Rapid Estimate of Inadequate Health Literacy (REIHL): development and validation of a practitioner-friendly health literacy screening tool for older adults

Angela Yee Man Leung, Yee Tak Esther Yu, James KH Luk Luk, Pui Hing Chau, Diane Levin-Zamir, Sze Him Isaac Leung, KT Cheung, Iris Chi

Research output: Journal article publicationJournal articleAcademic researchpeer-review


Introduction: This study aimed to develop and validate a brief practitioner-friendly health literacy screening tool, called Rapid Estimate of Inadequate Health Literacy (REIHL), that estimates patients’ health literacy inadequacy in demanding clinical settings.

Methods: This is a methodological study of 304 community-dwelling older adults recruited from one community health centre and five district elderly community centres. Logistic regression models were used to identify the coefficients of the REIHL score’s significant factors. Receiver operating characteristic (ROC) curve analysis was then used to assess the REIHL’s sensitivity and specificity. Path analysis was employed to examine the REIHL’s criterion validity with the Chinese Health Literacy Scale for Chronic Care and concurrent validity with self-rated health scale and the Geriatric Depression Scale–15.

Results: The REIHL has scores ranging from 0 to 23. It had 76.9% agreement with the Chinese Health Literacy Scale for Chronic Care. The area under the ROC curve for predicting health literacy inadequacy was 0.82 (95% confidence interval=0.78-0.87, P<0.001). The ROC curve of the REIHL showed that scores ≥11 had a sensitivity of 77.8% and specificity of 75.6% for predicting health literacy inadequacy. The path analysis model showed excellent fit (Chi squared [2, 304] 0.16, P=0.92, comparative fit index 1.00, root mean square error of approximation <0.001, 90% confidence interval=0.00-0.04), indicating that the REIHL has good criterion and concurrent validity.

Conclusion: The newly developed REIHL is a practical tool for estimating older adults’ inadequate health literacy in clinical care settings.
Original languageEnglish
Pages (from-to)404-412
JournalHong Kong Medical Journal
Issue number6
Publication statusPublished - 25 Sep 2020

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