Development of an easy-to-use Spanish health literacy test

Shoou Yih D. Lee, Deborah E. Bender, Rafael E. Ruiz, Ik Cho Young

Research output: Contribution to journalArticlepeer-review

147 Scopus citations


Objective. The study was intended to develop and validate a health literacy test, termed the Short Assessment of Health Literacy for Spanish-speaking Adults (SAHLSA), for the Spanish-speaking population. Study Design. The design of SAHLSA was based on the Rapid Estimate of Adult Literacy in Medicine (REALM), known as the most easily administered tool for assessing health literacy in English. In addition to the word recognition test in REALM, SAHLSA incorporates a comprehension test using multiple-choice questions designed by an expert panel. Data Collection. Validation of SAHLSA involved testing and comparing the tool with other health literacy instruments in a sample of 201 Spanish-speaking and 202 English-speaking subjects recruited from the Ambulatory Care Center at UNC Health Care. Principal Findings. With only the word recognition test, REALM could not differentiate the level of health literacy in Spanish. The SAHLSA significantly improved the differentiation. Item response theory analysis was performed to calibrate the SAHLSA and reduce the instrument to 50 items. The resulting instrument, SAHLSA-50, was correlated with the Test of Functional Health Literacy in Adults, another health literacy instrument, at r = 0.65. The SAHLSA-50 score was significantly and positively associated with the physical health status of Spanish-speaking subjects (p<.05), holding constant age and years of education. The instrument displayed good internal reliability (Cronbach's α = 0.92) and test-retest reliability (Pearson's r = 0.86). Conclusions. The new instrument, SAHLSA-50, has good reliability and validity. It could be used in the clinical or community setting to screen for low health literacy among Spanish speakers.

Original languageEnglish (US)
Pages (from-to)1392-1412
Number of pages21
JournalHealth Services Research
Issue number4 I
StatePublished - Aug 2006
Externally publishedYes


  • Health literacy
  • Spanish speakers
  • Test instrument

ASJC Scopus subject areas

  • Health Policy


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