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J Am Acad Nurse Pract. 2002 Jan;14(1):38-42.

Literacy in the health care system: a study on open heart surgery patients.

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  • 1Sacred Heart Medical Center, Eastern Washington University Dental Hygiene Department, Spokane, WA, USA.



To determine if patients recovering from open heart surgery were able to read and understand written discharge instructions and further to analyze the level of difficulty of standard discharge instructions and consent forms for open heart surgery.


After screening for visual acuity and efficiency, literacy was assessed with the Rapid Estimate of Adult Literacy in Medicine test (REALM) and comprehension was tested by a post-test of five questions based on the discharge instructions. Flesch-Kincaid scores were calculated on four sets of standard written discharge instructions and consent forms.


Results from the study indicated that the REALM test was more accurate than the reported grade level and that reading skills are needed to understand and comprehend information needed for post-operative care. The study further substantiated that health care facilities are not providing written instructional material that is within the reading level of the patient.


Illiteracy can have a major impact in the health care system. Low reading skills can disempower and can prove to be costly for patients who are requiring health care services. Further investigation is needed on the impact of patients' reading skills on the health care system.

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