Comparison of two screening methods to assess limited health literacy among Chinese adults

We performed this study to assess the levels of health literacy by using Rapid Estimate of Adult Literacy in Medicine (REALM) and Chinese version of short version of TOFHLA (C-S-TOFHLA) for Chinese Adults. Participants (n=309) from two hospitals and four communities completed in-person Interviews. REALM and S-TOFHLA tests were translated and modified into the Chinese language by translation-back translation process. The c-sTOFHLAd had good internal consistency reliability (Conbrach's alpha = .85) and excellent test-retest reliability (r= .95, p< .001). The prevalence of inadequate health literacy for C-S-TOFHLA and REALM were 8.9% and 9.2%, respectively. Area under the receiver operating characteristic curve for predicting inadequate health literacy was 0.74 [95% confidence interval (CI), 0.65–0.75; P < 0.001] for the S-TOFHLA Chinese version and 0.67 (95% CI, 0.63–0.73; P < 0.001) for the REALM Chinese version. Individual with inadequate health literacy would be more likely to smoke, did not know information from health professionals and has depressive feeling. The S-TOFHLA Chinese version has good reliability and validity and it could be used in the clinical or community setting to screen for low health literacy among Chinese adults.

KEY WORDS: health literacy, prevalence, measurement, Chinese adults