Developing a 20-item REALM-D Screen for Dental Health Literacy

Objectives: Few dental health literacy instruments are available to clinicians and researchers to help understand the implications of patient difficulty understanding health information. Those that do exist are lengthy and would not be conducive to use in a busy clinical setting. The purpose of this study is to test a brief 20-item screener for limited dental health literacy among adult dental patients. Methods: The first phase of development involved adding 18 dental terms to the 66-item REALM instrument. Additional common dental terms were arranged in the appropriate lists within the REALM, from easy to difficult according to number of syllables and difficulty of sound combinations. From this list of 84 medical and dental terms, 10 medical and 10 dental items ranging in level of difficulty from medium to complex terminology were selected based on two factors that emerged from conducting Principal Component Analysis. The study sample was 200 adult patients seeking treatment from the UCLA School of Dentistry Oral Diagnosis Clinic who were at least 18 years old, without cognitive, vision or hearing impairment, and English speaking. Reliability test was conducted on the 20 items using Cronbach's Alpha. To test for validity, Pearson's and Spearman's correlations were used along with Mann-Whitney, and Kruskal-Wallis t-tests. Results: The final 20-item instrument showed good reliability (alpha= 0.863) and was significantly correlated with education (p= 0.000), English as main language (p= 0.000), confident filling out medical forms (p= 0.000), needing help reading hospital material (p= 0.017), and regular follow-up care (p= 0.037). No significant correlation with gender or self-reported general health was observed. Conclusion: The REALMD-20 is a quick screening instrument that can be used to detect limited dental health literacy among adult patients seeking treatment in dental clinic settings. This study was supported by NIDCR R03-PAR-04-117.