Screening for oral health literacy in an urban dental clinic

Abstract

Objective Studies show that the average person fails to understand and use health care related materials to their full potential. The goal of this study was to evaluate a health literacy instrument based on the Rapid Estimate of Adult Literacy in Medicine (REALM) that incorporates dental and medical terms into one 84-item Rapid Estimate of Adult Literacy in Medicine and Dentistry (REALM-D) measure and determine its association with patient characteristics of a culturally diverse dental clinic population. Methods An 84-item dental/medical health literacy word list and a 48-item health beliefs and attitudes survey was provided to a sample of 200 adult patients seeking treatment for the first time at an oral diagnosis clinic located in a large urban medical center in Los Angeles, California. Results Of the total sample, 154 participants read all of list 1 correctly, 141 read list 2 correctly, and only 38 read list 3 correctly. Nonwhite participants had significantly lower REALM-D scores at each level of difficulty as well as the total scale score compared to white participants. Participants who reported English as not their main language had significantly lower REALM-D scores. REALM-D scores also varied significantly by level of education among participants where as level of education increased, oral health literacy increased. At a bivariate level, race, education, and English as a main language remain predictive of health literacy in a regression model. An interaction between education and English as a main language was significant. Conclusions The REALM-D is an effective instrument for use by medical and dental clinicians in detecting differences among people of different backgrounds and for whom English was not their primary language.

Effect of Family Income on the Relationship Between Parental Education and Sealant Prevalence, National Health and Nutrition Examination Survey, 2005–2010

“…We classified education as a predisposing factor because of its strong association with health literacy (12,13), which in turn predicts higher sealant prevalence (10). This classification is also consistent with Andersen and Aday’s identification of education as a predisposing factor in their PEN model (17).…”

“…The RAND Health Insurance Experiment (HIE) also found that health literacy (ie, parents’ knowledge of the medical care system) predicted use of dental health services among children (11). Studies further suggest that one of the strongest predictors of medical and oral health literacy is educational attainment (12,13). Knowledge of the preventive benefits of sealants is also almost 5 times higher among people with more than a high school education compared with those without a high school education (34% vs 7%) (14).…”

Oral health literacy among clients visiting a Rural Dental College in north India- A crosssectional study

“…Low health literacy is often described as ‘The Silent Health Epidemic’ in which there is a limited capacity to obtain, comprehend and act on health information (2). The same definition used in oral context is called ‘Oral Health Literacy (OHL)’.…”

Comparing Well-Tested Health Literacy Measures for Oral Health: A Pilot Assessment

“…In the limited oral health research that has been done on this topic, similar results have been found (Lee, Divaris, Baker, Rozier, Vann, 2012). The body of work on self-efficacy and health literacy has generally used three well-tested scales for measuring health literacy: the Newest Vital Sign (Weiss, Mays, Martz, Castro, DeWalt, Pignone et al, 2005), the Rabid Estimate of Adult Literacy in Medicine (REALM) (Davis, Long, Jackson, Mayeaux, George, Murphy et al 1993) or Dentistry (REALD) (Atchison, Gironda, Messadi, & Der-Martirosian, 2010; Stucky, Lee, Lee, Rozier, 2011), and the Test of Functional Health Literacy in Adults (TOFHLA) (Baker, Williams, Parker, Gazmararian, & Nurss, 1999; Parker, Baker, Williams & Nurss, 1995). While each study revealed significant findings, no study used more than one health literacy measure to note any differences across the sample depending on measure used.…”

“…Other, shorter versions of the REALM have been attempted, but with limited application (Bass, Wilson, & Griffith, 2003; Arozullah et al, 2007). Versions of REALM have been created for oral health literacy, such as REALD-30, REALD-99, and REALMD (Atchison et al, 2010; Stucky et al, 2011). These measures model the original REALM in that they are lists of terms related to dental and oral health care that are to be read aloud by the participant.…”