Protocol - Health Literacy
Description
The Short Assessment of Health Literacy-English (SAHL-E) includes 18 interviewer-administered items designed to assess an English-speaking adult’s ability to read and understand common medical terms. The test could help health professionals estimate the adult’s health literacy level. The interviewer shows the respondent a series of laminated 4” x 5” flash cards, with each card containing a medical term printed in boldface on the top and the two association words (i.e., the key and the distracter) at the bottom. Responses are summed to achieve the total SAHL-E score. A score less than or equal to 14 represents the cutoff point for low health literacy, or low health-related reading ability. An additional health literacy screening question, useful for surveys with space constraints, asks how confident the respondent is in completing medical forms.
Specific Instructions
Administration of the Short Assessment of Health Literacy-English is facilitated by using laminated 4” x 5” flash cards, with each card containing a medical term printed in boldface on the top and the two association words (i.e., the key and the distracter) at the bottom.
Availability
Protocol
Short Assessment of Health Literacy-English (SAHL-E)
Directions to the Interviewer:
- Before the test, the interviewer should say to the examinee: “I’m going to show you cards with 3 words on them. First, Id like you to read the top word out loud. Next, Ill read the two words underneath and Id like you to tell me which of the two words is more similar to or has a closer association with the top word. If you dont know, please say ‘I dont know. Dont guess.”
- Show the examinee the first card.
- The interviewer should say to the examinee: “Now, please, read the top word out loud.”
- The interviewer should have a clipboard with a score sheet to record the examinees answers. The clipboard should be held such that the examinee cannot see or be distracted by the scoring procedure.
- The interviewer will then read the key and distracter (the two words at the bottom of the card) and then say: “Which of the two words is most similar to the top word? If you dont know the answer, please say ‘I dont know.”
- The interviewer may repeat the instructions so that the examinee feels comfortable with the procedure.
- Continue the test with the rest of the cards.
- A correct answer for each test item is determined by both correct pronunciation and accurate association. Each correct answer gets one point. Once the test is completed, the interviewer should tally the total points to generate the SAHL-E score.
A score between 0 and 14 suggests the examinee has low health literacy.
Stem | Key or Distracter | ||
| [ ] urine | [ ] fever | [ ] dont know |
| [ ] work | [ ] education | [ ] dont know |
| [ ] instrument | [ ] treatment | [ ] dont know |
| [ ] healthy | [ ] soda | [ ] dont know |
| [ ] loss | [ ] marriage | [ ] dont know |
| [ ] plant | [ ] virus | [ ] dont know |
| [ ] addiction | [ ] recreation | [ ] dont know |
| [ ] birth | [ ] childhood | [ ] dont know |
| [ ] dizzy | [ ] calm | [ ] dont know |
| [ ] sleep | [ ] amount | [ ] dont know |
| [ ] growth | [ ] harmony | [ ] dont know |
| [ ] different | [ ] similar | [ ] dont know |
| [ ] instruction | [ ] decision | [ ] dont know |
| [ ] bored | [ ] anxiety | [ ] dont know |
| [ ] blocked | [ ] loose | [ ] dont know |
| [ ] evaluation | [ ] recovery | [ ] dont know |
| [ ] veins | [ ] heart | [ ] dont know |
| [ ] contraception | [ ] condom | [ ] dont know |
Health Literacy Screening Question
19. How confident are you filling out medical forms by yourself?
1[ ]Extremely
2[ ]Quite a bit
3[ ]Somewhat
4[ ]A little bit
5[ ]Not at all
Personnel and Training Required
The interviewer must be trained to conduct personal interviews with individuals from the general population. The interviewer must be trained and found to be competent (i.e., tested by an expert) at the completion of personal interviews. The interviewer should be trained to prompt respondents further if a “don’t know” response is provided.
Equipment Needs
The PhenX Working Group acknowledges that these questions can be administered in a computerized or noncomputerized format (i.e., paper-and-pencil instrument). Computer software is necessary to develop computer-assisted instruments. The interviewer will require a laptop computer or handheld computer to administer a computer-assisted questionnaire.
Requirements
| Requirement Category | Required |
|---|---|
| Major equipment | No |
| Specialized training | No |
| Specialized requirements for biospecimen collection | No |
| Average time of greater than 15 minutes in an unaffected individual | No |
Mode of Administration
Interviewer-administered questionnaire
Lifestage
Adult
Participants
Adults
Selection Rationale
The Short Assessment of Health Literacy-English (SAHL-E) protocol was selected because of its good reliability and validity, ease of administration, endorsement by the Agency for Healthcare Research and Quality, and availability in Spanish and English. An additional health literacy screening question from Chew, Bradley, and Boyko (2004) was added following the SAHL-E questionnaire.
Language
English, Spanish
Standards
| Standard | Name | ID | Source |
|---|
Derived Variables
None
Process and Review
The Expert Review Panel has not reviewed this measure yet.
Protocol Name from Source
Short Assessment of Health Literacy-English (SAHL-E) and
Chew, L. D., et al. Brief questions to identify patients with inadequate health literacy. Fam Med, 2004
Source
Short Assessment of Health Literacy-English
Lee, S.-Y. D., Stucky, B. D., & Lee, J. Y. (2010). Short assessment of health literacy–Spanish and English: A comparable test of health literacy for Spanish and English speakers. Health Services Research, 45(4), 1105–1120. Appendix SA6–SA7.
Health Literacy Screening Question
Chew, L. D., Bradley, K. A., & Boyko, E. J. (2004). Brief questions to identify patients with inadequate health literacy. Family Medicine, 36(8), 588–594. Appendix 1, question 14.
