Reducing Assessment Barriers for Patients With Low Literacy

Low health literacy as a barrier to healthcare. Health literacy is defined as "the degree to
which individuals have the capacity to obtain, process, and understand basic health
information and services needed to make appropriate health decisions." A vast body of
research shows that lower health literacy is associated with poorer outcomes, including
higher hospitalization rates, worse health, and greater mortality. Approximately 75 million
U.S. adults have low health literacy. Worse yet, racial and ethnic minorities and older
individuals (age 65+) are more likely to have low health literacy, creating another mechanism
for health disparities. These data indicate that many people will have difficulties adhering
to treatment regimens that require health literacy, as well as completing questionnaires for
public health and health research and care.

Improving self-report assessment. Health surveys are ubiquitous, but almost no questionnaires
used across the country have been validated for use with people who have low health literacy.
This is a glaring shortcoming in current survey validation methodology; inaccurate surveys
lead to false conclusions and threaten the empirical foundation of everyone's efforts to
understand and improve public health, healthcare, and health outcomes. Our goal is to rectify
this shortcoming. This study will 1) determine the effect of health literacy on widely-used
questionnaires, 2) determine the stability of psychometric properties of questionnaires over
time, and 3) test various testing formats to determine which ones work best for people with
low health literacy.

Inclusion Criteria:

- Be 18 years of age or older

- Be willing to provide informed consent, including signing the consent form

- Be willing to be randomized to administration method

- Be willing to complete questionnaires and interviews

- Be fluent in English and/or Spanish

- Be willing to attend three face-to-face sessions

- Have no plans to move out of the study area in the next six months

Exclusion Criteria:

- Significant cognitive or neurologic impairment

- Being a prisoner, detainee, or in police custody

- Unable to complete the consent process

- Inadequate vision to see study materials (worse than 20/80 corrected)

- Inadequate hearing or manual dexterity to use the computer system