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 |
BHLS = Brief Health Literacy Screen
T2DM = Type 2 Diabetes Mellitus
STOFHLA = Short Test of Functional Health Literacy in Adults
HL = Health Literacy
HN = Health Numeracy
NVS = Newest Vital Sign
REALM = Rapid Estimate of Adult Literacy in Medicine
SKILLD = Spoken Knowledge in Low Literacy in Diabetes Scale
REALM-R = Rapid Estimate of Adult Literacy in Medicine – Revised
REALM-SF = Rapid Estimate of Adult Literacy in Medicine – Short Form
SILS = Single-Item Literacy Screener
DNT-15 = Diabetes Numeracy Test – 15
WRAT = Wide Range Achievement Test
A1C = Hemoglobin A1C
DNT-A = Diabetes Numeracy Test - Adolescent
DNT-14 = Diabetes Numeracy Test 14
DNT-39 = Diabetes Numeracy Test 39
DHLI = Diabetes Specific Health Literacy Index
DKT = Diabetes Knowledge Test