A pilot study to assess oral health literacy by comparing a word recognition and comprehension tool

Abstract

BackgroundOral health literacy is important to oral health outcomes. Very little has been established on comparing word recognition to comprehension in oral health literacy especially in older adults. Our goal was to compare methods to measure oral health literacy in older adults by using the Rapid Estimate of Literacy in Dentistry (REALD-30) tool including word recognition and comprehension and by assessing comprehension of a brochure about dry mouth.Methods75 males and 75 females were recruited from the University of Connecticut Dental practice. Participants were English speakers and at least 50 years of age. They were asked to read the REALD-30 words out loud (word recognition) and then define them (comprehension). Each correctly-pronounced and defined word was scored 1 for total REALD-30 word recognition and REALD-30 comprehension scores of 0–30. Participants then read the National Institute of Dental and Craniofacial Research brochure “Dry Mouth” and answered three questions defining dry mouth, causes and treatment. Participants also completed a survey on dental behavior.ResultsParticipants scored higher on REALD-30 word recognition with a mean of 22.98 (SD = 5.1) compared to REALD-30 comprehension with a mean of 16.1 (SD = 4.3). The mean score on the brochure comprehension was 5.1 of a possible total of 7 (SD = 1.6). Pearson correlations demonstrated significant associations among the three measures. Multivariate regression showed that females and those with higher education had significantly higher scores on REALD-30 word-recognition, and dry mouth brochure questions. Being white was significantly related to higher REALD-30 recognition and comprehension scores but not to the scores on the brochure.ConclusionsThis pilot study demonstrates the feasibility of using the REALD-30 and a brochure to assess literacy in a University setting among older adults. Participants had higher scores on the word recognition than on comprehension agreeing with other studies that recognition does not imply understanding.

The value of a combined word recognition and knowledge measure to understand characteristics of our patients’ oral health literacy

“…This confirms the association between word recognition and comprehension for this measure. Noting that the mean for the REALMD‐20 (17.2 of 20 items) was higher than for the CMOHK (17.6 of 23 items) also confirms the results of Khan et al., who showed that word pronunciation and knowledge were not the same, and that, in more cases, recognition was more common than knowledge . In Khan's case, participants’ use of knowledge was represented by a simple definition.…”

“…People have questioned whether recognition of a word indicates that the individual comprehends the meaning . This analysis demonstrates for oral HL that words that dentists use may be recognized but not completely understood by their patients.…”

“…Noting that the mean for the REALMD-20 (17.2 of 20 items) was higher than for the CMOHK (17.6 of 23 items) also confirms the results of Khan et al, who showed that word pronunciation and knowledge were not the same, and that, in more cases, recognition was more common than knowledge. 16 We tried to balance the validity, reliability and usability in developing the measure. The validity of the original REALMD-20 and the CMOHK measures was demonstrated in different samples.…”

“…A measure of conceptual knowledge was developed by Macek that describes an individual's conceptual oral health knowledge . A limited number of oral HL measures have been developed that incorporate health knowledge into the measure …”

“…15 A limited number of oral HL measures have been developed that incorporate health knowledge into the measure. 15,16 In summary, a number of experts have identified the importance of lower HL and lower oral HL in creating barriers to access, understand, and interpret information that is needed to attain and maintain good health. While evidence-based reviews have identified some mutable and nonmutable characteristics associated with good health outcomes, they have also identified gaps in the knowledge | 381 framework which posits that oral HL and knowledge are influenced by people's socioeconomic status and their frequency of interaction with and their ability to understand dental professionals.…”