Return-Path: <nifl-health@literacy.nifl.gov> Received: from literacy (localhost [127.0.0.1]) by literacy.nifl.gov (8.10.2/8.10.2) with SMTP id i5CF1b910158; Sat, 12 Jun 2004 11:01:38 -0400 (EDT) Date: Sat, 12 Jun 2004 11:01:38 -0400 (EDT) Message-Id: <06F15178-BC81-11D8-89B2-00039381D39E@comcast.net> Errors-To: listowner@literacy.nifl.gov Reply-To: nifl-health@literacy.nifl.gov Originator: nifl-health@literacy.nifl.gov Sender: nifl-health@literacy.nifl.gov Precedence: bulk From: David Rosen <djrosen@comcast.net> To: Multiple recipients of list <nifl-health@literacy.nifl.gov> Subject: [NIFL-HEALTH:4467] Fwd: Re: Which Test? X-Listprocessor-Version: 6.0c -- ListProcessor by Anastasios Kotsikonas Content-Transfer-Encoding: 8bit X-Mailer: Apple Mail (2.553) Content-Type: text/plain; charset=ISO-8859-1; format=flowed Status: O Content-Length: 6413 Lines: 160 NIFL-Health Colleagues, I have had some conversation by e-mail with Dr. Terry Davis, the author of the REALM assessment, as a result of my posting. He has kindly given me permission to share our exchange, so here it is. To make it easier to follow here, I have put our e-mail messages in chronological order from top down. David J. Rosen djrosen@comcast.net > > From: David Rosen [mailto:djrosen@comcast.net] > > Sent:Tuesday, June 08, 20043:04 PM > > To: Multiple recipients of list > > Subject: [NIFL-HEALTH:4438] Re: Which Test? > > > > NIFL Health Colleagues, > > > > I have not seen the REALM before, so thanks, Carol, for the Web > page. > > Now that I have seen it, I am concerned. > > > > It is not clear to me what this assessment measures. It doesn't > > measure grade level, which is what it appears to report, and it > >doesn't measure comprehension. It appears to measure one's ability to > > pronounce medical vocabulary. I, for one can probably pronounce > > hundreds of medical words which I do not understand the meaning of. > > And I know people who do understand the meaning of some medical words > > but cannot pronounce them. So, can someone explain what this > > assessment does validly measure? > > > > I also have some concerns about administering literacy assessments in > > medical contexts. If someone comes in for medical help, isn't it the > > institution's or agency's responsibility to provide medical help, not > > to assess their literacy. For example, at least one hospital > inBoston > > does not bring up literacy, per se. Instead, patients with diseases > or > > medical conditions are told "You have a disease that you need to > learn > > about. What ways would you prefer to learn about it? Would you like > > to talk with someone? Read about it? Watch a video?" Patients who do > > not choose to read may or may not have difficulty reading, but that > > isn't the problem. Especially a time of crisis is not the time to > > confront problems of literacy. The problem is how to help patients > > learn what they need to in ways which work best for them. > > > > Others views on this? Do you use the REALM? How? Why? Please help > > me to understand the conditions under which it would be useful. Have > I > > missed something? > > > > Thanks, > > > > David J. Rosen > > On Friday, June 11, 2004, at 11:59 AM, Davis, Terry wrote: > > > Concerning David Rosen's concerns: > > > > I saw your note about the REALM and thought I might shed some light. > > The REALM is a reading recognition test and it does not give a > > specific reading grade level. It gives a grade range estimate. It > > does not measure comprehension. The AMA is coming out with a textbook > > on health literacy which will have a comprehensive chapter on > > measurement of literacy in medical settings. > > > > There are many concerns about testing patients for literacy in a > > clinical context. Most testing now is probably for research purposes. > > > > There are several studies in medical literature which have used the > > REALM. Also reading the 1993 FAM MED article that introduces the > REALM > > > and gives detailed information about its development might be > helpful. > > > > Glad you are interested in literacy. > > > > Terry Davis > > > > Author of the REALM > > > > Terry C. Davis, Ph.D. > >Professor of Medicine andPediatrics > > LSU Health Sciences Center-Shreveport > > 1501 Kings Highway > > Shreveport,Louisiana 71130-3932 > > phone (318) 675-5813 > > fax (318) 675-4319 > From: David Rosen > To: Davis, Terry > Sent: 6/12/2004 5:50 AM > Subject: Re: [NIFL-HEALTH:4438] Re: Which Test? > > Dear Dr. Davis: > > Thank you for your reply, and mention of the Fam Med article. I am not > concerned about the REALM being used for research purposes as a > screening instrument. As it correlates well with the PIAT-R, WRAT-R, > and SORT-R, if it is used as measure of a range of literacy, and as it > is quick, I can see its usefulness, for example, in determining the > appropriateness of participants for a focus group on health information > materials, and possibly for other research purposes. > > The context in which it was raised, however, was as a screening device > to determine the grade level of patients, presumably to determine if > they needed special materials or referral to literacy programs. There > have been several messages posted to the NIFL-Health electronic list > by health educators, literacy educators and by adults who have reading > difficulties. All raise serious concerns about the REALM and other > tests being used for that purpose in a medical setting. The concern > from a patient perspective is that taking a literacy assessment in a > medical setting is humiliating, From a health educator perspective, it > is a barrier for patients seeking health care. From the perspective of > some adult literacy educators, there is an additional concern: grade > levels are not valid for adults. > > I will be interested to see the AMA textbook. Can you tell me who the > authors are? Thank you. > > All the best, > > David J. Rosen > djrosen@comcast.net > From: "Davis, Terry" <TDavis1@lsuhsc.edu> > Date: Sat Jun 12, 2004 9:24:20 AM US/Eastern > To: 'David Rosen ' <djrosen@comcast.net>, "Davis, Terry" > <TDavis1@lsuhsc.edu> > Subject: RE: [NIFL-HEALTH:4438] Re: Which Test? > > Dear David > Thanks for you letter. I agree w you about not putting up additional > barriers and being sensitive and curious about pts > feelings/experience etc. > > In talks I give around the country about literacy and health I do not > talk about testing. I focus on communication and education. In > developing/testing interventions I stress the importance of including > pts in the development and getting feedback from them. This will help > make sure these are useful for pts and that they "land" right. > > Re the chapter : My co authors are Mark Williams, who among other > things helped develop the TOFHLA but has also moved on, Julie > Gazmararian and ELla Kennen. Call Joanne Schwartzberg of the AMA who > is the editor of the book for more info on when it is coming out etc. > 312 464 5355 > > Thanks for you sensitivity and curiosity. Your questions obviously > stirred a lot of interest and concern .Good job! We need more of this > discussion with input from all 'stakeholders" > > Terry >
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