A patient’s literacy level can easily be measured in about two minutes with an instrument called the Rapid Estimate of Adult Literacy in Medicine (REALM). The REALM is a word recognition test, in which subjects read from a list of 66 medical words arranged in order of complexity by the number of syllables and pronunciation difficulty. Patients are asked to read aloud as many words as they can, beginning with the first word and continuing through the list as far as possible until they reach words they cannot pronounce correctly.
The REALM yields a score that estimates a patient’s reading level (i.e., grades 0–3, grades 4–6, grades 7–8, grade 9 and above). Patients who score in grades 0–3 and 4–6 have literacy skills that correspond approximately to International Adult Literacy Survey levels 1 and 2, respectively. Because the REALM uses medical words, the test provides not just an assessment of general reading skills, but also an indication of the individual’s health literacy. The main limitations of the REALM are that it is available only in English and that it tests word recognition, not reading comprehension.
Davis TC, Long S, Jackson R, Mayeaux EJ, George RB, Murphy PW, et al. Rapid estimate of adult literacy in medicine: a shortened screening instrument. Fam Med. 1993; 25:391-395.