Title: Evaluation of the REALM Health Literacy Test in a Developing Country Ros Dowse Lebo Lecoko Tina Ehlers
1Evaluation of the REALM Health Literacy Test
in a Developing CountryRos DowseLebo Lecoko
Tina Ehlers
2Introduction
- Health care systems require that patients be able
to read - Low-literate patients have the highest morbidity
and mortality rates from chronic diseases and
conditions
3Definition of health literacy
- the capacity of an individual to obtain,
process and understand basic health information
and services needed to make appropriate health
decisions
4South Africa
- Verbal information PROBLEM!
- Written information PROBLEM!
- Widespread limited literacy skills
- Literacy statistics
- illiterate 45
- semi-literate 25
- literate 30
- 3 out of 4 patients problems with reading
5Measurement of health literacy
- Indirect measurement
- - standard of education
- Direct measurement
- - literacy test or task
- Valuable information
- - provide appropriately tailored medicine
information
6REALM Test
- Health literacy test developed in USA
- Available in English
- Takes 1 3 mins to administer
- Estimates reading level below grade 9
- Consists of 3 lists of 22 words each, arranged in
order of increasing difficulty - Words read aloud and pronunciation checked
- Grades estimated according to number of words
pronounced correctly
7Objective
- To evaluate the applicability of the REALM test
in a South African English second-language
population
8Methodology
- 125 Xhosa respondents of different educational
levels were tested with the aid of interpreters - All stated that they could read and understand
English - Demographic data obtained
- Respondents asked to read aloud as many words as
possible from the 3 lists and then to explain
their meaning
9Criteria for success or failure
Case Read Understand Succeeds / Fails
1 ? ? Succeeds
2 X X Succeeds
3 ? X Fails
4 X ? Fails
- Cases 1 and 2 to account for gt 80 respondents
- Apply this to gt 2/3 (44 of 66) words
10Demographics
Characteristic Number ()
Sex Male Female Age (yrs) lt 21 21 40 41 65 gt 65 Education None - Grade 3 Grades 4 6 Grades 7 8 gt Grade 9 50 (40.0) 75 (60.0) 6 (4.8) 65 (52.0) 51 (40.8) 3 (2.4) 30 (24.0) 30 (24.0) 30 (24.0) 35 (28.0)
11Case 3 REALM test fails
List 1 List 2 List 3
smear 58 pelvic 57 testicle 51
dose 58 menopause 62 obesity 56
incest 58 calories 71 hepatitis 59
rectal 65 irritation 62
hormones 66 constipation 64
bowel 72 anemia 73
herpes 74 inflammatory 73
impetigo 74
colitis 79
12Case 4 REALM test fails
List 1 List 2 List 3
rectal 1 fatigue 1 testicle 1
asthma 2 notify 1 emergency 1
cancer 2 directed 1 sexually 1
kidney 2 nausea 1 menstrual 2
meals 2 appendix 2 alcoholism 2
germs 2 exercise 2 diabetes 6
nerves 6 arthritis 5
eye 13 miscarriage 5
pregnancy 6
13Words which were poorly understood
- Haemorrhoids 0.0
- Colitis 0.0
- Osteoporosis 0.8
- Hepatitis 0.8
- Inflammatory 1.6
- Seizure 1.6
- Anemia 2.4
- Menopause 4.0
14REALM TestAccept / Reject?
- REALM test only worked for 8 of the 66 words
- It failed in 41 of a total of 8250 cases (125
respondents x 66 words)
15Conclusion
- REALM test is not a suitable tool to assess
health literacy in this population - Ability to pronounce words gives no indication of
comprehension - Schooling is an unreliable literacy marker
- Enables suitable terms to be identified for
inclusion in patient information leaflets
16Acknowledgements
- Rhodes University for financial support
- Professor Radloff for assistance with statistics
- Interpreters and respondents who contributed to
this project