title: Development of the two-stage rapid estimate of adult literacy in dentistry.
abstract: OBJECTIVE
  This work proposes a revision of the 30 item Rapid Estimate of Adult Literacy in Dentistry (REALD-30), into a more efficient and easier-to-use two-stage scale.
  
  
  METHODS
  Using a sample of 1405 individuals (primarily women) enrolled in a Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), the present work utilizes principles of item response theory and multi-stage testing to revise the REALD-30 into a two-stage test of oral health literacy, named Two-Stage REALD or TS-REALD, which maximizes score precision at various levels of participant ability.
  
  
  RESULTS
  Based on the participant's score on the five-item first-stage (i.e., routing test), one of three potential stage-two tests is administered: a four-item Low Literacy test, a six-item Average Literacy test, or a three-item High Literacy test.
  
  
  CONCLUSIONS
  The reliability of scores for the TS-REALD is >0.85 for a wide range of ability. The TS-REALD was found to be predictive of perceived impact of oral conditions on well-being, after controlling for educational level, overall health, dental health, and a general health literacy measure. While containing approximately one-third of the items on the original scale, the TS-REALD was found to maintain similar psychometric qualities.
authors: L.L. Thurstone Psychometric Laboratory, Department of Psychology, The University of North Carolina, Chapel Hill, NC 27599, USA. bstucky@email.unc.edu
authors: Brian D
authors: BD
authors: Stucky
authors: Jessica Y
authors: JY
authors: Lee
authors: Shoou-Yih D
authors: SY
authors: Lee
authors: R Gary
authors: RG
authors: Rozier
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