Applicability of the rapid estimate of adult health literacy in medicine –short form among patients attending a university hospital in southernIndia

Background and aim: Persons with limited general literacy skills usually also have limited health literacy. Rapid Estimate of Adult Literacy in Medicine (REALM) is a very commonly used health literacy tool in advanced countries. We decided to test the applicability of shorter version of the REALM test consisting of seven test words among patients attending a tertiary care teaching hospital in southern India. It was hypothesized that those familiar with English language may be able read a word correctly without knowing the meaning of the word or the converse may also be true. Both would yield false results. Methodology: REALM-Short Form (REALM-SF) was used among 200 patients attending the outpatient department. Both pronunciation and comprehension was tested and scored. Results: Of the 200 study participants, 53.5% had attended college and 12.5% had post-graduate qualifications. Most of the subjects (75.5%) obtained a REALM score of 7 with regards to pronunciation. When the same scoring system was applied to score comprehension only 2.5% of the subjects obtained a score of 7. While correctness of pronunciation and comprehension increased with increasing educational status, even among subjects with an educational status higher than the 12th grade, number of words correctly comprehended was lower in comparison to pronunciation. Conclusions: The results show that consideration of only pronunciation as a parameter to assess health literacy, as suggested by the developers of the REALM-SF tool, can be misleading since analysis of comprehension shows that mere reading skills is likely to be misleading resulting in a large number of false positive results.