Testing the BRIEF Health Literacy Screening Tool

I nadequate health literacy is a major problem in the United States. Patients’ health literacy skills affect their ability to communicate with health care providers, adhere to health care regimens, access and navigate health care services, and manage health issues. Yet the Institute of Medicine estimated in 2004 that nearly half of all American adults (about 90 million people) have difficulty understanding and acting upon health information. Each year, inadequate health literacy results in approximately $73 billion in unnecessary health care costs. In order to facilitate effective and timely interventions that can promote a high quality, cost-efficient health care experience, health care providers are in need of a brief, effective tool for detecting inadequate health literacy among their patients. At present, there are validated tools for assessing health literacy, including the Short Test of Functional Health Literacy in Adults (STOFHLA) and the Rapid Estimate of Adult Literacy (REALM). Current tools, however, either take too long to administer or are potentially embarrassing to patients. Recent studies have attempted to create a brief and effective health literacy screening tool. Chew and colleagues developed 16 health literacy screening questions and administered them, along with the STOFHLA, to 332 participants. They found that, as determined by the STOFHLA, three of the new questions were effective at detecting inadequate health literacy, that these three questions were weaker at detecting inadequate/ marginal health literacy, and that no combination of the three questions was more effective at identifying inadequate health literacy than any of those individual questions. Wallace and colleagues administered the same three questions, along with the REALM, to 305 participants who differed demographically from the participants in Chew and colleagues’ study. Their results indicated that, as determined by the REALM, one of the questions was accurate in detecting limited and limited or marginal health literacy and was more accurate than any combination of the three questions. Later, Baker asserted that the inconsistencies between Chew and colleagues’ study and Wallace and colleagues’ study indicate a need for further research, while Parker and Kindig called for more research on the measurement of both individual and population-level health literacy skills. With these issues in mind, we developed the Brief Health Literacy Screening Tool (known as the BRIEF) and conducted a study to determine its efficacy. The BRIEF consists of the three questions evaluated by Chew and colleagues and Wallace and colleagues, along with a fourth question that we developed. We investigated the tool’s efficacy at detecting inadequate and inadequate/marginal health literacy in a VA ambulatory care setting by using the STOFHLA and the REALM as standards of actual health literacy. In this article, we present our findings and discuss how we have implemented the BRIEF within our own health care system.