General Reading and Literacy Test and Their Measurement in Nursing Education
Tests to Measure General Reading Skills and Health Literacy Skills of Clients
The four most popular standardized methods to measure reading and health literacy skills are the Wide Range Achievement Test (WRAT), the Rapid Estimate of Adult Literacy in Medicine (REALM), the Test of Functional Health Literacy in Adults (TOFHLA), and the Newest Vital Sign (NVS). In addition, the eHealth Literacy Scale (eHEALS) assesses client comfort in using the Internet and technology to obtain health information.
The Literacy Assessment for
Diabetes (LAD) is an instrument specific to patients with diabetes. The
Suitability Assessment of Materials (SAM) assesses how well instructional
materials are presented to clients.
WRAT (Wide Range Achievement Test)
The WRAT is a word recognition screening test. It is used to assess a learner's ability to recognize and pronounce a list of words out of context as a criterion for measuring reading skills. Other word recognition tests are available, but the WRAT requires the least time to administer (approximately 5 minutes as compared with 30 minutes or more for the other tests).
Limitations of WRAT Test
Although it
is limited to measuring only word recognition and does not test other aspects
of reading such as vocabulary and comprehension of text material, this test is
nevertheless useful for determining an appropriate level of instruction and for
establishing a client's level of literacy. It is based on the belief that
reading skill is associated with the ability to look at written words and put
them into oral language, a necessary first step in comprehension (Doak et al.,
1996).
As designed, the WRAT should be used only to test people whose
native language is English. It tests on two levels: Level I is designed for
testing children 5 to 12 years of age, and Level II is intended for testing
persons older than age 12. The WRAT scores are normed on age but can be
converted to grade levels.
Grading of WRAT test
The WRAT consists of a graduated list of 42 words. Starting with
the easiest and ending with the most difficult, the person taking the test is
asked to pronounce the words from the list, starting from the top, where the
easier words are located. The individual administering the test listens
carefully to the patient's responses and scores those responses on a master
score sheet. Next to those words that are mispronounced, a checkmark should be
placed. When five words are mispronounced, indicating that the patient has
reached his or her limit, the test is stopped.
Score of WRAT Test
To score the test, the number of words missed or not tried is
subtracted from the total list of words on the master score sheet to get a raw
score. A table of raw scores is then used to find the equivalent grade rating
(GR). For more information on this test, see Doak et al. (1996), Davis et al.
(1998), and Quirk (2000). Now in its fourth edition, the WRAT-4 is the latest
version of the original instrument developed in 1946 (Wilkinson &
Robertson, 2000).
REALM (Rapid Estimate of Adult Literacy in Medicine)
The REALM test has advantages over the WRAT and other word tests because it measures a patient's ability to read medical and health-related vocabulary, it takes less time to administer, the scoring is simpler, and the test is well received by most clients (Davis et al., 1998; Duffy & Snyder, 1999, Foltz & Sullivan, 1998).
This instrument has been field tested on
large populations in public health and primary care settings (Davis et al.,
1993). Although it has established validity, REALM offers less precision than
other word tests (Hayes, 2000). The raw score is converted to a range of grade
levels rather than an exact grade level, but this result correlates well with
the WRAT reading scores.
Method of REALM Test
The procedure for administering the test is to ask patients to read aloud words from three-word lists. Sixty-six medical and health-related words are arranged in three columns of 22 words each, beginning with short, easy words such as fat, flu, pill, and dose, and ending with more difficult words such as anemia, obesity, osteoporosis, and impetigo. Clients are asked to begin at the top of the first column and read down, pronouncing all the words that they can from the three lists. If they come upon a word they cannot pronounce, they are told to skip it and proceed to the next word.
Limitation REALM Test
There is no time limit.
The examiner keeps score on a separate copy of the list and places a plus sign
next to words correctly pronounced and a minus next to those mispronounced or
skipped (Davis et al., 1993). The total number of words pronounced correctly is
the client's raw score, which is converted to a grade ranging from third grade
and below (score of 0-18) to ninth grade and above (score of 61-66). Those
persons whose scores fall at sixth grade or below have literacy skills
equivalent to NALS Levels 1 and 2 (Schultz, 2002; Weiss, 2003).
The relatively new REALM-R, a revised shorter version (8-item) of
the original instrument of 66 items, is designed to rapidly screen patients at
risk for low literacy in a clinical setting. Studies have shown it to be a
reliable and valid tool, as well as a practical one, for assessing literacy.
The delivery time is less than 2 minutes (Bass, Wilson, & Griffith, 2003).
The REALM-SF, a short form version at seven items correlates very strongly with
the original REALM instrument in assessing patient literacy in various settings
(Arozullah et al., 2007).
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