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.
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 _______________
Word | |
Menopause |
☐ |
Antibiotics |
☐ |
Exercise |
☐ |
Jaundice |
☐ |
Rectal |
☐ |
Anemia |
☐ |
Behavior |
☐ |
Instructions for Administering the REALM-SF
- 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."
- 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:
-
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."
-
Show the examinee the first card.
- The interviewer should say to the examinee:
"Ahora, por favor, lea la palabra arriba en voz alta."
- 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.
- 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'.
- The interviewer may repeat the instructions so that the examinee feels comfortable with the procedure.
- Continue the test with the rest of the cards.
- 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.
- A score between 0 and 37 suggests the examinee has inadequate health literacy.
Current as of January 2009
Internet Citation:
Health Literacy Measurement Tools. January 2009. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/populations/sahlsatool.htm