title: Validation of a health literacy screening tool (REALM) in a UK population with coronary heart disease.
abstract: BACKGROUND
  Health literacy (HL) has been recognized as an important public health issue in other developed countries such as the US. There is currently no HL screening tool valid for use in the UK. This study aimed to validate a US-developed HL screening tool (the Rapid Estimate for Adult Literacy in Medicine; REALM) for use in the UK against the UK's general literacy screening tool (the Basic Skills Agency Initial Assessment Test, BSAIT).
  
  
  METHODS
  A cross-sectional survey involving 300 adult patients admitted to hospital for investigation of coronary heart disease were given the REALM and BSAIT tools to complete as well as specific questions considered likely to predict HL. These questions relate to the difficulty in understanding medical information, medical forms or instructions on tablets, frequency of reading books and whether the participant's job involves reading.
  
  
  RESULTS
  The REALM was significantly correlated with the BSAIT (r = 0.70; P < 0.001), and significantly related to seven of the eight questions likely to be predictive of HL.
  
  
  CONCLUSIONS
  This study has shown that the REALM has face, criterion and construct validity for use as an HL screening tool in the UK, in research and in everyday clinical practice. Further studies are needed to assess the prevalence of low HL in a wider population and to explore the links that may exist between low HL and poor health in the UK.
authors.affiliation: Faculty of Health and Social Care, Institute of Primary Care and Public Health, London South Bank University, London, UK. ibrahis5@lsbu.ac.uk
authors.forename: S Y
authors.initials: SY
authors.lastname: Ibrahim
authors.forename: F
authors.initials: F
authors.lastname: Reid
authors.forename: A
authors.initials: A
authors.lastname: Shaw
authors.forename: G
authors.initials: G
authors.lastname: Rowlands
authors.forename: G B
authors.initials: GB
authors.lastname: Gomez
authors.forename: M
authors.initials: M
authors.lastname: Chesnokov
authors.forename: M
authors.initials: M
authors.lastname: Ussher
mesh_terms: D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D011634:Public Health; D011795:Surveys and Questionnaires; D006113:United Kingdom / Q000453:epidemiology