title: Screening for low literacy in a rheumatology setting: more than 10% of patients cannot read "cartilage," "diagnosis," "rheumatologist," or "symptom".
abstract: OBJECTIVE
  The objectives of the study were to analyze literacy in 194 consecutive patients at an academic rheumatology setting with the Rapid Estimate of Adult Literacy in Medicine (REALM) and an "Arthritis-Adapted" REALM (A-REALM), and to compare responses to one another and to demographic and clinical measures.
  
  
  METHODS
  The REALM and A-REALM are two 66-item word recognition tests. Both were administered to 194 consecutive patients in usual rheumatology care. Multidimensional Health Assessment Questionnaire (MDHAQ) scores for physical function, pain, fatigue, and global estimate, and laboratory assessments also were available. Descriptive statistics and analyses of agreement were computed.
  
  
  RESULTS
  REALM and A-REALM administration involved 2 to 3 minutes each. Scores below 61, indicating a reading level at eighth grade or less, were seen in 35 (18%) of 194 patients on the REALM and 46 patients (24%) on the A-REALM. No patient was classified as having severely low literacy at or below a third-grade level. However, words not read correctly by 10% or more of the patients on the REALM included diagnosis (14%), osteoporosis (17%), and inflammatory (10%), and on the A-REALM, rheumatologist (11%), cartilage (14%), and symptom (14%). REALM and A-REALM scores were correlated significantly (Pearson r = 0.94, P < 0.001). Almost all patients (33/35) with REALM scores of less than 61 also had A-REALM scores of less than 61, less formal education, and poorer clinical status on all measures, most not statistically significant.
  
  
  CONCLUSIONS
  Low literacy is an important underrecognized problem in medical care, which may be assessed easily in standard care using the REALM or A-REALM. Further attention to literacy-associated barriers may reduce socioeconomic disparities in health.
authors.affiliation: Biostatistics Section, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Swearingen
authors.forename: Lauren
authors.initials: L
authors.lastname: McCollum
authors.forename: Lawren H
authors.initials: LH
authors.lastname: Daltroy
authors.forename: Theodore
authors.initials: T
authors.lastname: Pincus
authors.forename: Darren A
authors.initials: DA
authors.lastname: Dewalt
authors.forename: Terry C
authors.initials: TC
authors.lastname: Davis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004522:Educational Status; D005260:Female; D057220:Health Literacy / Q000592:standards*; D006306:Health Surveys; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D010353:Patient Education as Topic; D012189:Retrospective Studies; D012216:Rheumatic Diseases; D012648:Self Care; D012923:Social Class; D009626:Terminology as Topic