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Evaluation of the REALM Health Literacy Test in a Developing Country Ros Dowse Lebo Lecoko Tina Ehlers

Evaluation of the REALM Health Literacy Test in a Developing Country Ros Dowse Lebo Lecoko Tina Ehlers. Introduction. 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.

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Evaluation of the REALM Health Literacy Test in a Developing Country Ros Dowse Lebo Lecoko Tina Ehlers

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  1. Evaluation of the REALM Health Literacy Test in a Developing CountryRos DowseLebo Lecoko Tina Ehlers FIP September 2002

  2. Introduction • 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 FIP September 2002

  3. Definition of health literacy “…the capacity of an individual to obtain, process and understand basic health information and services needed to make appropriate health decisions” FIP September 2002

  4. South 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 FIP September 2002

  5. Measurement of health literacy • Indirect measurement - standard of education • Direct measurement - literacy test or task • Valuable information - provide appropriately tailored medicine information FIP September 2002

  6. REALM 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 FIP September 2002

  7. Objective To evaluate the applicability of the REALM test in a South African English second-language population FIP September 2002

  8. Methodology • 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 FIP September 2002

  9. Criteria for success or failure • Cases 1 and 2 to account for > 80% respondents • Apply this to > 2/3 (44 of 66) words FIP September 2002

  10. Demographics FIP September 2002

  11. Case 3 – REALM test fails FIP September 2002

  12. Case 4 – REALM test fails FIP September 2002

  13. Words 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% FIP September 2002

  14. REALM 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) FIP September 2002

  15. Conclusion • 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 FIP September 2002

  16. Acknowledgements • Rhodes University for financial support • Professor Radloff for assistance with statistics • Interpreters and respondents who contributed to this project FIP September 2002

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