General References
Chew, L. D., Griffin, J. M., Partin, M. R., Noorbaloochi, S., Grill, J. P., Snyder, A., … Vanryn, M. (2008). Validation of screening questions for limited health literacy in a large VA outpatient population. Journal of General Internal Medicine, 23(5), 561–566.
Nutbeam, D., McGill, B., & Premkumar, P. (2018). Improving health literacy in community populations: A review of progress. Health Promotion International, 33(5), 901–911.
Protocol ID
270401
Variables
Export Variables| Variable Name | Variable ID | Variable Description | dbGaP Mapping | |
|---|---|---|---|---|
| PX270401_Health_Literacy_Abnormal | ||||
| PX270401120000 | Which of the two words is most similar to more | N/A | ||
| PX270401_Health_Literacy_Alcoholism | ||||
| PX270401070000 | Which of the two words is most similar to more | N/A | ||
| PX270401_Health_Literacy_Constipation | ||||
| PX270401150000 | Which of the two words is most similar to more | N/A | ||
| PX270401_Health_Literacy_Diagnosis | ||||
| PX270401160000 | Which of the two words is most similar to more | N/A | ||
| PX270401_Health_Literacy_Directed | ||||
| PX270401130000 | Which of the two words is most similar to more | N/A | ||
| PX270401_Health_Literacy_Dose | ||||
| PX270401100000 | Which of the two words is most similar to more | N/A | ||
| PX270401_Health_Literacy_Hemorrhoids | ||||
| PX270401170000 | Which of the two words is most similar to more | N/A | ||
| PX270401_Health_Literacy_Hormones | ||||
| PX270401110000 | Which of the two words is most similar to more | N/A | ||
| PX270401_Health_Literacy_Infection | ||||
| PX270401060000 | Which of the two words is most similar to more | N/A | ||
| PX270401_Health_Literacy_Kidney | ||||
| PX270401010000 | Which of the two words is most similar to more | N/A | ||
| PX270401_Health_Literacy_Medical_Forms | ||||
| PX270401190000 | How confident are you filling out medical more | N/A | ||
| PX270401_Health_Literacy_Medication | ||||
| PX270401030000 | Which of the two words is most similar to more | N/A | ||
| PX270401_Health_Literacy_Miscarriage | ||||
| PX270401050000 | Which of the two words is most similar to more | N/A | ||
| PX270401_Health_Literacy_Nerves | ||||
| PX270401140000 | Which of the two words is most similar to more | N/A | ||
| PX270401_Health_Literacy_Nutrition | ||||
| PX270401040000 | Which of the two words is most similar to more | N/A | ||
| PX270401_Health_Literacy_Occupation | ||||
| PX270401020000 | Which of the two words is most similar to more | N/A | ||
| PX270401_Health_Literacy_Pregnancy | ||||
| PX270401080000 | Which of the two words is most similar to more | N/A | ||
| PX270401_Health_Literacy_Seizure | ||||
| PX270401090000 | Which of the two words is most similar to more | N/A | ||
| PX270401_Health_Literacy_Syphilis | ||||
| PX270401180000 | Which of the two words is most similar to more | N/A | ||
Measure Name
Health Literacy
Release Date
May 11, 2020
Definition
This questionnaire is used to assess an adult’s health literacy level, the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.
Purpose
This measure can be used to evaluate an individual’s health literacy level. Low health literacy is associated with not understanding health and disease information, difficulties following medical instructions and scheduling preventive and routine appointments, increased hospitalizations and medical costs, and ultimately higher mortality rates.
Keywords
Agency for Healthcare Research and Quality, English Speakers, Health Literacy, Health Literacy Screening, National Institute of Dental and Craniofacial Research, Short Assessment of Health Literacy-English (SAHL-E), Social Determinants of Health, University of North Carolina at Chapel Hill
Measure Protocols
| Protocol ID | Protocol Name |
|---|---|
| 270401 | Health Literacy |
Publications
Levites Strekalova, Y. A., et al. (2024) Application of the Delphi method to the development of common data elements for social drivers of health: A systematic scoping review. Translational Behavioral Medicine. 2024 June; 14(7): 426-433. doi: 10.1093/tbm/ibae020
Zhang, A. M. Y., et al. (2024) Loneliness and Crowded Living Predicted Poor Health in a Sample of Cancer Patients During COVID-19 Pandemic. Clinical Nursing Research. 2024 June; 33(5): 370-383. doi: 10.1177/10547738241252889
Burnett-Bowie, S. A. M., et al. (2024) The American Society for Bone and Mineral Research Task Force on clinical algorithms for fracture risk report. Journal of Bone and Mineral Research. 2024 May; 39(5): 517-530. doi: 10.1093/jbmr/zjae048
Strekalova, Y. A. L., et al. (2024) Trends in publication and levels of social determinants of health reporting in Journal of Clinical and Translational Science from 2017 to 2023 Journal of Clinical and Translational Science. 2024 April; 8(1). doi: 10.1017/cts.2024.508
Bartholomew, T. S., et al. (2024) Project CHARIOT: study protocol for a hybrid type 1 effectiveness-implementation study of comprehensive tele-harm reduction for engagement of people who inject drugs in HIV prevention services Addiction Science & Clinical Practice. 2024 March; 19(1). doi: 10.1186/s13722-024-00447-9
Chan, N. W., et al. (2022) Social determinants of health data in solid organ transplantation: National data sources and future directions. Am J Transplant. 2022 October; 22(10): 2293-2301. doi: 10.1111/ajt.17096
Pomeroy, A., et al. (2022) Protocol for a Longitudinal Study of the Determinants of Metabolic Syndrome Risk in Young Adults. Translational Journal of the American College of Sports Medicine. 2022 April; 7(2): 8. doi: 10.1249/tjx.0000000000000197