Author Affiliations: Denver Health Medical Center, Denver, Colorado (Dr Peterson) (firstname.lastname@example.org); and University of Colorado Denver, Aurora (Dr Masoudi).
In Reply: Dr McNaughton and colleagues raise several important questions about the optimal approach to assessing and using health literacy in terms of the instrument, the mode of administration, and the optimal cutoff score. We incorporated the 3-question instrument in our study because of existing evidence of validity and the burden of administering more traditional instruments, which are cumbersome outside of the research environment. Approximately 75% of respondents answered the survey in writing; we were not able to validate written responses against an oral administration of the survey. It is conceivable that written responses may misclassify patients with low literacy; however, this differential misclassification would be expected to bias the results toward the null. In a clinical setting, we agree that any literacy assessment would be best administered in person at the bedside, which further justifies a streamlined approach. However, this was not feasible in the context of our study design.
Peterson PN, Masoudi FA. Health Literacy and Patients With Heart Failure—Reply. JAMA. 2011;306(5):489–491. doi:10.1001/jama.2011.1065