Written screening tests confuse some patients

A pair of studies suggests that these tools may be limited by deficiencies in literacy and numeracy.

By Victoria Stagg Elliott — Posted Nov. 3, 2008

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The usefulness of having patients complete written screening tests while in the waiting room may be limited by a lack of understanding of the questions, according to a pair of papers presented at the American College of Surgeons 94th Annual Clinical Congress in San Francisco, Oct. 12-16.

"There is a true epidemic of health illiteracy in this country. Do not assume that your patients are literate with either prose or numeracy," said Viraj A. Master, MD, PhD, one of the authors and an assistant professor of urology at Emory University School of Medicine in Atlanta.

Researchers enrolled two cohorts of men older than 40. One group of 300 men completed the seven-question International Prostate Symptom Score -- once by themselves and a second time with the assistance of an interviewer.

About 16% understood all the questions, and 38% comprehended at least half. Another 18% could handle fewer than half. Twenty-eight percent misunderstood all of the questions.

A lack of education made literacy problems more likely. Age, income, employment, race and language did not seem to play a role.

A second cohort of 266 men completed the prostate health screening test and a three-question numeracy quiz. About 68% were bad with numbers, and this group was more likely to misclassify their symptoms. They also were four times more likely to misunderstand this screening tool.

"Being innumerate, in addition to being illiterate, results in high levels of misunderstanding that severely limit access to appropriate health care," Dr. Master said.

Health literacy has long been a concern of public health agencies and medical societies. The American Medical Association recognized low health literacy as a barrier to effective medical diagnosis and treatment in 1998.

Through the AMA Foundation, the AMA has organized numerous educational opportunities and materials for physicians. The Foundation report, "Assessing the Nation's Health Literacy," was released in July.

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External links

American College of Surgeons 94th Annual Clinical Congress, San Francisco, Oct. 12-16 (link)

AMA Foundation on health literacy (link)

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