Evaluation of a word recognition instrument to test health literacy in dentistry: the REALD-99

J Public Health Dent. Spring 2007;67(2):99-104. doi: 10.1111/j.1752-7325.2007.00022.x.


Objective: This study aims to evaluate a dental health literacy word recognition instrument.

Methods: Based on a reading recognition test used in medicine, the Rapid Estimate of Adult Literacy in Medicine (REALM), we developed the Rapid Estimate of Adult Literacy in Dentistry (REALD-99). Parents of pediatric dental patients were recruited from local dental clinics and asked to read aloud words in both REALM and REALD-99. REALD-99 scores had a possible range of 0 (low literacy) to 99 (high literacy); REALM scores ranged from 0 to 66. Outcome measures included parents' perceived oral health for themselves and of their children, and oral health-related quality of life of the parent as measured by the short-form Oral Health Impact Profile (OHIP-14). To determine the validity, we tested bivariate correlations between REALM and REALD-99, REALM and perceived dental outcomes, and REALD-99 and perceived dental outcomes. We used ordinary least squares regression and logit models to further examine the relationship between REALD-99 and dental outcomes. We determined internal reliability using Cronbach's alpha.

Results: One hundred two parents of children were interviewed. The average REALD-99 and REALM-66 scores were high (84 and 62, respectively). REALD-99 was positively correlated with REALM (PCC = 0.80). REALM was not related to dental outcomes. REALD-99 was associated with parents' OHIP-14 score in multivariate analysis. REALD-99 had good reliability (Cronbach's alpha = 0.86).

Conclusions: REALD-99 has promise for measuring dental health literacy because it demonstrated good reliability and is quick and easy to administer. Additional studies are needed to examine the validity of REALD-99 using objective clinical oral health measures and more proximal outcomes such as behavior and compliance to specific health instructions.

Publication types

  • Evaluation Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Validation Study

MeSH terms

  • Adult
  • Dentistry*
  • Educational Measurement / methods*
  • Educational Status
  • Female
  • Health Education, Dental*
  • Health Knowledge, Attitudes, Practice*
  • Humans
  • Least-Squares Analysis
  • Logistic Models
  • Male
  • Parents
  • Pilot Projects
  • Quality of Life
  • Reproducibility of Results
  • Self-Assessment
  • Surveys and Questionnaires
  • Vocabulary*