Assessing literacy in clinical and community settings: the patient perspective.

A common concern among patient advocates and practitioners is the potential to offend patients with literacy testing in clinical settings. Patients' perceptions of, and comfort level with, literacy testing have not been well established. The aim of this study was to assess patient attitudes about literacy assessments in a primary care clinic and a community-based wellness program and to explore whether patients preferred one assessment tool over another. Participant recruitment occurred at a general internal medicine clinic and two community settings (YMCAs) in the southeast. Two literacy measures (Rapid Estimate of Adult Literacy in Medicine and Test of Functional Health Literacy in Adults) and a questionnaire to assess opinions on the instruments were administered. Most participants were comfortable having their literacy assessed and indicated that it would be useful for practitioners to know the literacy levels of patients. A sizable minority (10%) were concerned that such testing in health care settings may be inappropriate. An additional finding was that self-reported reading skills of participants did not correspond to actual reading scores. Patients recognize the importance of literacy in their health care and most are comfortable with literacy assessments. An important minority, however, object to this practice.