Determining which of our patients struggle with numeracy or literacy is difficult and clinicians overestimate the levels of patient literacy. In a report in this journal, we demonstrate that 33% of new patients and 16% of serial users have difficulty completing the Epworth Sleepiness Scale (ESS). To explore reasons for this we have assessed literacy in a further group of 122 patients attending either the Sleep Centre (Sleep group) or the Lung Function Laboratory (LF group). The level of functional literacy in medicine was assessed using the Rapid Estimate of Adult Literacy in Medicine (MALM) questionnaire. A REALM score < =60 suggests that the patient would struggle with patient education materials and prescription labels. In addition to REALM, information about educational attainments and use of the English language was collected.
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