"In a recently published article in the Journal of Health Communication, Lincoln, Arford, Prener, Garverich, and Koenen (2013) highlight concerns about the use of potentially triggering language in existing and frequently used health literacy instruments such as the Rapid Estimate of Adult Literacy in Medicine (REALM) and the Test of Functional Health Literacy in Adults (TOFHLA). These instruments present a list of words with which examinees are to choose from and read aloud. The authors suggest that some represent nouns or verbs associated with trauma or victimization, including words like incest and rectal. In some cases, the words are used without an underlining function, such as when they are incorrect options in a multiple-choice question. The authors argue that use of these potentially triggering words not only may generate unnecessary distress, but also may compromise the instrument’s validity by causing the examinee to become confused and less accurate, as in the case of the Emotional Stroop test in which affect laden stimuli interrupt task functioning. The authors strongly suggest revising the wording of these instruments and advocate for developers to take a more trauma-sensitive approach when designing such instruments."
Lincoln, A. K., Arford, T., Prener, C., Garverich, S., & Koenen, K. C. (2013). "The need for trauma-sensitive language use in literacy and health literacy screening instruments." Journal of Health Communication, 18(sup1), 15-19.
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