RESUMEN
BACKGROUND: In 2005 the Spoken Knowledge in Low Literacy in Diabetes scale (SKILLD) was introduced as a diabetes knowledge test. The SKILLD has not been validated since its introduction. OBJECTIVE: To perform a validation analysis on the SKILLD. DESIGN AND PARTICIPANTS: Cross-sectional observational study of 240 patients with diabetes at an academic family practice center. MAIN MEASURES: SKILLD's correlation with an oral form of the Diabetes Knowledge Test (DKT) was used to assess criterion validity. A regression model tested construct validity, hypothesizing that SKILLD score was independently related to health literacy and education level. Content validity was tested using Cronbach's Alpha for inter-item relatedness and by comparing SKILLD items with the content of a National Institutes of Health (NIH) diabetes education website. We assessed inter-rater reliability and bias using Spearman correlation coefficients and sign-rank tests between interviewers scoring the same interview. KEY RESULTS: The SKILLD demonstrated fair correlation with the DKT (Pearson's coefficient 0.54, 95% CI=0.49 to 0.66, p<0.001). Health literacy, education level, male gender, household income, and years with diabetes were independent predictors of SKILLD score in the regression model. Cronbach's Alpha for inter-item relatedness was 0.54. There were some topics on the NIH website not addressed by the SKILLD. The inter-rater correlation coefficient was 0.79 (95% CI 0.56 to 0.91, p<0.001). CONCLUSIONS: The SKILLD is an adequate diabetes knowledge test and is appropriate for people of all literacy levels. However, it should be expanded to more completely evaluate diabetes knowledge.
Asunto(s)
Diabetes Mellitus/terapia , Conocimientos, Actitudes y Práctica en Salud , Alfabetización en Salud/normas , Educación del Paciente como Asunto/normas , Percepción del Habla , Diabetes Mellitus/epidemiología , Escolaridad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Autocuidado/normasRESUMEN
PURPOSE: Limited health literacy is increasingly recognized as a barrier to receiving adequate health care. Identifying patients at risk of poor health outcomes secondary to limited health literacy is currently the responsibility of clinicians. Our objective was to identify which screening questions and demographics independently predict limited health literacy and could thus help clinicians individualize their patient education. METHODS: Between August 2006 and July 2007, we asked 225 patients being treated for diabetes at an academic primary care office several questions regarding their reading ability as part of a larger study (57% response rate). We built a logistic regression model predicting limited health literacy to determine the independent predictive properties of these questions and demographic variables. Patients were classified as having limited health literacy if they had a Short Test of Functional Health Literacy in Adults (S-TOFHLA) score of less than 23. The potential predictors evaluated were self-rated reading ability, highest education level attained, Single-Item Literacy Screener (SILS) result, patients' reading enjoyment, age, sex, and race. RESULTS: Overall, 15.1% of the patients had limited health literacy. In the final model, 5 of the potential predictors were independently associated with increased odds of having limited health literacy. Specifically, patients were more likely to have limited health literacy if they had a poorer self-rated reading ability (odds ratio [OR] per point increase in the model = 3.37; 95% confidence interval [CI], 1.71-6.63), more frequently needed help reading written health materials (assessed by the SILS) (OR = 2.03; 95% CI, 1.26-3.26), had a lower education level (OR = 1.89; 95% CI, 1.12-3.18), were male (OR = 4.46; 95% CI, 1.53-12.99), and were of nonwhite race (OR = 3.73; 95% CI, 1.04-13.40). These associations were not confounded by age. The area under the receiver operating characteristic curve was 0.9212. CONCLUSIONS: Self-rated reading ability, SILS result, highest education level attained, sex, and race independently predict whether a patient has limited health literacy. Clinicians should be aware of these associations and ask questions to identify patients at risk. We propose an "SOS" mnemonic based on these findings to help clinicians wishing to individualize patient education.