Table 4. Comparison of Single-Item Literacy Screener/Brief Health Literacy Screen (SILS/BHLS) Model Identification of Limited Health Literacy With Objective Health Literacy Measures (Rapid Estimate of Adult Literacy in Medicine, Revised, and Newest Vital Sign*)
Models*Limited Health Literacy n (%)Adequate Health Literacy n (%)Kappa95% CIMisclassified (%)SensitivitySpecificityPositive Likelihood RatioNegative Likelihood Ratio
Difficulty with written information (SILS) and demographics model*
    REALM-R limited health literacy13262.08138.00.430.35–0.5128.10.620.813.260.47
    REALM-R adequate health literacy4719.419580.6
    NVS limited health literacy23381.55318.50.490.41–0.5723.70.820.682.560.26
    NVS adequate health literacy5532.511467.5
Brief Health Literacy Screen and demographics model*
    REALM-R limited health literacy17180.34219.70.420.34–0.5029.50.800.622.110.32
    REALM-R adequate health literacy9238.015062.0
    NVS limited health literacy22177.36522.70.480.40–0.5624.80.770.722.750.32
    NVS adequate health literacy4828.412171.6
  • * Models control for age, sex, race, and education.

  • NVS, Newest Vital Sign; REALM-R, Rapid Estimate of Health Literacy in Medicine, Revised.