Measurement of General Reading Skills and Literacy In Nursing Education

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General Reading and Literacy Test and Their Measurement in Nursing Education

Measurement of General Reading Skills and Literacy In Nursing Education

Tests to Measure General Reading Skills and Health Literacy Skills of Clients,WRAT (Wide Range Achievement Test),REALM (Rapid Estimate of Adult Literacy in Medicine).

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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