Development and validation of a short-form, rapid estimate of adult literacy in medicine.
BACKGROUND
Although prior studies used the 66-item Rapid Estimate of Adult Literacy in Medicine (REALM instrument) for literacy assessment, researchers may require a shorter, validated instrument when designing interventions for clinical contexts.


OBJECTIVE
To develop and validate a very brief literacy assessment tool, the REALM-Short Form (REALM-SF).


METHODS
The model development, validation, and field testing validation samples included 1336, 164, and 50 patients, respectively.


METHODS
General medicine and subspecialty clinics and medicine inpatient wards.


METHODS
For development and validation samples, indicator variables for REALM instrument items were evaluated as potential predictors of REALM instrument score by stepwise multiple regression analysis with subsequent bootstrap and confirmatory factor analysis of selected items. Pearson correlations compared REALM-SF and REALM instrument scores and kappa analyses compared grade level assignments. For the field testing validation sample, Pearson correlations compared Wide Range Achievement Test and REALM-SF scores.


RESULTS
The REALM-SF included 7 items with stable model coefficients and 1 underlying linear factor. REALM-SF and REALM instrument scores were highly correlated in development (r = 0.95, P < 0.001) and validation (r = 0.94, P < 0.001) samples. There was excellent agreement between REALM-SF and REALM instrument grade-level assignments when dichotomized at the 6th grade (development: 97% agreement, K = 0.88, P < 0.001; validation: 88% agreement, K = 0.75, P < 0.001) and 8th grade levels (development: 94% agreement, K = 0.78, P < 0.001; validation: 84% agreement, K = 0.67, P < 0.001). REALM-SF and Wide Range Achievement Test scores were highly correlated (r = 0.83, P < 0.001) in field testing validation.


CONCLUSIONS
The REALM-SF provides researchers a brief, validated instrument for assessing patient literacy in diverse research settings.
Jesse Brown Veterans Affairs Medical Center, 820 S. Damen Avenue, Chicago, IL 60612, USA. arozulla@uic.edu
Ahsan M
AM
Arozullah
Paul R
PR
Yarnold
Charles L
CL
Bennett
Robert C
RC
Soltysik
Michael S
MS
Wolf
Rosario M
RM
Ferreira
Shoou-Yih D
SY
Lee
Stacey
S
Costello
Adil
A
Shakir
Caroline
C
Denwood
Fred B
FB
Bryant
Terry
T
Davis
D000328:Adult; D000368:Aged; D004522:Educational Status; D005260:Female; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D013997:Time Factors