Health literacy assessment: relexicalising a US test for a South African population

The problems of illiteracy in health contexts have been well documented in the literature and include such serious repercussions as medication non-compliance and failure to seek medical help during the course of an illness. The Rapid Estimate of Adult Literacy in Medicine (REALM) is a standardised health literacy test developed in the United States that has been previously administered and researched in South Africa (Lecoko, 2000). It is an objective vocabulary test, designed as a screening instrument to identify the health literacy levels of patients in clinics, which uses item recognition of 66 health-related words. Lecoko found that, in a South African setting, only 8 out of the 66 words in the US-developed test could be deemed acceptable. Therefore, the current study focused on the principled relexicalisation of the REALM, using words gathered from health information and promotional texts in local clinics, hypothesising that this would improve its applicability. After administration to a statistically similar group of respondents, the number of acceptable words on the test increased from eight to 38. Thus it is concluded that principled relexicalisation may be one way of improving the applicability of standardised health literacy tests to local populations and settings. However, the limitations of standardised tests may prove to be a significant barrier overshadowing the value of relexicalisation.