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Health Literacy Discussion
here we are discuss the Health Literacy according to the Wikipedia
The REALM is a medical-word recognition and pronunciation test for screening adult reading ability in medical settings.
It can be administered and scored in under 3 minutes by personnel with minimal training,
making it easy to use in clinical settings.
Participants read from a list of 66 common medical terms
that patients may be expected to be able to read in order to participate effectively in their own health care.
The words are arranged in three columns according to the number of syllables and pronunciation difficulty. Each correctly read and pronounced word increases the participant’s score by 1. Scores (0–66 words read and pronounced correctly) can be converted into four reading grade levels: grades 0–3 (0–18 words), grades 4–6 (19–44 words), grades 7–8 (45–60 words), and grade 9 and above (61–66 words).
The REALM’s criterion validity is established through correlation with other standardized reading tests:
Peabody Individual Achievement Test-Revised, 0.97 (Markwardt, 1989),
Slosson Oral Reading Test-Revised, 0.96 (Slosson, 1990), and WRAT-R, 0.88 (Davis et al., 1993, 1998; all correlations p < 0.0001).
The REALM also reports high intra-subject reliability (0.97). The REALM has been developed in English only. A Spanish-language version is not possible because reading tests based on pronunciation are not valid in Spanish.
This is due to the regular phoneme–grapheme correspondence of Spanish, in which there is usually a one-to-one correspondence between letters and sounds, making it relatively easy to pronounce unfamiliar words even for readers with limited literacy skills (Nurss et al., 1995).
Measures of Health Literacy
The TOFHLA includes a 17-item test of numerical ability and a 50-item test of reading comprehension,
as measured by a Cloze procedure (see Appendix C for examples of items from the TOFHLA). The TOFHLA draws on materials commonly used in health-care settings at the time the test was developed. Reading passages were selected from instructions for preparation for an upper gastrointestinal series,
the patient “Rights and Responsibilities” section of a Medicaid application,
and a standard informed consent form. The numeracy items on the TOFHLA test a patient’s ability to understand monitoring blood glucose, keep a clinic appointment,
obtain financial assistance, and understand directions for taking medicines using an actual pill bottle.
Total scores for the TOFHLA are divided into three criterion levels: inadequate, marginal, and adequate. Those with inadequate health literacy scores often misread medication dosing instruction,
appointment slips, and instructions for the upper gastrointestinal tract radiographic procedure.
Those with marginal health literacy scores
perform better on those tasks,
but often misread information on prescription bottles and have trouble understanding the Medicaid “Rights and Responsibilities” passage.
Those who score in the adequate range do well on these tasks,
but may have some difficulty comprehending the more difficult tasks like determining financial eligibility and the informed consent document (Parker et al., 1995).
The TOFHLA takes up to 22 minutes to administer and has good criterion validity, with correlation coefficients of r = 0.74 with the WRAT-R and r = 0.84 with the REALM, and a high reliability (Cronbach’s alpha = 0.98; Parker et al., 1995).
The Scope of Health Literacy
For time considerations, the TOFHLA was reduced to an abbreviated version called the S-TOFHLA
that takes 12 minutes or less to administer (Baker et al., 1999).
It consists of a reading comprehension section containing
a 36-item test using the initial two passages in the reading comprehension section of the full TOFHLA—
instructions for preparation for an upper gastrointestinal series and the patient “Rights and Responsibilities” section of a Medicaid application.
It also contains a shortened 4-item measure of numeracy. The S-TOFHLA has been shown to have good internal consistency reliability (Cronbach’s alpha = 0.98 for all items combined)
and concurrent validity compared to the long version of the TOFHLA (r = 0.91) and the REALM (r = 0.80).
Both the TOFHLA and the S-TOFHLA are available in English and in Spanish. The Spanish and English versions were developed simultaneously and use the same standard of measurement.
including a measure of health literacy in Veterans Administration hospital populations based on the S-TOFHLA (Chew and Bradley, 2003),
a literacy test for patients with diabetes (Nath et al., 2001),
and a functional test of ability to maintain a medication regimen (Edelberg et al., 1998, 1999, 2001).
Health Literacy principles
The use of these tests of literacy for printed material in the health context has enabled medical
researchers to explore differences among various health-related outcomes
for patients based on approximations of patients’ health literacy as indicated by patients’ reading skills for health materials.
As a result, a growing body of research has shown that limited reading and/or numeracy skills reduce
access to health information and preventive services, reduce understanding of illness and disease,
regimens and medications, and increase outcomes such as hospitalization or decrease outcomes such as disease management markers.