Time to sign: The relationship between health literacy and signature time.

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 21.3s. 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 (7.3s) and adequate (4.7s, 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.