How can literacy be best assessed in an urgent care setting?

Best Methods for Literacy Assessment in Urgent Care Settings

The most effective way to assess literacy in an urgent care setting is to use the Brief Health Literacy Screen (BHLS), which consists of 3 self-administered Single-Item Literacy Screener (SILS) questions that can be quickly implemented in time-constrained clinical environments. 1

Quick Screening Tools for Urgent Care

Brief Health Literacy Screen (BHLS)

The BHLS offers the best balance of speed and accuracy for urgent care settings, where time constraints are significant:

• Consists of 3 simple questions that patients can self-administer
• Takes minimal time to complete (1-2 minutes)
• Requires minimal staff training to administer
• Particularly useful question: "How confident are you filling out forms by yourself?" 2

Single-Item Literacy Screener (SILS)

For even more time-constrained situations, the most effective single question is:

• "How often do you have someone help you read hospital materials?" 2
• Scores on a 5-point Likert scale (higher scores indicate lower health literacy)
• A score >10 indicates low health literacy 2

Implementation Algorithm for Urgent Care

1. Initial Assessment: Have patients complete the 3-question BHLS while waiting
2. Scoring: Quickly score the responses (scores >10 indicate low health literacy)
3. Adaptation: For patients with identified low literacy:
   • Use verbal reinforcement of key instructions
   • Employ "teach-back" methods to verify understanding
   • Provide simplified written materials with visual aids

More Comprehensive Options (When Time Permits)

If more time is available or higher precision is needed:

REALM-SF (Rapid Estimate of Adult Literacy in Medicine-Short Form)

• 7-item word recognition test 3
• Takes approximately 2-3 minutes to administer 4
• High correlation with longer literacy assessments (r = 0.94) 3
• Fewer interruptions during administration compared to other tools 4

Newest Vital Sign (NVS)

• Uses a nutrition label to assess both literacy and numeracy
• Takes approximately 3 minutes to administer 4
• Most useful for ruling out limited health literacy (negative likelihood ratio of 0.04) 4
• However, may overidentify limited health literacy (identifies 64.8% of patients as having limited health literacy) 4

Special Considerations

Non-English Speakers

• For patients with limited English proficiency, use formal interpreters to improve both patient and provider satisfaction 2
• Spanish-speaking patients show significant differences in recall of medical information compared to English-speaking patients 2

Verification of Understanding

• Use "read-back, teach-back" communication strategies where patients repeat key points to verify comprehension 2
• This approach has been associated with improved outcomes in various clinical settings 2

Common Pitfalls to Avoid

1. Overreliance on written materials: Even when 72% of patients can read discharge instructions aloud, only 49% can outline their treatment plan 2

2. Assuming comprehension without verification: Studies show only 22% of patients are given an opportunity to confirm their understanding of instructions 2

3. Misclassification risk: Despite their utility, subjective literacy assessments have misclassification rates >20% 1

4. Time pressure: The average discharge process in EDs lasts only 76 seconds, which is insufficient for proper literacy assessment and education 2

By implementing these brief but effective literacy assessment tools, urgent care providers can quickly identify patients at risk for limited health literacy and adjust their communication strategies accordingly, ultimately improving patient outcomes through better understanding and adherence to medical instructions.