University of California, San Francisco, San Francisco, California, USA.
J Card Fail. 2011 Nov;17(11):887-92. doi: 10.1016/j.cardfail.2011.06.651.
Health literacy has important implications for health interventions and clinical outcomes. The Shortened Test of Functional Health Literacy in Adults (S-TOFHLA) is a timed test used to assess health literacy in many clinical populations. However, its usefulness in heart failure (HF) patients, many of whom are elderly with compromised cognitive function, is unknown. We investigated the relationship between the S-TOFHLA total score at the recommended 7-minute limit and with no time limit (NTL).
We enrolled 612 rural-dwelling adults with HF (mean age 66.0 ± 13.0 years, 58.8% male). Characteristics affecting health literacy were identified by multiple regression. Percentage of correct scores improved from 71% to 86% (mean percent change 15.1 ± 18.1%) between the 7-minute and NTL scores. Twenty-seven percent of patients improved ≥1 literacy level with NTL scores (P < .001). Demographic variables explained 24.2% and 11.1% of the variance in % correct scores in the 7-minute and the NTL scores, respectively. Female gender, younger age, higher education, and higher income were related to higher scores.
Patients with HF may be inaccurately categorized as having low or marginal health literacy when the S-TOFHLA time limits are enforced. New ways to assess health literacy in older adults are needed.
健康素养对健康干预和临床结果有重要影响。成人简化功能性健康素养测试（S-TOFHLA）是一种限时测试，用于评估许多临床人群的健康素养。然而，它在心力衰竭（HF）患者中的有用性尚不清楚，HF 患者中有许多是认知功能受损的老年人。我们研究了 S-TOFHLA 总分为推荐的 7 分钟限时和无时间限制（NTL）之间的关系。
我们招募了 612 名居住在农村的 HF 成年患者（平均年龄 66.0 ± 13.0 岁，58.8%为男性）。通过多元回归确定影响健康素养的特征。在 7 分钟和 NTL 评分之间，正确分数的百分比从 71%提高到 86%（平均百分比变化 15.1 ± 18.1%）。在 NTL 评分下，27%的患者的健康素养水平提高了≥1 级（P<0.001）。人口统计学变量分别解释了 7 分钟和 NTL 评分中正确分数方差的 24.2%和 11.1%。女性、年龄较小、受教育程度较高和收入较高与较高的分数相关。
当执行 S-TOFHLA 时间限制时，HF 患者可能会被不准确地归类为具有低或边缘健康素养。需要新的方法来评估老年人的健康素养。
