Volume 41 | Number 4p1 | August 2006

Abstract List

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


The study was intended to develop and validate a health literacy test, termed the (SAHLSA), for the Spanish‐speaking population.

Study Design

The design of SAHLSA was based on the (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 , another health literacy instrument, at =0.65. The SAHLSA‐50 score was significantly and positively associated with the physical health status of Spanish‐speaking subjects (<.05), holding constant age and years of education. The instrument displayed good internal reliability (Cronbach's =0.92) and test–retest reliability (Pearson's =0.86).


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.