Health Literacy in the emergency department

Brice, Jane H., Debbie Travers, Christopher S. Cowden, Matthew D. Young, Antonio Sanhueza, and Yolanda Dunston. “Health Literacy Among Spanish-Speaking Patients in the Emergency Department.” Journal of the National Medical Association 100, no. 11 (November 2008): 1326-1332.

This article, in conjunction with the US Census Report on Race and Hispanic Origin, really kick-started my interest in examining health literacy. This study used a matched cohort design to pair English and Spanish-speaking patients who arrived at an emergency room. Pairs were matched by age, gender, and area being treated. The researchers collected demographic information (including self-assessed reading ability) and administered a health literacy test. The researchers used the Test of Functional Health Literacy in Adults (TOFHLA).

The results of this study support what health literacy experts have been saying for some time: minorities are at greater risk of low health literacy. This study found that the Spanish-speaking patients scored, on average, 59.72 on the TOHFLA, which falls in the "inadequate functional health literacy" range. The English-speaking patients scored, on average, 90.78, which falls into the range of "adequate literacy".

This study was conducted in a surburban emergency room. Participants were enrolled during the hours of 11 am and 11 pm. 172 partipants were enrolled, resulting in 86 matched pairs. One drawback of the study is that participants self-reported their years of education and reading abilities. There is still a large social stigma regarding having a lower level of education and not being able to read well (or at all), so there could be some under-reporting by some participants.

This study is a good starting point in comparing health literacy levels across ethnic groups. While the sample size seems reasonable, it would be great to see this study expanded to include emergency departments across different types of communities (suburban, city, rural, etc.). The results of this study underscore the need to improve health information so more people can interpret and understand it.