Short Assessment of Health Literacy—Spanish and English: A Comparable Test of Health Literacy for Spanish and English Speakers
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Objective. The intent of the study was to develop and validate a comparable health literacy test for Spanish‐speaking and English‐speaking populations. Study Design. The design of the instrument, named the Short Assessment of Health Literacy—Spanish and English (SAHL‐S&E), combined a word recognition test, as appearing in the Rapid Estimate of Adult Literacy in Medicine (REALM), and a comprehension test using multiple‐choice questions designed by an expert panel. We used the item response theory (IRT) in developing and validating the instrument. Data Collection. Validation of SAHL‐S&E involved testing and comparing the instrument with other health literacy instruments in a sample of 201 Spanish‐speaking and 202 English‐speaking subjects recruited from the Ambulatory Care Center at the University of North Carolina Healthcare System. Principal Findings. Based on IRT analysis, 18 items were retained in the comparable test. The Spanish version of the test, SAHL‐S, was highly correlated with other Spanish health literacy instruments, Short Assessment of Health Literacy for Spanish‐Speaking Adults (r=0.88, p<.05) and the Spanish Test of Functional Health Literacy in Adults (TOFHLA) (r=0.62, p<.05). The English version, SAHL‐E, had high correlations with REALM (r=0.94, p<.05) and the English TOFHLA (r=0.68, p<.05). Significant correlations were found between SAHL‐S&E and years of schooling in both Spanish‐ and English‐speaking samples (r=0.15 and 0.39, respectively). SAHL‐S&E displayed satisfactory reliability of 0.80 and 0.89 in the Spanish‐ and English‐speaking samples, respectively. IRT analysis indicated that the SAHL‐S&E score was highly reliable for individuals with a low level of health literacy. Conclusions. The new instrument, SAHL‐S&E, has good reliability and validity. It is particularly useful for identifying individuals with low health literacy and could be used to screen for low health literacy among Spanish and English speakers.
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Parent health literacy was measured at baseline with the SAHL-S&E, an 18-item validated word recognition and comprehension test with a cut-off of 14 or less for low health literacy.
“Parent health literacy was measured at baseline using the Short Assessment of Health Literacy – Spanish and English (SAHL-S&E), an 18-item word recognition and comprehension test validated in a low-income population with an established cut-off to identify families with low health literacy (SAHL-S&E≤14).21”
From Access to preventive services after the integration of oral health care into early childhood education and medical care (2018) · cites this paper as [21]
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Health Literacy: A Prescription to End Confusion
Committee on Health Literacy, Board on Neuroscience and Behavioral Health, & Institute of Medicine (2004) · doi:10.17226/10883 · Cited by 3,444 · see citing works
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Shuter, J., Morales, D. A., Considine-Dunn, S. E., An, L. C., & Stanton, C. A. (2014) · JAIDS Journal of Acquired Immune Deficiency Syndromes · doi:10.1097/qai.0000000000000226 · Cited by 51 · see citing works
Connelly, K., Stein, K. F., Chaudry, B., & Trabold, N. (2016) · JMIR Public Health and Surveillance · doi:10.2196/publichealth.5511 · Cited by 27 · see citing works
Burgette, J. M., Preisser, J. S., & Rozier, R. G. (2018) · The Journal of the American Dental Association · doi:10.1016/j.adaj.2018.07.019 · Cited by 9 · see citing works
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- Authors
- Lee, S. D., Stucky, B. D., Lee, J. Y., Rozier, R. G., & Bender, D. E.
- Affiliations
- University of North Carolina at Chapel Hill (US)
- Corresponding author
- Lee, Shoou‐Yih Daniel
- Venue
- Health Services Research
- Publisher
- Wiley
- Published
- 2010-07-08
- Volume
- 45
- Issue
- 4
- Pages
- 1105-1120
- ISSN
- 0017-9124 (ISSN-L)
- 1475-6773
- PMC
- PMC2910571
- OpenAlex
- W1893431871
- Cited by
- 279
- References
- 1
- Citations by year
- 2026: 22 · 2025: 24 · 2024: 13 · 2023: 23 · 2022: 28 · 2021: 23 · 2020: 34 · 2019: 18 · 2018: 30 · 2017: 19 · 2016: 14 · 2015: 7 · 2014: 11 · 2013: 4 · 2012: 4
- FWCI
- 6.83
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Health Services Research (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (2r24hd050924-06)
- Agency for Healthcare Research and Quality (R03 HS013233, R03-HS13233)
- National Institute of Dental and Craniofacial Research (R01DE0180451, R01DE018236, R01DE018045)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (R24 HD-050924)
- Topics
- Health Sciences › Health Professions › General Health Professions › Health Literacy and Information Accessibility
- Health Sciences › Health Professions › General Health Professions › Interpreting and Communication in Healthcare
- Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
- Keywords
- health literacy, Spanish-speaking adults, English-speaking adults, cross-cultural comparability, test development, word recognition, comprehension, REALM, Test of Functional Health Literacy in Adults, instrument validation, item response theory
- MeSH terms
- Communication, Humans, Language, North Carolina, Psychometrics, Reproducibility of Results, Comprehension, Health Literacy
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