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Powers BJ, Trinh JV, Bosworth HB. Can this patient read and understand written health information? JAMA. 2010 Jul 7;304(1):76-84.

Patients with limited literacy are at higher risk for poor health outcomes; however, doctor's perceptions are inaccurate for identifying these patients. The aim of this research was to review the accuracy of brief instruments for identifying patients with limited literacy.

Ten studies using 6 different instruments met inclusion criteria.  The Newest Vital Sign performed moderately well for identifying limited literacy.  Newest Vital Sign is a bilingual (English and Spanish) screening tool that identifies patients at risk for low health literacy. The tool can be administered in a clinical setting in just three minutes. It is based on a nutrition label from an ice cream container. Patients are given the label and then asked 6 questions about how they would interpret and act on the information contained on the label.

Among the single-item questions, asking about a patient's use of a surrogate reader, confidence filling out medical forms, and self-rated reading ability performed moderately well in identifying patients with inadequate or marginal literacy.

The authors concluded that several single-item questions, including use of a surrogate reader and confidence with medical forms, were moderately effective for quickly identifying patients with limited literacy.

www.ncbi.nlm.nih.gov/pubmed/20606152