Rapid Estimate of Inadequate Health Literacy (REIHL): development and validation of a practitioner-friendly health literacy screening tool for older adults

Abstract

Introduction: This study aimed to develop and validate a brief practitioner-friendly health literacy screening tool, called Rapid Estimate of Inadequate Health Literacy (REIHL), that estimates patients’ health literacy inadequacy in demanding clinical settings.

Methods: This is a methodological study of 304 community-dwelling older adults recruited from one community health centre and five district elderly community centres. Logistic regression models were used to identify the coefficients of the REIHL score’s significant factors. Receiver operating characteristic (ROC) curve analysis was then used to assess the REIHL’s sensitivity and specificity. Path analysis was employed to examine the REIHL’s criterion validity with the Chinese Health Literacy Scale for Chronic Care and concurrent validity with self-rated health scale and the Geriatric Depression Scale–15.

Results: The REIHL has scores ranging from 0 to 23. It had 76.9% agreement with the Chinese Health Literacy Scale for Chronic Care. The area under the ROC curve for predicting health literacy inadequacy was 0.82 (95% confidence interval=0.78-0.87, P<0.001). The ROC curve of the REIHL showed that scores ≥11 had a sensitivity of 77.8% and specificity of 75.6% for predicting health literacy inadequacy. The path analysis model showed excellent fit (Chi squared [2, 304] 0.16, P=0.92, comparative fit index 1.00, root mean square error of approximation <0.001, 90% confidence interval=0.00-0.04), indicating that the REIHL has good criterion and concurrent validity.

Conclusion: The newly developed REIHL is a practical tool for estimating older adults’ inadequate health literacy in clinical care settings.

引言：本研究旨在開發和驗證一種對從業者友好的精簡健康素養篩查工具，稱為「快速預測健康素養不足工具」（REIHL）。這工具可用作評估患者在繁忙的臨床環境中的健康素養不足情況。 方法：從一間社區健康中心和五間地區老年社區中心招募304例社區較年長人士進行方法研究。使用邏輯迴歸模型來確定REIHL得分的重要因素的係數，然後使用接受者操作特性（ROC）曲線分析來評估REIHL的敏感性和特異性。運用通徑分析檢驗REIHL的標準效度和中文慢性疾病健康認知量表，以及自評健康量表和老年抑鬱量表的同時效度。 結果：REIHL得分介乎0到23。它與中文慢性疾病健康認知量表的一致性達76.9%。預測健康素養不足的ROC曲線下面積為0.82（95%置信區間=0.78-0.87，P < 0.001）。REIHL的ROC曲線顯示得分11或以上可預測健康素養不足，敏感性為77.8%，特異性為75.6%。通徑分析模型顯示出極佳的擬合度（卡方[2, 304] 0.16、P=0.92、比較擬合指數1.00、估計誤差均方根< 0.001、90%置信區間=0.00-0.04），表明REIHL具有良好的標準效度和同時效度。 結論：新開發的REIHL是一種實用工具，可用作評估較年長人士在臨床護理環境中的健康素養不足情況。