Wallston Kenneth A, Cawthon Courtney, McNaughton Candace D, Rothman Russell L, Osborn Chandra Y, Kripalani Sunil
School of Nursing, Vanderbilt University, Nashville, TN, USA.
J Gen Intern Med. 2014 Jan;29(1):119-26. doi: 10.1007/s11606-013-2568-0. Epub 2013 Aug 6.
The three-item Brief Health Literacy Screen (BHLS) has been validated in research settings, but not in routine practice, administered by clinical personnel.
As part of the Health Literacy Screening (HEALS) study, we evaluated psychometric properties of the BHLS to validate its administration by clinical nurses in both clinic and hospital settings.
Beginning in October 2010, nurses in clinics and the hospital at an academic medical center have administered the BHLS during patient intake and recorded responses in the electronic health record.
Trained research assistants (RAs) administered the short Test of Functional Health Literacy in Adults (S-TOFHLA) and re-administered the BHLS to convenience samples of hospital and clinic patients. Analyses included tests of internal consistency reliability, inter-administrator reliability, and concurrent validity by comparing the nurse-administered versus RA-administered BHLS scores (BHLS-RN and BHLS-RA, respectively) to the S-TOFHLA.
Cronbach's alpha for the BHLS-RN was 0.80 among hospital patients (N = 498) and 0.76 among clinic patients (N = 295), indicating high internal consistency reliability. Intraclass correlation between the BHLS-RN and BHLS-RA among clinic patients was 0.77 (95 % CI 0.71-0.82) and 0.49 (95 % CI 0.40-0.58) among hospital patients. BHLS-RN scores correlated significantly with BHLS-RA scores (r = 0.33 among hospital patients; r = 0.62 among clinic patients), and with S-TOFHLA scores (r = 0.35 among both hospital and clinic patients), providing evidence of inter-administrator reliability and concurrent validity. In regression models, BHLS-RN scores were significant predictors of S-TOFHLA scores after adjustment for age, education, gender, and race. Area under the receiver operating characteristic curve for BHLS-RN to predict adequate health literacy on the S-TOFHLA was 0.71 in the hospital and 0.76 in the clinic.
The BHLS, administered by nurses during routine clinical care, demonstrates adequate reliability and validity to be used as a health literacy measure.
三项简短健康素养筛查量表（BHLS）已在研究环境中得到验证，但尚未在临床人员进行的常规实践中得到验证。
作为健康素养筛查（HEALS）研究的一部分，我们评估了BHLS的心理测量特性，以验证临床护士在诊所和医院环境中使用该量表的有效性。
从2010年10月开始，一所学术医疗中心的诊所和医院的护士在患者就诊时使用BHLS，并将回答记录在电子健康记录中。
经过培训的研究助理（RA）对成人功能性健康素养简短测试（S-TOFHLA）进行施测，并对医院和诊所患者的便利样本再次施测BHLS。分析包括内部一致性信度测试、施测者间信度测试以及通过比较护士施测的BHLS分数（分别为BHLS-RN）和RA施测的BHLS分数（BHLS-RA）与S-TOFHLA分数来进行同时效度测试。
在医院患者（N = 498）中，BHLS-RN的Cronbach's α系数为0.80，在诊所患者（N = 295）中为0.76，表明内部一致性信度较高。诊所患者中BHLS-RN与BHLS-RA的组内相关系数为0.77（95% CI 0.71 - 0.82），医院患者中为0.49（95% CI 0.40 - 0.58）。BHLS-RN分数与BHLS-RA分数显著相关（医院患者中r = 0.33；诊所患者中r = 0.62），并且与S-TOFHLA分数相关（医院和诊所患者中r均为0.35），这为施测者间信度和同时效度提供了证据。在回归模型中，在对年龄、教育程度、性别和种族进行调整后，BHLS-RN分数是S-TOFHLA分数的显著预测因子。BHLS-RN预测S-TOFHLA上足够健康素养的受试者工作特征曲线下面积在医院为0.71，在诊所为0.76。
由护士在常规临床护理期间使用的BHLS表现出足够的信度和效度，可作为一种健康素养测量工具。
