In Reply: Ms. Osborne underscores the need for health care agencies to make available to all patients clearly written information and alternative education methods. We wholeheartedly support her call for organizational changes in health education because its aim is likely to result in more accessible and effective health care for those who possess low literacy skills. However, we still maintain that individual differences in reading levels among patients ought to be initially assessed by the clinicians responsible for their care. The use of the Rapid Estimate of Adult Literacy in Medicine (REALM) is a valid and reliable tool for conducting these initial evaluations.
An individual's difficulty in comprehending medical information or instructions may not be adequately addressed by generalized institutional information. For example, patients reading at the seventh- or eighth-grade level can likely comprehend low-literacy written materials, but patients who read at the third-grade level or below probably cannot understand even simple written information like an appointment slip or a prescription label. This latter group of patients will require a different approach in meeting their literacy needs that may include additional verbal explanations and audiovisual aids. We are currently conducting a study that specifically examines differences in health education needs among low-literacy individuals.
In summary, we agree with Ms. Osborne that health care organizations should implement innovative teaching methods and technology and offer clear and simple written materials to all patients. However, we believe clinicians should select appropriately tailored strategies based on a particular individual's reading level. The use of screening tools like the REALM provides clinicians with the opportunity to identify those patients who will benefit most from an organization's particular health education methods and strategies.