This 84-item dental/medical health literacy word list was provided to a sample of 200 adult patients seeking treatment for the first time at the UCLA School of Dentistry Oral Diagnosis Clinic between January 2005 and June 2006 following approval of the study protocol by the UCLA institutional review board. Potential participants were screened by the clinic coordinator based on information from the patient’s completed intake form which included a medical history to screen out people who had great difficulty communicating in English and were unable to consent to the study. People were chosen for inclusion in the study using the criteria of being at least 18 years of age, without cognitive, vision or hearing impairment, and having either limited or no difficulty understanding the intake questions posed to the patient by the coordinator in English. Each eligible participant was given a letter describing the study, emphasizing the voluntary confidential nature of the research, and the subject’s ability to withdraw at any time, and inviting them to participate. This letter was read to the patient while they followed with their own copy in hand. Comprehension of the information was done by asking the subject to reiterate the procedures included in the study. Following informed consent, participants were administered the 84-item REALM-D and a 48-item survey instrument on health beliefs, attitudes, and knowledge. Each patient received $5.00 after completing the initial survey and another $5.00 after completing a follow-up survey.
The protocol for administration and scoring of the original instrument was retained. Each of the 200 study participants was given a laminated copy of the REALM-D by the interviewer and asked to read each word aloud. If the subject could not read a word, he/she was instructed to say “blank” and move to the next word. Over the course of the study, five interviewers were trained by the coinvestigator on how to administer and score the REALM-D instrument. Calibration was done by having two interviewers complete and score a sample REALM-D instrument as the coinvestigator listened for accurate phonetic pronunciation. Interviewers were given the original REALM-coding rubric and instructed to score accordingly, use the following marking system; a correctly pronounced word received a plus (+), a mispronounced word received check (√), and a word not attempted received a minus (−). Words pronounced correctly received a score of 1 by the interviewer, and mispronounced or not attempted words received a score of 0.
The protocol for administration and scoring of the original instrument was retained. Each of the 200 study participants was given a laminated copy of the REALM-D by the interviewer and asked to read each word aloud. If the subject could not read a word, he/she was instructed to say “blank” and move to the next word. Over the course of the study, five interviewers were trained by the coinvestigator on how to administer and score the REALM-D instrument. Calibration was done by having two interviewers complete and score a sample REALM-D instrument as the coinvestigator listened for accurate phonetic pronunciation. Interviewers were given the original REALM-coding rubric and instructed to score accordingly, use the following marking system; a correctly pronounced word received a plus (+), a mispronounced word received check (√), and a word not attempted received a minus (−). Words pronounced correctly received a score of 1 by the interviewer, and mispronounced or not attempted words received a score of 0.