The Brazilian version of the 20-item rapid estimate of adult literacy in medicine and dentistry

Author(s)

Cruvinel, Agnes Fatima P. ; Mendez, Daniela Alejandra C. ; Oliveira, Juliana G. ; Gutierres, Eliezer ; Lotto, Matheus ; Machado, Maria Aparecida A. M. ; Oliveira, Thais M. ; Cruvinel, Thiago

• Document type: Journal article
• Source: PeerJ; v. 5, AUG 29 2017.
• Web of Science Citations: 6

Abstract

Background. The misunderstanding of specific vocabulary may hamper the patienthealth provider communication. The 20-item Rapid Estimate Adult Literacy in Medicine and Dentistry (REALMD-20) was constructed to screen patients by their ability in reading medical/dental terminologies in a simple and rapid way. This study aimed to perform the cross-cultural adaptation and validation of this instrument for its application in Brazilian dental patients. Methods. The cross-cultural adaptation was performed through conceptual equivalence, verbatim translation, semantic, item and operational equivalence, and back-translation. After that, 200 participants responded the adapted version of the REALMD-20, the Brazilian version of the Rapid Estimate of Adult Literacy in Dentistry (BREALD-30), ten questions of the Brazilian National Functional Literacy Index (BNFLI), and a questionnaire with socio-demographic and oral health-related questions. Statistical analysis was conducted to assess the reliability and validity of the REALMD-20 (P < 0 : 05). Results. The sample was composed predominantly by women (55.5%) and white/brown (76%) individuals, with an average age of 39.02 years old (+/- 15 : 28). The average REALMD-20 score was 17.48 (+/- 2.59, range 8 - 20). It displayed a good internal consistency (Cronbach's alpha = 0.789) and test-retest reliability (ICC = 0 : 73; 95% CI {[} 0 : 66 0 : 79]). In the exploratory factor analysis, six factors were extracted according to Kaiser's criterion. The factor I (eigenvalue = 4.53) comprised four terms - ``Jaundice'', ``Amalgam'', ``Periodontitis'' and ``Abscess'' - accounted for 25.18% of total variance, while the factor II (eigenvalue = 1.88) comprised other four terms - ``Gingivitis'', ``Instruction'', ``Osteoporosis'' and ``Constipation'' - accounted for 10.46% of total variance. The first four factors accounted for 52.1% of total variance. The REALMD-20 was positively correlated with the BREALD-30 (Rs = 0 : 73, P < 0 : 001) and BNFLI (Rs = 0 : 60, P < 0 : 001). The scores were significantly higher among health professionals, more educated people, and individuals who reported good/excellent oral health conditions, and who sought preventive dental services. Distinctly, REALMD-20 scores were similar between both participants who visited a dentist < 1 year ago and >= 1 year. Also, REALMD-20 was a significant predictor of self-reported oral health status in a multivariate logistic regression model, considering socio-demographic and oral health-related confounding variables. Conclusion. The Brazilian version of the REALMD-20 demonstrated adequate psychometric properties for screening dental patients in relation to their recognition of health specific terms. This instrument can contribute to identify individuals with important dental/medical vocabulary limitations in order to improve the health education and outcomes in a person-centered care model. (AU)

• FAPESP's process: 14/21515-1 - Translation, transcultural adaptation and validation of REALMD-20 (Rapid Estimate of Adult Literacy in Medicine and Dentistry)
• Grantee: Juliana Godoy de Oliveira Buzatto
• Support Opportunities: Scholarships in Brazil - Scientific Initiation