Health Literacy Measurement Tools

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Health literacy is the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. AHRQ-funded researchers have developed two tools to measure an aspect of health literacy—individuals' reading comprehension in a medical context. These tools can be used for research, clinical, or program planning purposes.

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Rapid Estimate of Adult Literacy in Medicine—Short Form (REALM-SF)

The Rapid Estimate of Adult Literacy in Medicine—Short Form (REALM-SF) is a 7-item word recognition test to provide clinicians with a valid quick assessment of patient health literacy. The REALM-SF has been validated and field tested in diverse research setting, and has excellent agreement with the 66-item REALM instrument in terms of grade-level assignments.

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REALM-SF Form

Patient name _______________ Date of birth _______________ Reading level _______________

Date ________________ Examiner _______________ Grade completed _______________

Menopause	☐
Antibiotics	☐
Exercise	☐
Jaundice	☐
Rectal	☐
Anemia	☐
Behavior	☐

Instructions for Administering the REALM-SF

1. Give the patient a laminated copy of the REALM-SF form and score answers on an unlaminated copy that is attached to a clipboard. Hold the clipboard at an angle so that the patient is not distracted by your scoring. Say:

   "I want to hear you read as many words as you can from this list. Begin with the first word and read aloud. When you come to a word you cannot read, do the best you can or say, 'blank' and go onto the next word."

2. If the patient takes more than five seconds on a word, say "blank" and point to the next word, if necessary, to move the patient along. If the patient begins to miss every word, have him or her pronounce only known words.

Scores and Grade Equivalents for the REALM-SF

Score	Grade range
0	Third grade and below; will not be able to read most low-literacy materials; will need repeated oral instructions, materials composed primarily of illustrations, or audio or video tapes.
1-3	Fourth to sixth grade; will need low-literacy materials, may not be able to read prescription labels.
4-6	Seventh to eighth grade; will struggle with most patient education materials; will not be offended by low-literacy materials.
7	High school; will be able to read most patient education materials.

Short Assessment of Health Literacy for Spanish Adults (SAHLSA-50)

The Short Assessment of Health Literacy for Spanish Adults (SAHLSA-50) is a validated health literacy assessment tool containing 50 items designed to assess a Spanish-speaking adult's ability to read and understand common medical terms. The SAHLSA was based on the Rapid Estimates of Adult Literacy in Medicine (REALM), known as the most easily administered tool for assessing health literacy in English.

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SAHLSA-50 Form

Stem	Key or Distracter		"no se" (Don't know)
próstata	__glándula	__circulación	__no se
empleo	__trabajo	__educación	__no se
menstrual	__mensual	__diario	__no se
gripe	__sano	__enfermo	__no se
avisar	__medir	__decir	__no se
comidas	__cena	__paseo	__no se
alcoholismo	__adicción	__recreo	__no se
grasa	__naranja	__manteca	__no se
asma	__respirar	__piel	__no se
cafeína	__energía	__agua	__no se
osteoporosis	__hueso	__músculo	__no se
depresión	__apetito	__sentimientos	__no se
estreñimiento	__bloqueado	__suelto	__no se
embarazo	__parto	__niñez	__no se
incesto	__familia	__vecinos	__no se
pastilla	__tableta	__galleta	__no se
testículo	__óvulo	__esperma	__no se
rectal	__regadera	__inodoro	__no se
ojo	__oír	__ver	__no se
irritación	__rígido	__adolorido	__no se
abnormal	__diferente	__similar	__no se
estrés	__preocupación	__feliz	__no se
aborto espontáneo	__pérdida	__matrimonio	__no se
ictericia	__amarillo	__blanco	__no se
papanicolaou	__prueba	__vacuna	__no se
impétigo	__pelo	__piel	__no se
indicado	__instrucción	__decisión	__no se
ataque	__herida	__sano	__no se
menopausia	__señoras	__niñas	__no se
apéndice	__rascar	__dolor	__no se
comportamiento	__pensamiento	__conducta	__no se
nutrición	__saludable	__gaseosa	__no se
diabetes	__azúcar	__sal	__no se
sífilis	__anticonceptivo	__condón	__no se
inflamatorio	__hinchazón	__sudor	__no se
hemorroides	__venas	__corazón	__no se
herpes	__aire	__sexo	__no se
alérgico	__resistencia	__reacción	__no se
riñón	__orina	__fiebre	__no se
calorías	__alimentos	__vitaminas	__no se
medicamento	__instrumento	__tratamiento	__no se
anemia	__sangre	__nervio	__no se
intestinos	__digestión	__sudor	__no se
potasio	__mineral	__proteína	__no se
colitis	__intestino	__vejiga	__no se
obesidad	__peso	__altura	__no se
hepatitis	__pulmón	__hígado	__no se
vesícula biliar	__arteria	__órgano	__no se
convulsiones	__mareado	__tranquilo	__no se
artritis	__estómago	__articulación	__no se

Instructions for Administering SAHLSA-50

Administration of the test could be facilitated by using laminated 4" x 5" flash cards, with each card containing a medical term printed in boldface on the top and the two association words—i.e., the key and the distracter—at the bottom.

Directions to the Interviewer:

1. Before the test, the interviewer should say to the examinee: "Le voy a mostrar tarjetas con 3 palabras en ellas. Primero, me gustaría que usted lea la palabra arriba en voz alta. Entonces, yo leeré las dos palabras debajo a usted y me gustaría que usted me dijera cuál de las dos palabras es más similar a la palabra arriba. Si usted no sabe la respuesta, por favor diga, 'no se'. No adivine."
2. Show the examinee the first card.
3. The interviewer should say to the examinee: "Ahora, por favor, lea la palabra arriba en voz alta."
4. The interviewer should have a clipboard with a score sheet to record the examinee's answers. The clipboard should be held such that the examinee cannot see or be distracted by the scoring procedure.
5. The interviewer will then read the key and distracter (the two words at the bottom of the card) and then say: "Cuál de las dos palabras es más similar a la palabra arriba? Si usted no sabe la respuesta, por favor diga, 'no se'.
6. The interviewer may repeat the instructions so that the examinee feels comfortable with the procedure.
7. Continue the test with the rest of the cards.
8. A correct answer for each test item is determined by both correct pronunciation and accurate association. Each correct answer gets one point. Once the test is completed, the interviewer should tally the total points to generate the SAHLSA-50 score.
9. A score between 0 and 37 suggests the examinee has inadequate health literacy.

Current as of January 2009

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Internet Citation:

Health Literacy Measurement Tools. January 2009. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/populations/sahlsatool.htm

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