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REALM-R List &
Examiner Record

Download Instructions
(Instructions for use)

The REALM-R is a word recognition test consisting of 11 items used to identify people at risk for poor literacy skills (Bass et al, 2003). Words that appear in this test are:

Fat Osteoporosis Anemia Colitis
Flu Allergic Fatigue Constipation
Pill Jaundice Directed  

Fat, Flu, and Pill are not scored and are positioned at the beginning of the REALM-R to decrease test anxiety and enhance confidence.

  1. Examiner Sensitivity
    Many adults with low literacy skills will attempt to hide their deficiency. Ensure that you approach each person with respect and compassion. You may need to provide encouragement and reassurance. Many people with low literacy feel ashamed. Be sensitive.
  2. Visual Acuity
    If the person wears glasses, ask them to wear the glasses for the test. The word list should be set in 18-point font.
  3. Pronunciation
    Dictionary pronunciation is the scoring standard.
  4. Dialect, Accent, or Articulation Problems
    Count a word as correct if it is pronounced correctly and no additions or deletions have been made to the beginning or ending of the word. For example, a person who says "jaundiced" would not receive credit for the word "jaundice"; "directs" would not receive credit for the word "directed". Words pronounced with a dialect or accent should be counted as correct, provided there are no additions or deletions to the word. Particular attention should be paid to persons who use English as a second language.
  5. Limitations of the REALM-R
    The REALM-R can only be used for persons who read English; it has not been validated in other languages.
  1. Print the list in 18-point font or greater.
  2. Introduce the REALM-R to the person. The words "read" and "test" should be avoided when introducing and administering the REALM-R. The following statement can be used to introduce the REALM-R:
    "Sometimes in the health care system, medical words are
    used that many people are not familiar with. I would like to
    get an idea of what medical words you are familiar with."
  3. Give the person the list of the REALM-R words. Point to the first word and ask the person read the 11 words out loud. Be sensitive to dialect, accent, and articulation problems.
  4. If the person takes more than five seconds on a word, they should be encouraged to move on to the next word (e.g., say "Let's try the next word.") If the person begins to miss every word or appears to be struggling or frustrated, tell them, "Just look down the list and say the words you know."

Use the REALM-R Examiner Record to record the outcome of the test. The words Fat Flu and Pill are not scored. Count as an error any word that is not attempted or is mispronounced. Place a check mark ("v") next to each word the person pronounces correctly, and an "X" next to each work the person does not attempt or mispronounces. Those with a score of 6 or less should be considered to be at risk for poor health literacy.