New test helps Latino patients, health care workers communicate

June 08, 2006
Researchers at the University of North Carolina at Chapel Hill’s School of Public Health have designed an easy-to-use health literacy test to help U.S. health care workers better communicate with and care for Spanish-speaking patients.

Dr. Shoou-Yih D. Lee

Dr. Shoou-Yih D. Lee

The new test, SAHLSA (Short Assessment of Health Literacy for Spanish-speaking Adults), helps health care workers identify patients with low health literacy, alerting the workers that alternative communication methods – audio, video or pictures – may be needed. The test is administered in Spanish.

Poor health literacy – inability to understand commonly used health terms – can cause communication problems for Latinos and health care staff, resulting in higher health care costs, lower quality of care and possible medical errors.

“It’s not uncommon for bilingual Latino children to act as interpreters for their parents in a hospital,” said Dr. Shoou-Yih D. Lee, professor of health policy and administration in the School of Public Health. “That’s a lot of pressure on a young person to get the information right.”

Lee, principal investigator in a federally funded study to evaluate the new test, said it is valuable because Spanish-speaking residents often face health threats, such as job-related accidents. They also may be reluctant to enter a hospital because of the language barrier.

Dr. Deborah E. BenderAlso participating in the study were co-investigator Dr. Deborah E. Bender, research professor, and Rafael E. Ruiz, a doctoral candidate in health policy and administration, both in the School of Public Health; and Dr. Young Ik Cho of the University of Illinois at Chicago.

Health professionals who work with Latinos have expressed a need for an easy-to-use health literacy test, Lee said. Spanish-speaking populations have risen dramatically in some areas of the country. North Carolina’s Latino population grew 400 percent from 1990 to 2000.

The test takes a few minutes and is administered by asking a patient to read aloud in Spanish a list of common medical terms, such as embarazo (pregnancy), microbios (germs) and infeccisn (infection). The patient must associate each term with another word similar in meaning to demonstrate comprehension.

Patients who have trouble pronouncing the words are more likely than others to have difficulty with comprehension, researchers said.

They conducted the study at UNC Health Care’s Ambulatory Care Center with 201 Spanish-speaking participants. The study compared SAHLSA with two other tests now in use: REALM (Rapid Estimate of Adult Literacy in Medicine) and TOFHLA (Test of Functional Health Literacy in Adults).

REALM takes just a few minutes, but it has not been translated into Spanish successfully. TOFHLA has been translated into Spanish but takes at least 20 minutes to administer. The study showed that SAHLSA significantly reduced the time needed to administer a test and could be conducted entirely in Spanish.

Health organizations may obtain the test from Lee at (919) 966-7770 or The journal Health Services Research published the study online.

The study was supported financially by the Agency for Healthcare Research and Quality, an arm of the U.S. Department of Health and Human Services.


School of Public Health contacts: Gene Pinder, (919) 966-9756 or

For further information please contact Ramona DuBose either by phone at 919-966-7467 or by e-mail at