Assessing patient activation and health literacy in the ED

Sophia Sheikh, Phyllis Hendry, Colleen Kalynych, Brittany Owensby, Jennifer Johnson, Dale F. Kraemer, Donna Carden

Research output: Contribution to journalArticle

10 Citations (Scopus)


Background Low health literacy and patient activation are linked to unmet health needs, excess emergency department (ED) use, and hospital admission. However, most studies have assessed these measures in non-ED populations. Objective The objective of the study is to assess health literacy and patient activation in the ED. Methods A cross-sectional study in adults older than 18 years presenting to an ED were selected using systematic sampling. Demographic data and reason for ED visit were collected. Health literacy was assessed using Rapid Estimate of Adult Literacy in Medicine (REALM). Patient activation was assessed using Patient Activation Measure. Kruskal-Wallis tests compared groups. Spearman rank correlations compared numeric variables. Results A total of 140 patients were approached, and 108 enrolled. Average age was 51 years. Most were unemployed (71%), were unmarried (80%), had a primary physician (62%), were male (60%), were African American (63%), and were on public insurance (58%). Most had an activation level of 3 or 4. The mean REALM score was 52. Patients with higher REALM scores had higher activation levels (rs = 0.30; P =.0017), although, when adjusted for age, this association was no longer significant. Sex, education, insurance status, and race were not significantly associated with REALM or activation levels. Activation levels decreased with increasing age (rs = - 0.24; P =.01). Low activation levels and limited health literacy were significantly associated with admission (odds ratio, 4.4; 95% confidence interval, 1.5-12.6; P =.0061). Conclusions This is the first study to assess Patient Activation Measure in the ED. Low activation levels and limited REALM scores assessed in the ED population were significantly associated with hospital admission. Assessing activation levels of ED patients could lead to better education and tailored discharge planning by ED clinicians potentially reducing ED revisits.

Original languageEnglish
Pages (from-to)93-96
Number of pages4
JournalAmerican Journal of Emergency Medicine
Issue number1
Publication statusPublished - Jan 1 2016


ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Sheikh, S., Hendry, P., Kalynych, C., Owensby, B., Johnson, J., Kraemer, D. F., & Carden, D. (2016). Assessing patient activation and health literacy in the ED. American Journal of Emergency Medicine, 34(1), 93-96.