Division of Emergency Medicine, Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, MO; Washington University Institute for Public Health, St. Louis, MO.
Acad Emerg Med. 2014 Feb;21(2):147-53. doi: 10.1111/acem.12310.
The objective was to quantify the correlation between general numeracy and health literacy in an emergency department (ED) setting.
This was a prospective cross-sectional convenience sample study of adult patients in an urban, academic ED with 97,000 annual visits. General numeracy was evaluated using four validated questions and health literacy using three commonly used validated screening tools (Short Test of Functional Health Literacy in Adults [S-TOFHLA], Rapid Estimate of Adult Literacy in Medicine-Revised [REALM-R], and the Newest Vital Sign [NVS]). Scores were dichotomized for health literacy tests to limited (low or marginal) versus adequate health literacy, and the proportion of patients answering all numeracy questions correctly was calculated with the mean proportion of correct responses in these groups. The correlation between numeracy scores and scores on the health literacy screening tools was evaluated using Spearman's correlation.
A total of 446 patients were enrolled. Performance on questions evaluating general numeracy was universally poor. Only 18 patients (4%) answered all numeracy questions correctly, 88 patients (20%) answered zero questions correctly, and overall the median number of correct answers was one (interquartile range [IQR] = 1 to 2). Among patients with limited health literacy (LHL) by any of the three screening tools used, the mean number of correct numeracy answers was approximately half that of patients with adequate health literacy. However, even among those with adequate health literacy, the average number of correct answers to numeracy questions ranged from 1.6 to 2.4 depending on the screening test used. When dichotomized into those who answered ≤50% versus >50% of numeracy questions correctly, there was a significant difference between those with LHL and those who scored ≤50% on numeracy. Health literacy screening results were correlated with general numeracy in the low to moderate range: S-TOFHLA rs = 0.428 (p < 0.0001); REALM, rs = 0.400 (p < 0.0001); and NVS, rs = 0.498 (p < 0.0001).
Correlations between measures of general numeracy and measures of health literacy are in the low to moderate range. Performance on numeracy testing was nearly universally poor, even among patients performing well on health literacy screens, with a substantial proportion of the latter patients unable to answer half of the numeracy items correctly. Insofar as numeracy is considered a subset of health literacy, these results suggest that commonly used health literacy screening tools in ED-based studies inadequately evaluate and overestimate numeracy. This suggests the potential need for separate numeracy screening when these skills are important for health outcomes of interest. Providers should be sensitive to potential numeracy deficits among those who may otherwise have normal health literacy.
旨在定量评估急诊科（ED）环境中一般计算能力与健康素养之间的相关性。
这是一项前瞻性横断面便利样本研究，纳入了 97000 名年就诊量的城市学术 ED 的成年患者。采用四个经过验证的问题评估一般计算能力，采用三种常用的经过验证的筛查工具（成人功能性健康素养简短测试 [S-TOFHLA]、修订后的成人医学简易读写能力快速评估 [REALM-R] 和最新生命体征 [NVS]）评估健康素养。为健康素养测试将得分划分为有限（低或边缘）与足够的健康素养，并计算出在这些组中正确回答所有计算能力问题的患者比例，以及计算这些患者的平均正确反应比例。使用 Spearman 相关系数评估计算能力评分与健康素养筛查工具评分之间的相关性。
共纳入 446 例患者。评估一般计算能力的问题表现普遍较差。只有 18 例患者（4%）正确回答了所有计算能力问题，88 例患者（20%）正确回答了零个问题，总体中位数正确答案数为 1 个（四分位距 [IQR] 1 至 2）。在使用三种筛查工具中的任何一种被判定为健康素养有限（LHL）的患者中，正确回答计算能力问题的平均数量约为健康素养足够的患者的一半。然而，即使在健康素养足够的患者中，使用不同的筛查工具，正确回答计算能力问题的平均数量也在 1.6 到 2.4 之间。当将回答率≤50%与>50%的患者进行二分法划分时，与 LHL 患者相比，计算能力≤50%的患者存在显著差异。健康素养筛查结果与一般计算能力呈低度到中度相关：S-TOFHLA r s 为 0.428（p<0.0001）；REALM，r s 为 0.400（p<0.0001）；和 NVS，r s 为 0.498（p<0.0001）。
一般计算能力和健康素养的测量之间的相关性处于低度到中度范围。计算能力测试的表现几乎普遍较差，即使在健康素养筛查表现良好的患者中也是如此，其中相当一部分患者无法正确回答一半的计算能力项目。鉴于计算能力被认为是健康素养的一个子集，这些结果表明，ED 中常用的健康素养筛查工具不能充分评估和高估计算能力。这表明，在这些技能对感兴趣的健康结果很重要时，可能需要单独进行计算能力筛查。医护人员应该对那些可能有正常健康素养但存在潜在计算能力缺陷的患者保持敏感。
