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Low literacy is described as the inability to read, write or use numbers effectively. The limited ability to read and understand health care instructions directly translates into poor health outcomes. The purpose of the study was to determine the English reading levels of patients in a primary health care clinic in the west of Tshwane and to adapt and validate a suitable literacy instrument to measure the English literacy levels in primary health care patients. Sub-problem 1 includes adapting the current REALM-R for the South African context. Sub-problem 2 includes determining the English literacy levels of primary care patients using the Learning Ability Battery and determining how the results of the REALM correlate with the Learning Ability Battery. The result of the study was an adapted REALM-R for the South African context, the English literacy levels of primary care patients was determined and a correlation between the REALM-R and the Learning Ability Battery could be established.