Chakkalakal Rosette J, Venkatraman Sneha, White Richard O, Kripalani Sunil, Rothman Russell, Wallston Kenneth
Division of General Internal Medicine and Public Health, Department of Internal Medicine, Vanderbilt University Medical Center.
Department of Psychiatry, University of Arizona College of Medicine.
Health Lit Res Pract. 2017;1(2):e23-e30. doi: 10.3928/24748307-20170329-01. Epub 2017 Apr 21.
Validation studies of existing health literacy or numeracy tools among racial/ethnic minorities are limited.
This study assessed the validity of the Subjective Numeracy Scale (SNS), the Diabetes Numeracy Test (DNT-5), the Brief Health Literacy Screen (BHLS), and the Short Test of Functional Health Literacy in Adults (S-TOFHLA) by trait (health literacy or numeracy) and by method (subjective or objective) among non-Hispanic white (NHW), non-Hispanic black (NHB), and Hispanic patients with type 2 diabetes mellitus (T2DM).
We conducted a secondary analysis of baseline data from the Partnering to Improve Diabetes Education (PRIDE) study, a clustered randomized controlled trial testing the efficacy of a health communication intervention on T2DM outcomes at state Department of Health clinics in middle Tennessee. PRIDE participants with race/ethnicity data available ( = 398) were included in this study. Most patients identified as NHW (59%), 18% identified as NHB, and 23% identified as Hispanic. Pearson correlations among the 4 measures were compared for each racial/ethnic group by trait and method. The convergent validity of each measure with education was also assessed using Pearson correlation analyses.
Significant correlations were observed across all 3 subgroups for the numeracy measures (SNS and DNT-5) and the objective measures (DNT-5 and S-TOFHLA). Nonsignificant correlations were observed among Hispanic participants for the health literacy measures (BHLS and S-TOFHLA, correlation coefficient = 0.13) and among NHB and Hispanic participants for the subjective measures (SNS and BHLS, correlations coefficients = 0.15 and 0.09, respectively). A significant positive correlation was noted between education and each measure across all 3 subgroups.
Subjective and health literacy measures demonstrate weaker correlations than objective and numeracy measures, respectively, among minority patients in this study. Our findings highlight the need to further evaluate the appropriateness of these tools for use with minority populations, particularly the BHLS for Hispanic patients.
针对种族/族裔少数群体开展的现有健康素养或数字运算能力工具的验证研究有限。
本研究通过特质（健康素养或数字运算能力）和方法（主观或客观），评估了非西班牙裔白人（NHW）、非西班牙裔黑人（NHB）和患有2型糖尿病（T2DM）的西班牙裔患者中主观数字运算量表（SNS）、糖尿病数字运算测试（DNT - 5）、简易健康素养筛查（BHLS）以及成人功能性健康素养简短测试（S - TOFHLA）的有效性。
我们对“携手改善糖尿病教育（PRIDE）”研究的基线数据进行了二次分析，该研究是一项整群随机对照试验，在田纳西州中部的州卫生诊所测试健康传播干预对T2DM结局的疗效。本研究纳入了有可用种族/族裔数据的PRIDE参与者（n = 398）。大多数患者被认定为NHW（59%），18%被认定为NHB，23%被认定为西班牙裔。按特质和方法比较了每个种族/族裔群体中4种测量方法之间的皮尔逊相关性。还使用皮尔逊相关性分析评估了每种测量方法与教育程度的收敛效度。
在所有3个亚组中，数字运算测量方法（SNS和DNT - 5）以及客观测量方法（DNT - 5和S - TOFHLA）之间均观察到显著相关性。在西班牙裔参与者中，健康素养测量方法（BHLS和S - TOFHLA，相关系数 = 0.13）之间以及在NHB和西班牙裔参与者中，主观测量方法（SNS和BHLS，相关系数分别为0.15和0.09）之间观察到不显著的相关性。在所有3个亚组中，教育程度与每种测量方法之间均观察到显著正相关。
在本研究的少数族裔患者中，主观测量方法和健康素养测量方法的相关性分别比客观测量方法和数字运算测量方法的相关性弱。我们的研究结果凸显了进一步评估这些工具在少数族裔人群中使用的适宜性的必要性，尤其是针对西班牙裔患者的BHLS。
