Assessing Health Literacy
The Christ College of Nursing and Health Sciences
March 28, 2011
Assessing Health Literacy
When a registered nurse gets a new client, the nursing process begins with assessing the client. Initial assessment establishes a complete database for problem identification and care planning (Taylor, 2008). There are many issues that can come about if the initial assessment doesn’t consider all aspects of a client’s health including health literacy. United States Department of Health and Human Services defined the term health literacy as "the degree to which individuals have the capacity to obtain, process, and understand basic health ...view middle of the document...
Healthcare facilities are more willing to incorporate effective methods to assess health literacy that are easy to use, quick, and inexpensive.
The REALM version is a 125 word recognition test developed to identify clients with low health literacy and to provide a reading grade for those with limited literacy skills in about 3-5 minutes. Some positive aspects of this method are the excellent reliability with acceptable validity. The shortened version, Short-REALM, is the same grade concept but is a 66 word recognition test taking about 1- 2 minutes. This method is takes less time, has excellent reliability with acceptable validity. The brief version, REALM- R, is again the same design but with only 8 words taking 1-2 minutes with scores less than or equal to 6 being at risk for low health literacy. The validity of REALM-R is questionable. The REALM and its reduced versions are all quick and easy to use and calculate the scores. Also, using health-related words for the word recognition is an acceptable method in a health-care facility. Some drawbacks for REALM include the following: all versions don’t measure the client’s understanding of the words but only measure sight-reading ability, versions are only available in English, and more research needs to be done in regards to reliability and validity (Mancuso, 2009).
TOFHLA is the “golden standard” to test health literacy through a client’s ability to read passages and phrases containing numbers using real materials from the health-care setting. The test consists of two timed parts of numeracy and reading comprehension at 4th, 10th, and 19th grade level involving the client to choose and fill in the most acceptable word from choices to place in a phrase. TOFHLA is a 50 item reading comprehension and 17 item numerical evaluations taking about 22 minutes and scored by the sum of both parts ranging 0-100. Both Spanish and English versions had excellent reliability with good validity. With an original time of 22 minutes the brief version of the TOFHLA, was designed with 40 total items with a time of only 5-7 minutes. The shortest TOFHLA version is only 36 reading comprehension questions taking 7 minutes and scored only 0-36, with good validity. The short TOFHLA only measures reading comprehension and technically not health literacy. Advantages of TOFHLA it has quick and easy administration with strong reliability and an available Spanish version (Mancuso, 2009).
The Medical Achievement Reading Test (MART) in a word recognition test consisting of 42 words based on the Wide Range Achievement Test (WRAT) which determines a clients reading grade level. MART was designed to resolve the excuses a client might give for not being able to read such as using medical terms, small print, and a glossy cover. The advantages of MART are the following: strong reliability, quick use and scoring for more precise grade levels in about 3-5 minutes. A drawback like the REALM-R is that it only assesses sight...