"¿Cómo se siente?"

Tools for Determining the Health Literacy of Spanish-Speaking Patients

How can care providers be sure that their Spanish speaking patients understand the health and medical information they are given?  It’s an important question, particularly as native Spanish speakers in the US now top 41 million, more than in Spain and second only to Mexico.  


Health literacy is a concept that refers to a patient’s ability to take the information that they receive in the health care setting and then later use that information to manage their health. Tools that providers and organizations may use to measure the health literacy of their patient population assess skills such as reading ability, numeracy, and listening comprehension among other factors.  Currently, there is not a single accepted standard to assess health literacy, so providers looking to measure health literacy have to choose from a plethora of measuring tools.


To help nurses, researchers and other health care providers trying to improve communication about health with and within Spanish-speaking populations, Columbia Nursing PhD student Samantha Stonbraker identified and summarized 19 validated methods that can be used to measure health literacy among Latinos in clinical and research settings. Her research, “Tools to Measure Health Literacy Among Spanish Speakers: An Integrative Review of the Literature,” was recently published in the journal Patient Education and Counseling.  


 “Health care providers have the best of intentions,” Stonbraker says, “but we can’t always tell how much our patients understand the health care system or even how much they understand issues related to their own health. My hope is that health care professionals can use this article as a reference guide of the tools that might help bridge the health literacy gap between providers and patients.”


The article started as a literature review assignment in a class Stonbraker took last fall with Assistant Professor Rebecca Schnall, PhD, with Associate Dean for Research Elaine Larson, PhD, acting as Stonbraker’s advisor. All three are credited as authors on the article.  


In her review, Stonbraker performed Spanish and English language searches of nine databases, including MEDLINE and PubMed, searching for papers published on tools that could be used to assist Spanish speakers. Her goal was to capture information on all validated tools for measuring the health literacy of Spanish speakers -- tools designed or adapted to Spanish speakers after undergoing peer review, including an evaluation in which its methodology was assessed for efficacy.  


Stonbraker discovered 20 articles that described 19 validated tools, which are described individually in a useful chart that is the heart of article.   This chart is essentially a Consumer Reports of the main tools to be found online that help caregivers understand the health literacy levels of their specific patient populations.


The chart provides a quick overview of each tool, including information on each one’s purpose, cultural context, method for assessing patient skills, administration and scoring.  In addition, the chart notes each tool’s focus, audience and approach.  For example, the list includes:


  • Tools that focus on specific health conditions, such as diabetes, breast and cervical cancers, nutrition, genetics, etc.
  • Tools that focus on issues related to accessing the system, such as Medicare, Medicaid, general comprehension
  • Tools that target specific audiences, such as parents of young children, adults in primary care settings, and the Hispanic population along the U.S.-Mexico border


"The tools are not universal – they don’t cover all dialects and they aren’t applicable to all situations,” Stonbraker points out. “However, they are much better than having only English language tools for assessing a patient’s level of health literacy.”


 “As health care providers in a multicultural era, we have an obligation to provide the information that patients need to manage their health, in a way that patients can understand it,” Stonbraker says. "To do that, we must be able to measure patient’s ability understand and use the information they receive in health care settings. Health literacy assessments may be the first step toward that understanding.”