A shortened instrument for literacy screening

Abstract

Furthermore, marginal functional literacy has been associated with poorer physical health, psychological health, and higher health care costs. [4][5][6] The implication for physicians is that at least one-fourth of our patients may not be able to discern prescription bottles, understand patient education materials, or use written directions to find a lab or get a mammogram. Identifying patients with potential literacy problems is important if physicians are to attempt to combat the adverse effects literacy has on health care. Because many illiterate patients will attempt to hide this disability from their physicians and because people with more schooling may still be functionally illiterate, physicians cannot merely ask a patient if they can read or what their educational achievement is. search attempting to identify a shorter literacy screening instrument was unsuccessful. We designed the Rapid Estimate of Adult Literacy in Medicine-Revised (REALM-R), a shortened version of the REALM. The REALM-R was designed as a rapid-screening instrument to assess how well primary care patients read words that they commonly experience and are expected to understand in the course of interacting with their physician. This pilot study was conducted to determine whether the REALM-R could be used as a screening instrument to identify patients with potential literacy problems. METHODSWe set out to revise the REALM, a well-validated and reliable instrument, but one that is still too long to practically administer in busy clinical settings. The 66-item REALM was administered to 50 patients in the Internal Medicine Clinic at the University of Kentucky. We examined 2 item characteristics of the 66 words from the full scale REALM. First, we identified items with an item-whole correlation of greater than 0.40, and then selected those that maximized discrimination by being as close as possible to a 50 / 50 correct / incorrect split. The new 8-item REALM-R demonstrated a Cronbach's α of 0.91. The part whole correlation between the REALM-R and the REALM was 0.72.

Health Literacy and the Digital Divide Among Older Americans

“…36 The 2010 health literacy module also included the revised, shortened version of the Rapid Estimate of Adult Literacy in Medicine (REALM-R); we followed established convention defining low health literacy as seven or fewer words pronounced correctly. 37,38 Cognitive Function. We used three measures of cognitive function included in the HRS: serial sevens subtraction (7 from 100 successively), immediate and delayed recall (from a list of common words), and counting backwards.…”

A QI initiative for bridging the health literacy gap by Educating internal medicine residents at a community hospital

“…Second, the lack of a validated instrument for measuring RPs’ knowledge about HL and its effects resulted in the developing of an instrument that has not been validated for that purpose. Nevertheless, our tool was similar to an instrument used to grant continuing education to pharmacists who read the article discussed in our pre-clinic conference, making the use of this instrument reasonable [7]. Third, our literature search did not show evidence that HL knowledge-base or behavior can be improved by educational interventions targeting health professionals.…”

“…This questionnaire was administered to collect their perceived barriers to effective communication. In addition to their demographics (age, gender and educational status), we asked them, ‘How well can you understand your doctor?’ ‘Tell us what makes it difficult to understand your doctor.’ Before clinical interaction with RPs, patients were screened for their low HL risk with REALM-R (Rapid Estimate of Adult Literacy in Medicine-Revised) by medical assistants [7]. REALM-R, a short screening tool, has 8-word items; each item is scored with one point if pronounced correctly using a dictionary standard (maximum score 8, health illiterate if score ≤ 6).…”

“…Low HL is a universal problem. The purpose of this QI project was to compare the ability of IM-RPs to accurately identify their patients with low HL as assessed by a validated tool [7]. We wanted to measure RPs’ baseline HL-knowledge and their understanding of the consequences of low HL, so we designed an evaluation instrument similar to the one used in the pharmacy literature for continuing education [8].…”

Effect of Patient Navigation on Breast Cancer Screening Among African American Medicare Beneficiaries: A Randomized Controlled Trial

“…Participants' risk of low health literacy skills was assessed with the Rapid Estimate of Adult Literacy in Medicine-Revised (REALM-R) instrument. 41 Participants with a score of ≤6 were classified as having low health literacy; a score of 6 corresponds to a sixth grade reading level and is associated with difficulty comprehending written and oral materials. 41,42 Family history of breast cancer was assessed by the question, BHave your grandmother, mother, sister, or daughter ever been diagnosed with breast cancer?^Participants' comorbidities were a tally of the number of self-reported medical conditions from the following list: hypertension, diabetes, chronic lung disease, coronary heart disease or other heart problems, stroke, gastrointestinal problems, psychiatric disorders, arthritis, and memory-related disease.…”