Journal of Public Health Advance Access originally published online on July 25, 2008
Journal of Public Health 2008 30(4):449-455; doi:10.1093/pubmed/fdn059
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Validation of a health literacy screening tool (REALM) in a UK Population with coronary heart disease
S. Y. Ibrahim, Research Assistant1
F. Reid, Senior Lecturer in Medical Statistics2
A. Shaw, Senior Research Fellow1
G. Rowlands, Professor and Director of the Institute of Primary Care and Public Health1
G. B. Gomez, Research Assistant/PhD Student3
M. Chesnokov, Research Programme Manager4
M. Ussher, Senior Lecturer in Psychology2
1 Institute of Primary Care and Public Health, Faculty of Health and Social Care, London South Bank University, 103 Borough Road, London SE1 0AA, UK
2 Division of Community Health Sciences, St. George's, University of London, UK
3 Division of Epidemiology, Public Health and Primary Care, Imperial College, London, UK
4 Institute of Psychiatry, King's College London, UK
Address correspondence to Saima Y. Ibrahim, E-mail: ibrahis5{at}lsbu.ac.uk
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Abstract |
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Background Health literacy (HL) has been recognized as an important public health issue in other developed countries such as the US. There is currently no HL screening tool valid for use in the UK. This study aimed to validate a US-developed HL screening tool (the Rapid Estimate for Adult Literacy in Medicine; REALM) for use in the UK against the UK's general literacy screening tool (the Basic Skills Agency Initial Assessment Test, BSAIT).
Methods A cross-sectional survey involving 300 adult patients admitted to hospital for investigation of coronary heart disease were given the REALM and BSAIT tools to complete as well as specific questions considered likely to predict HL. These questions relate to the difficulty in understanding medical information, medical forms or instructions on tablets, frequency of reading books and whether the participant's job involves reading.
Results The REALM was significantly correlated with the BSAIT (r = 0.70; P < 0.001), and significantly related to seven of the eight questions likely to be predictive of HL.
Conclusions This study has shown that the REALM has face, criterion and construct validity for use as an HL screening tool in the UK, in research and in everyday clinical practice. Further studies are needed to assess the prevalence of low HL in a wider population and to explore the links that may exist between low HL and poor health in the UK.
Keywords: health literacy, literacy, patient needs, poor health, screening tools