More Than Meets the Eye: Measuring the Dual Risks of Low Health Literacy and Poor Vision in Hospitalized Patients

1University of Chicago Medical Center, Chicago, IL
2University of Chicago, Chicago, IL

Meeting: Hospital Medicine 2012, April 1-4, San Diego, Calif.

Abstract number: 97609


A “universal precaution” approach for all inpatients should be used to ensure adequate education for safe discharge home. However, identification of vulnerable, high–risk (e.g., low health literacy) patients may be necessary in resource–limited hospital settings to ensure safe care transitions. Chew et al. have validated a brief, 3–item verbal screening questionnaire to detect low health literacy among outpatients. Our objective is to evaluate the validity of the Chew screening questions compared to the validated Rapid Estimate of Adult Literacy in Medicine–Revised (REALM–R) tool for hospitalized patients.


Hospitalized general medicine patients were enrolled from an ongoing study of resource allocation and quality of care at our hospital. Eligible patients (cognitively intact, English–speaking) were asked the Chew screening questions: (q1) “How often do you have problems learning about your medical condition because of difficulty understanding written information?”; (q2) “How confident are you filling out medical forms by yourself?”; (q3) “How often do you have someone help you read hospital materials?” Participants responded on a Likert scale from 0 to 4 and were considered “at–risk” for poor health literacy if they answered “sometimes, often, or always” (q1, 3) or “somewhat, a little bit, or not at all” (q2). To validate these questions, we administered the REALM–R if participants’ vision was sufficient (Snellen screening card).


To date, n = 216. The mean age is 53; the majority are female (54%) and African–American (81.5%). About 1/2 have <= high–school degree. About 40% (88) screened “at–risk” on the Chew screening questions; 57 (32%) were unable to complete the REALM–R due to insufficient vision, with 51% of these participants not having their glasses with them in the hospital. In total, 122 participants completed both health literacy screening tools, with 32% (39) considered “at–risk” based on the Chew screening questions, and 46% (56) considered to have inadequate literacy based on the REALM–R (P = 0.02). The Chew screening questions had a sensitivity of 45%. Data collection is ongoing and formal correlation statistics will be conducted.


We demonstrate that in a low–income, primarily African–American urban hospitalized population, two health literacy tools found differing prevalence of low health literacy. Our data suggest that the Chew screening questions may have low sensitivity among hospitalized and/or African–American patients; if upon completion of the study these findings remain, further evaluation of clinically relevant tools is needed. Additionally, the prevalence of poor vision (∼1/3 of participants) in this population is non–trivial and requires further study. Hospitalists should take into account the implications of the dual risks of poor health literacy and poor vision: up to 2/3 of patients may have difficulty reading, seeing, and/or understanding written material provided in the hospital setting, including informed consent documents.

To cite this abstract:

Mayo A, Meltzer D, Shapiro M, Press V, Arora V. More Than Meets the Eye: Measuring the Dual Risks of Low Health Literacy and Poor Vision in Hospitalized Patients. Abstract published at Hospital Medicine 2012, April 1-4, San Diego, Calif. Abstract 97609. Journal of Hospital Medicine. 2012; 7 (suppl 2). Accessed May 23, 2019.

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