The Institute of Medicine report on health literacy called for incorporation of health literacy assessment into healthcare information systems, as well as largescale epidemiologic studies of the effects of health literacy on clinical outcomes. To our knowledge, no institution has incorporated health literacy screening into routine clinical practice.
The Health Literacy Screening (HEALS) Study aimed to determine the feasibility of incorporating three brief health literacy screening items into the inpatient nursing assessment at a large academic hospital.
In collaboration with nursing leadership at Vanderbilt University Hospital (VUH), we revised the “Learning Readiness” section of the nursing admission documentation to incorporate three health literacy screening items, a structured assessment of patients’ educational attainment, language preference, and request for an interpreter. The three items assessed confidence with forms, need for assistance in reading hospital materials, and problems learning about medical conditions, respectively. The learning readiness documentation is required for all adult inpatients and observation patients and is completed by a staff of approximately 5000 nurses in the electronic health record. We developed educational resources on health literacy for staff nurses. This included webpages detailing the documentation change, tips on clear health communication, links to outside resources, an email address for questions or concerns, and a training video featuring a message from the chief nursing officer and a demonstration of how to best administer the screening items. Documentation was monitored through a dashboard that linked to the EDW. The documentation change was activated on October 19, 2010. Nursing leadership communicated the change to staff using electronic communication, with links to the resources. Between 10/October 24/, 2010 and 3/March 19/, 2011, 13,127 (91.3%) adults hospitalized at VUH had the nursing admission documentation completed. Among those patients, 11,918 (90.8%) had responses recorded for all three health literacy items. Completion rates across the hospital climbed from 83% in the first week, to 94% by week 7, and leveled at 91% by week 11. Using a cutoff of “somewhat” or “sometimes” on each item, the prevalence of low health literacy on each of the three screening items was 27.8% (confidence with forms), 32.3% (need for assistance in reading hospital materials), and 27.3% (problems learning about medical conditions). Across hospital units, the proportion of patients with low health literacy ranged from between 9% and 44%.
With support from clinical leadership and electronic documentation tools, health literacy screening for hospitalized patients is feasible. Further investigation is underway to determine the accuracy and fidelity of administration by clinical personnel, to assess testretest reliability, and to determine association of these measures with clinical outcomes.
To cite this abstract:Osborn C, Roumie C, Davis C, Cawthon C, Willens D, Wallston K, Mion L, Woods M, Rothman R, Kripalani S. Feasibility of Routine Health Literacy Assessment for Hospitalized Adults: The Health Literacy Screening (Heals) Study. Abstract published at Hospital Medicine 2012, April 1-4, San Diego, Calif. Abstract 97709. Journal of Hospital Medicine. 2012; 7 (suppl 2). https://www.shmabstracts.com/abstract/feasibility-of-routine-health-literacy-assessment-for-hospitalized-adults-the-health-literacy-screening-heals-study/. Accessed May 26, 2019.