Health Literacy Assessment via STOFHLA: Paper vs Computer Administration

Background. Low health literacy affects more than one-third of American adults, resulting in poor physician-patient communication, worse health outcomes, and increased medical costs. Many physicians are uninformed of their patients’ health literacy status. Current paper-based surveys require extra staff, time, and resources for administration, while a computer-based survey may provide efficient assessment to increase provider awareness. The study assessed the efficacy of a computer-based health literacy test compared to an established, paper-based format for use in an office setting. Methods. A prospective, non-blinded, randomized experimental design was conducted. A brief demographic survey and health literacy test (STOFHLA) was administered to 100 adult subjects at a Midwestern family medicine residency clinic. Recruitment flyers were distributed in the office and all eligible, willing patients were randomized to one of two groups. Fifty participants were administered the paper test and 50 were administered the computer-based test. Results. The majority of subjects had “adequate” health literacy (85%) and completed the test within the allotted time period (82%). When comparing the paper and computer groups, there were no statistically significant differences for demographics, test scores, or completion time. Conclusions. A computer-based health literacy test is as effective as an established, paper-based format to assess health literacy in a family medicine office population. Future research studies should investigate the impact of having patient health literacy scores available to the physician prior to the office visit and how it may affect communication, compliance, and health outcomes. KJM 2011; 4(3):55-61.