Time to sign: the relationship between health literacy and signature time

Patient Educ Couns. 2013 Jan;90(1):18-22. 
Authors: Sharp LK, Ureste PJ, Torres LA, Bailey L, Gordon HS, Gerber BS.

Objective: To evaluate the relationship between amount of time taken to sign one's name and health literacy.

Methods: A prospective, one time assessment was conducted on a convenience sample of 98 patients recruited in an inner-city outpatient internal medicine clinic. The amount of time required to sign (i.e. initiation to completion of writing) was measured by stopwatch. Health literacy was measured with the REALM.

Results: The sample averaged 54.1 (SD 16.2) years of age. Twenty-seven percent had less than high school education and 33% had a terminal general equivalency diploma or high school degree. The time required to sign ranged from 0.91 to 21.3 s. Sixty-two percent of the sample had health literacy challenges. Signature time was longest for those with inadequate health literacy (mean 10.0 s), compared with marginal (7.3 s) and adequate (4.7 s, p ≤ 0.001). Signature time remained significant in a logistic regression model after controlling for education and age (AOR = 0.785, CI = 0.661–0.932).

Conclusion: Individuals with signatures completed in six seconds or less were highly likely to display adequate health literacy.

Practice implications: Signature time may offer a practical and quick approach to health literacy screening in the health care setting.

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