Tests to Measure Comprehension of Printed Education Materials

Standardized tests have proved reliable and valid in measuring reader’s comprehension levels.

 so we all know that tests are for measuring our knowledge on a certain topic but rather than
knowledge it is essential to test our comprehension or the capability of an individual in
understanding something. The two most popular standardized methods to measure
comprehension of written materials are the cloze test and the listening test, these two test can
help assess the learners of how much they understand from reading a text.

Cloze Procedure

 derived from the term closure based on Gestalt psychology

 this procedure has been widely used and is highly recommended for use, even if this test
requires tie and resources it has been validated for its adequacy.
 The cloze test can be administered to individual clients who demonstrate difficulty
comprehending health material
 It is highly suggested that not every patient in the health setting should participate in this test,
rather a representative will be tested and we should remember when doing his test we should
make sure that the individual who is reading has the skill that are at the sixth grade
 The reader is asked to fill in the blanks with the exact word replacements.
 One point is scored for every missing word guessed correctly by the reader
 The final cloze score is the total number of blanks filled in correctly by the reader
 If the reader successfully filled the blanks, then it indicates that the reading material is being
comprehended appropriately

Listening Test

 a good approach to determining what a lowliterate person understands and remembers

when listening to oral instruction
 so we all know by now that the cloze test is appropriate for a sixth grader and above, o unlike
that the listening test is suitable for low literate person
 select a passage from instructional materials that takes about 3 minutes to read aloud
 and we have to make sure that it is is written at approximately the fifth-grade level
 Formulate 5 to 10 short questions relevant to the content of the passage by selecting
key points of the text.
 Read the passage to the person at a normal rate
 Ask the listener the questions orally and record the answers
 So in this case, we will now if the learner successfully understand the reading material by
dividing the number of questions answered correctly by the total number of questions if the
percentage is above 75% - 895% then we can say that it may need assistance, 90% or higher
means that the material is comprehended and 75% means that the material is too hard and
should be replaced by a easier material.
Tests to Measure General Reading Skills and Health Literacy Skills of Clients

WRAT (Wide Range Achievement Test)

 It is used to assess a learner’s ability to recognize and pronounce a list of words out of
context as a criterion for measuring reading skills
 In other words this test is a word recognition screening test, although this test does not test
other aspects such as comprehension, this enables the educator to determine the level of
instruction for the client.
 It tests on two levels: Level I is designed for testing children 5 to 12 years of age, and
Level II is intended for testing persons older than age 12
 The WRAT consists of a graduated list of 42 words
 Starting with the easiest and to the hardest
 The individual administering the test listens carefully to the patient’s responses and
scores those responses on a master score sheet
 When 5 words are mispronounced, this indicates that the learner has meet its limits and we
have to stop the test. To score the test, the number of words missed or not tried is subtracted
from the total list of words on the master score sheet to get a raw score

REALM (Rapid Estimate of Adult Literacy in Medicine)

 It measures a patients ability to read medical and health-related vocabulary

 ask patients to read aloud words from three word lists.
 So as the same as the WRAT There are sixty-six medical and health-related words that is
arranged by easier to complex words.
 Clients are asked to begin at the top of the first column and read down, pronouncing all
the words that they can from the three lists
 If they cant pronounce the word they will be told to skip and proceed on to the next
 The total number of words pronounced correctly is the client’s raw score, which is converted to
a grade ranging from third grade and below (score of 0–18) to ninth grade and above (score of
61–66). Those persons whose scores fall at sixth grade or below have literacy skills equivalent to
NALS Levels 1 and 2
 The relatively new REALM-R, a revised shorter version (8-item) of the original
instrument of 66 items

TOFHLA (Test of Functional Health Literacy in Adults)

 Used in measuring patients’ health literacy skills using actual hospital materials, such as
prescription labels, appointment slips, and informed consent documents
 Two parts: reading comprehension and numeracy
 It has demonstrated reliability and validity, requires approximately 20 minutes to administer,
and is available in a Spanish version
 An abbreviated version, known as the S-TOFHLA, was developed in 1999; it takes only 12
minutes to administer
  Not only has this short version been tested for reliability and validity, but it is a more practical
measure of functional health literacy to determine who needs assistance with achieving learning
goals
 The TOFHLA instrument and directions can be accessed at
http://www.peppercornbooks.com/catalog/information.php?info_id=5.

NVS (Newest Vital Sign)

 is a tool developed to identify those at risk for low health literacy

 It is easy and inexpensive to administer, taking as little as 3 minutes from start to finish
 Patients are asked to look at an ice cream label and answer questions in relation to the
label, which also allows an assessment of numeracy’
 Each correct answer gives them one point.
 Patients are placed into one of three categories related to their literacy level: 1–2, likelihood of
limited literacy; 3–4, possibility of limited literacy; and 5–6, adequate literacy
 It is suggested that the tool be administered while the nurse is obtaining vital signs
 More information on this tool can be found free of charge on the Internet at
http://www.pfizer.com/health/literacy

eHEALS (eHealth Literacy Scale)

 which was designed by Norman and Skinner (2006b), is one of only a few tools available
to determine a patient’s ability to find and navigate electronic health information
 It consists of eight items that collectively measure patients’ comfort level and perceived ability
to address their health problems by finding and using electronic health information
 Questions center on the client’s use of the Internet in relation to locating health
information.
 This scale offers a way to assess whether a client would be a good candidate to engage
in eHealth materials

LAD (Literacy Assessment for Diabetes)

 Used to measure word recognition in adult patients with diabetes

 It consists of three word lists presented in ascending order of difficulty.
 Many terms are at the 4th-grade reading level, but the remaining words range from 6th-
through 16th-grade levels. The LAD can be administered in 3 minutes or less
 This standardized test was modeled after REALM but emphasizes common words used when
teaching self-care management of diabetes.
 The LAD instrument is copyrighted but is available with permission from Charlotte Nath
(nathcharlotte@gmail. com) at https://healthliteracy.bu.edu/76/104/122
/mobile/documents/lad.

SAM (Instrument for Suitability Assessment of Materials)

  Although not designed to specifically measure health literacy or evaluate only health-
related materials, it can be a very useful tool in determining the effectiveness of
instructional materials for diverse patient populations in the healthcare arena
 Not only can the SAM tool be used with print material and illustrations, but it also has been
applied to videotaped and audiotaped instructions.
 The SAM instrument yields a numerical (percentage) score, with materials tested falling
into one of three categories: superior (70–100%), adequate (40–69%), or not suitable
(0–39%).
 The application of this tool can identify specific deficiencies in instructional materials that
reduce their suitability. The SAM instrument includes 22 factors to assess the content, literacy
demand, graphics, layout and typography, learning stimulation and motivation, and cultural
appropriateness of instructional materials being developed or already in use