Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, 508 Fulton St, Durham, NC 27705, USA.
JAMA. 2010 Jul 7;304(1):76-84. doi: 10.1001/jama.2010.896.
Patients with limited literacy are at higher risk for poor health outcomes; however, physicians' perceptions are inaccurate for identifying these patients.
To systematically review the accuracy of brief instruments for identifying patients with limited literacy.
Search of the English-language literature from 1969 through February 2010 using PubMed, Psychinfo, and bibliographies of selected manuscripts for articles on health literacy, numeracy, reading ability, and reading skill.
Prospective studies including adult patients 18 years or older that evaluated a brief instrument for identifying limited literacy in a health care setting compared with an accepted literacy reference standard.
Studies were evaluated independently by 2 reviewers who each abstracted information and assigned an overall quality rating. Disagreements were adjudicated by a third reviewer.
Ten studies using 6 different instruments met inclusion criteria. Among multi-item measures, the Newest Vital Sign (English) performed moderately well for identifying limited literacy based on 3 studies. Among the single-item questions, asking about a patient's use of a surrogate reader, confidence filling out medical forms, and self-rated reading ability performed moderately well in identifying patients with inadequate or marginal literacy. Asking a patient, "How confident are you in filling out medical forms by yourself?" is associated with a summary likelihood ratio (LR) for limited literacy of 5.0 (95% confidence interval [CI], 3.8-6.4) for an answer of "a little confident" or "not at all confident"; a summary LR of 2.2 (95% CI, 1.5-3.3) for "somewhat confident"; and a summary LR of 0.44 (95% CI, 0.24-0.82) for "quite a bit" or "extremely confident."
Several single-item questions, including use of a surrogate reader and confidence with medical forms, were moderately effective for quickly identifying patients with limited literacy.
文化程度有限的患者更有可能出现健康状况不佳的后果；然而，医生在识别这些患者时的认知存在偏差。
系统综述用于识别文化程度有限患者的简短工具的准确性。
通过 PubMed、Psychinfo 以及选定的健康素养、计算能力、阅读能力和阅读技巧文献的参考文献，对 1969 年至 2010 年 2 月的英文文献进行检索。
纳入了在医疗环境中评估简短工具以识别文化程度有限患者的前瞻性研究，这些研究将患者与公认的文化程度参考标准进行了比较。
两名审阅者独立评估研究，每位审阅者提取信息并对整体质量进行评分。有分歧的地方由第三名审阅者裁决。
符合纳入标准的研究有 10 项，使用了 6 种不同的工具。在多项指标中，根据 3 项研究，Newest Vital Sign（英文）在识别文化程度有限方面表现中等。在单项问题中，询问患者是否使用代笔读者、填写医疗表格的信心以及自我评估的阅读能力，在识别阅读能力不足或边缘性阅读能力的患者方面表现中等。询问患者：“您对自己填写医疗表格有多大信心？”对于文化程度有限的患者，其汇总似然比（LR）为 5.0（95%置信区间 [CI]，3.8-6.4），回答“有点信心”或“一点也没有信心”；“有点信心”的汇总 LR 为 2.2（95% CI，1.5-3.3）；“非常有信心”的汇总 LR 为 0.44（95% CI，0.24-0.82）。
包括使用代笔读者和对医疗表格的信心在内的几个单项问题，对于快速识别文化程度有限的患者是比较有效的。
