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New Tool Assesses Teen Patient Health Literacy in 30 Seconds

The tool assesses teen patient health literacy by screening which words patients can recognize and pronounce.

A new tool will help assess teen patient health literacy in a short time period.

Source: Thinkstock

By Sara Heath

- Pediatric clinicians can now assess adolescent patient health literacy in under 30 seconds using a new tool developed by researchers from the University at Albany.

Created by Jennifer Manganello, PhD, MPH, the tool addresses a knowledge gap about health literacy in pediatric and adolescent healthcare. Although it is common knowledge amongst most clinicians that teenagers are largely unable to understand their own health, diagnoses, and other critical information, there is little headway on a solution.

“Numerous studies have indicated low health literacy is linked to negative health outcomes in adults. However, limited research has been done on adolescents,” Manganello said in a press release. “[The tool] offers researchers and clinicians a brief screening tool that can be used to quickly assess adolescent health literacy in a variety of settings."‚Äč

Jennifer Manganello developed a tool to assess teen health literacy.
Jennifer Manganello, PhD, MPH Source: Paul Miller

“There is much less research on teens than on adults, which is one of the reasons why this tool is so important,” Manganello continued in email correspondence with “However, with the limited research we have, it appears that low health literacy is related to outcomes such as poor asthma management and limited understanding of how to use products containing acetaminophen.”

READ MORE: Five Best Practices for Improving Patient Health Literacy

Manganello, who is an associate professor in the Health Policy, Management & Behavior department at the University at Albany, created Rapid Estimate of Adolescent Literacy in Medicine, shortened to REALM-TeenS.

REALM-TeenS is a condensed version of another health literacy assessment, REALM-Teen. The fundamental difference is the time needed to complete either assessment.

Developed in 2006 by Terry Davis of the Louisiana State University Health Sciences Center, REALM-Teen asks patients to read out loud a list of 66 health-related words within three minutes. REALM-TeenS shortens that list to 10 health-related words in 30 seconds.

Tested words include terms such as “diabetes,” “asthma,” “exercise,” and “bronchial.”

Both assessments look at how many words adolescent patients can pronounce correctly within the allotted timeframe. If the patient struggles to pronounce several words, it is likely she is unfamiliar with it and needs more education in that area, Manganello reasoned.

READ MORE: How Digital, Health Literacy Drives mHealth Patient Engagement

“Although this tool does not fully measure all concepts related to health literacy, such as getting health information and thinking critically about it, it does provide a simple way to identify those teens who may require more support to understand health information,” Manganello explained.

REALM-TeenS is nearly as accurate as its more extensive predecessor, Manganello said. She compared past research about REALM-Teen with results using her own tool and found that REALM-TeenS was 92 percent as successful as the long-form counterpart.

Knowing that the quicker tool is nearly as effective as the more extensive assessments is key, Manganello said. Not a lot of clinicians actually test for patient health literacy because assessments can take too long or get in the way of other appointment priorities.

“We understand that researchers and health professionals often have a very limited amount of time to ask questions and collect their information,” Manganello acknowledged. “Our new tool makes it easier. Identifying low health literacy in adolescents can be useful for tailoring important health information, medication instructions, and follow-up support.”

Additionally, this tool is more conducive to assessing overall patterns in teen health literacy.

READ MORE: How Hospitals Can Raise Patient Satisfaction, CAHPS Scores

“Current recommendations suggest that health providers use 'universal precautions' to make information easy to understand for all patients as opposed to screening individual patients,” Manganello noted. “However, this tool will be useful for those who want to look at overall rates of low health literacy for adolescents in a practice or find out how low health literacy relates to certain health conditions or behaviors.”

It’s important to diagnose teen health literacy so clinicians can improve patient understanding but also so clinicians can make health information more navigable and easy to comprehend.

Perhaps the issue is not that patients lack the ability to understand health concepts, Manganello posited. Instead, the challenge may be that information is too complex to understand.

“One thing to remember is that health literacy is viewed as a combination of an individual’s skills and the complexity of the information or health care environment they need to navigate,” Manganello explained.

“While we need to think about innovative ways to improve health literacy for teens, another option is to focus on how we can help make the information and system easier to understand,” she continued. “For instance, many recommend that providers use the teach back method to ensure patients have clearly understood the information they are told.”

Healthcare professionals need to offer more support to their patients to facilitate patient understanding. Educational resources and an explanation of how various structures – related to both physical health and the healthcare industry as a whole – may be helpful for ensuring patients are well-equipped to navigate the system on their own.

“While many think of health literacy as the ability to read and understand health information, it goes beyond that,” Manganello concluded.

“Health literacy also includes skills such as numeracy, clear communication with providers, and the ability to obtain, understand, and think critically about health information,” she said. “An understanding of how to navigate the health system is important as well, which includes knowing the difference between a primary care provider and a specialist, for instance.”


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