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RACHELLE BUCHBINDER, STEPHEN HALL, and JOANNE M. YOUD ABSTRACT. Objective. To determine the health literacy of patients with rheumatoid arthritis (RA) attending community-based rheumatology practice. Methods. Eighty patients were administered the Test of Functional Health Literacy in Adults (TOFHLA), a 50-item reading comprehension and 17-item numerical ability test (score 0-100); the Rapid Estimate of Adult Literacy in Medicine (REALM), which asks participants to read aloud 66 words of varying difficulty (score 0–66); and the Test of Reading Comprehension (TORCH), which asks participants to read a short text and then fill in the gaps of another version by using one or more of their own words (score 1-9). Results. The study group included 60 women (75%), mean age (SD) 60.29 (15.02) years, median duration of RA 8 years (range 0.3–39). Nineteen of 80 (24%) had completed ≤ 8 years of formal education, 24/80 (30%) had completed 9 or 10 years, and 37/80 (46%) had completed ≥ 11 years. TOFHLA and REALM scores ranged from 39–100 and 41–66 respectively. Scores for 8 patients (10%) indicated they would have difficulty reading and interpreting health texts and struggle with most currently available patient education materials. Of those who attempted the TORCH, 8/65 (12%) scored low or below average and 23/65 (35%) scored average compared with students completing 9th grade. All 3 literacy tests were significantly correlated with education level, but use of educational level alone as a measure of literacy would have misclassified more than 10% as health literate/illiterate. Conclusion. A significant number of patients with RA have limited health literacy and may not understand even simple written instructions or prescription labels. (First Release Mar 1 2006; J Rheumatol 2006;33:879–86) Key Indexing Terms: LITERACY
From the Monash Department of Clinical Epidemiology, Cabrini Hospital; and the Department of Epidemiology and Preventive Medicine and Department of Medicine, Monash University, Malvern, Victoria, Australia. Supported in part by a research grant from the Cabrini Clinical Education and Research Institute. R. Buchbinder, MBBS (Hons), MSc, FRACP, Director, Department of Clinical Epidemiology, Cabrini Hospital; Associate Professor, Department of Epidemiology and Preventive Medicine, Monash University; Rheumatologist, Cabrini Medical Centre; S. Hall, MBBS (Hons), B Med Sci, FRACP, Associate Professor, Department of Medicine, Monash University; Rheumatologist, Cabrini Medical Centre; J.M. Youd, BSc (Hons), PhD, Research Associate, Department of Clinical Epidemiology, Cabrini Hospital and Department of Epidemiology and Preventive Medicine, Monash University. Address reprint requests to Dr. R. Buchbinder, Monash Department of Clinical Epidemiology at Cabrini Hospital, Suite 41 Cabrini Medical Centre, 183 Wattletree Rd, Malvern, Victoria, Australia, 3144. E-mail: rachelle.buchbinder@med.monash.edu.au Accepted for publication December 6, 2005.
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