ArticlePharmacy world & science : PWS2010
Applicability of the REALM health literacy test to an English second-language South African population.
Article in Pharmacy world & science : PWS, 2010. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 1 of them a synthesis that pooled it.
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Who cites it
11 citing papers in PubMed, 1 synthesis or guideline pooled it, 26 citations in OpenAlex.
- Health literacy and cancer screening: a systematic review.Patient education and counseling · 2014Pooled it
- Development of the Swahili Cancer Health Literacy Test for use in the African context.African journal of primary health care & family medicine · 2026Article
- The reliability and validity of the isixhosa version of the euroqol toddler and infant populations (EQ-TIPS) health related quality of life instrument.African health sciences · 2023Article
- Development of a Sesotho health literacy test in a South African context.African journal of primary health care & family medicine · 2019Article
- Measuring Health Literacy Among Adults with HIV Infection in Mozambique: Development and Validation of the HIV Literacy Test.AIDS and behavior · 2017Article
- Understanding the medicines information-seeking behaviour and information needs of South African long-term patients with limited literacy skills.Health expectations : an international journal of public participation in health care and health policy · 2015Article
- Examining antenatal health literacy in Ghana.Journal of nursing scholarship : an official publication of Sigma Theta Tau International Honor Society of Nursing · 2014Article
- Evaluation of health literacy status among patients in a tertiary care hospital in coastal karnataka, India.Journal of clinical and diagnostic research : JCDR · 2013Article
- Article
- Comparing written and oral measures of comprehension of cancer information by English-as-a-Second-Language Chinese immigrant women.Journal of cancer education : the official journal of the American Association for Cancer Education · 2011Article
- Measuring health literacy among immigrants with a phonetic primary language: a case of Korean American women.Journal of immigrant and minority health · 2011Article
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Authors and funding
3 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
OBJECTIVE AND
settingTo investigate health literacy in an English second language population using the REALM test, to evaluate its appropriateness and to compare health literacy between four different education categories.
settingPrimary healthcare clinics and participant homes in Grahamstown, South Africa.
methodThe REALM test, a US-developed test, was administered via an interpreter to 125 Xhosa-speaking, English second language participants from a range of educational backgrounds. Participants were asked to read all 66 words (three lists of 22 words each), and pronunciation was assessed. In a deviation from the standard method, an explanation for each word was requested to evaluate comprehension. Results were classified into four categories: adequately pronounced and comprehended; neither adequately pronounced nor comprehended; adequately pronounced but not comprehended; not adequately pronounced but comprehended. The first two categories were rated as "applicable". The percentage of "applicable" cases of the total of 8250 cases (125 participants; 66 words each) was calculated. The association between education and both pronunciation and comprehension was investigated using chi-square tests, with a significance level of P < 0.05.
main outcome measuresAverage grade-equivalent reading level; number of words adequately pronounced and comprehended; applicability of the REALM to individual words.
resultsAverage grade-equivalent reading level of the study population according to the REALM test was grade 7-8. An average of 46 of 66 words were adequately pronounced, whereas less than half this number (20) were adequately comprehended. Comprehension ability was 57% lower than the ability to adequately pronounce the words, a finding that highlights the inability of pronunciation data to predict comprehension of a health-related text. Examples of poor comprehension include antibiotics (16.0%), fatigue (6.4%), nausea (8.0%), anaemia (2.4%), osteoporosis (0.8%), hepatitis (0.8%), haemorrhoids (0%), impetigo (0%) and colitis (0%). Both pronunciation (P = 0.016) and comprehension (P = 0.001) were significantly influenced by education. Applicability of the REALM to individual words ranged from 20.8 to 96.0%, with an average of 59.1%. Given that the REALM was deemed inapplicable for an average of four out of every 10 words, it appears to be unsuitable for use in its current form for assessing health literacy of the study population.
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