacy Index

s

DKT = Diabetes Knowledge Test

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