While REALM only measures reading ability and correct pronunciation of words, TOFHLA correlates well with other health literacy tests and is considered a more accurate indicator of patients’ reading ability because it measures comprehension of both prose passages and numerical information.
Patients identified as having inadequate functional health literacy as measured by TOFHLA have less knowledge about chronic diseases and self-management, suggesting that current educational strategies may be less successful for this group (Baker et al. 1999).