Using SAS/STAT® Software to Validate a Health Literacy Prediction Model in a Primary Care Setting


Existing health literacy assessment tools developed for research purposes have constraints that limit their utility for clinical practice. The measurement of health literacy in clinical practice can be impractical due to the time requirements of existing assessment tools. Single Item Literacy Screener (SILS) items, which are self-administered brief screening questions, have been developed to address this constraint. We developed a model to predict limited health literacy that consists of two SILS and demographic information (for example, age, race, and education status) using a sample of patients in a St. Louis emergency department. In this paper, we validate this prediction model in a separate sample of patients visiting a primary care clinic in St. Louis. Using the prediction model developed in the previous study, we use SAS/STAT® software to validate this model based on three goodness of fit criteria: rescaled R-squared, AIC, and BIC. We compare models using two different measures of health literacy, Newest Vital Sign (NVS) and Rapid Assessment of Health Literacy in Medicine Revised (REALM-R). We evaluate the prediction model by examining the concordance, area under the ROC curve, sensitivity, specificity, kappa, and gamma statistics. Preliminary results show 69% concordance when comparing the model results to the REALM-R and 66% concordance when comparing to the NVS. Our conclusion is that validating a prediction model for inadequate health literacy would provide a feasible way to assess health literacy in fast-paced clinical settings. This would allow us to reach patients with limited health literacy with educational interventions and better meet their information needs.

SAS Global Forum 2014