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J Natl Med Assoc. 2007 Jul;99(7):795-8.

Testing of a verbal assessment tool of English proficiency for use in the healthcare setting.

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  • 1School of Policy Studies, Roosevelt University Chicago, IL, USA.



The purpose of the study is to test a verbal test of English comprehension for use in the healthcare setting. The BEST (Basic English Skills Test) oral interview test is a verbal test to determine language competency. There is currently no verbal test for determination of English language competency used in healthcare. Currently, the STOFHLA (Short Test of Functional Health Literacy Assessment) is used; however, it measures health literacy using a written exam, which does not measure language competency.


A convenience sample was used to conduct the study in an urban level-1 pediatric and adult trauma center with 45,000 annual visits. The two tests, STOFHLA and BEST, were administered by trained research fellows in patient rooms to 100 patients, 52% who were English speakers and 48% whom self-declare they spoke English as a second language. Participants include adult patients aged > 18, who were medically stable and able to give consent and who presented to the emergency department from May of 2004 to November of 2004. The study was approved by the institutional review board.


Using an ANOVA test with a significance of < or = 0.05, the BEST exam showed a difference between native speakers and ESL with F = 16.718 significant at 0.01. The STOFHLA also showed a difference between the two groups with F = 5.890 significant at 0.017. There was a significant relationship, p value of 0.000, between those passing the BEST exam and those individuals with passing the STOFHLA exam, thus showing that those who passed STOFHLA also passed the BEST exam.


The oral interview BEST test can be used in the ED to determine English competency. The results of the BEST test could be used to independently determine the need for a translator within the emergency department. A modified version based on results of this study may be administered to quickly determine English competency. The BEST test and STOFHLA test results, despite measuring different types of skills, were significantly related at the 0.05 level. This may indicate that an underlying factor such as educational levels plays a significant role in determining both types of competency.

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