Evaluation Measures and Tools for Health Literacy Programs
Rural health literacy programs should identify measures that map to the program evaluation questions. There are
several resources programs can use when identifying or developing measures.
When choosing an appropriate scale, programs should consider program goals, target population, and other
specific contexts such as:
Is the program addressing specific health literacy concepts: communication (speaking/listening),
application, conceptual knowledge, information seeking, media literacy, or numeracy?
Is the program addressing a specific disease state, such as cancer, oral health, diabetes, or general health
Is the program designed for a specific age range, including children, adolescents, adults, or older
How long will the scale take respondents to complete?
How is the scale administered: face-to-face, paper and pencil, computer-based, or mailed?
What is the language of the validated scale?
Personal Health Literacy Measures and Tools
The Boston University Health Literacy Tool Shed is a
resource that describes health literacy validated scales to measure personal health literacy. These scales are
tailored for specific populations and disease states and could be adapted for use in many different communities.
The website gives information on peer-reviewed, validated, published measures tested for reliability with at
least 100 participants.
Examples of evaluation tools in the Health Literacy Tool Shed include:
The Agency for Healthcare Research and
Quality (AHRQ) Health Literacy Measurement Tools were developed to measure different aspects of health
literacy, such as examining medical terminology for reading comprehension. The AHRQ resources assist with
improving health literacy among those who speak English and Spanish.
Examples of evaluation tools highlighted on the AHRQ Health Literacy tool website include:
Organizational Health Literacy Measures and Tools
Literacy Environment of Hospitals and Health Centers (HLE2) assessment tool allows organizations,
healthcare systems, and hospitals to rate health literacy specific factors within an organization. The tool
helps measure organizational policies, practices, healthcare system navigation, culture and language, and
communication materials (print, forms, websites, and patient portals). The resulting information will help
assess health literacy levels and establish administration and organizational priorities and action steps.
AHRQ's Consensus Organizational
Literacy Quality Improvement Measures identifies 22 measures for assessing organizational health
literacy. The measures were developed for hospitals and are grouped in the following domains:
- Organizational Structure, Policy, and Leadership
- Ease of Navigation
- Patient Engagement and Self-Management Support
- Measures that Cut Across the Four Domains Above
Quantitative surveys can be used as an evaluation tool to include various types of health literacy outcomes,
targeting multiple audiences. For example, the National Assessment
of Adult Literacy (NAAL) is a nationally representative survey of American adults aged 16 or older that
includes an assessment of adults' ability to use literacy skills with health-related materials and forms. These
types of questions can be used by programs looking to improve individuals' health literacy levels. Adapting
items from national datasets can be beneficial to organizations interested in examining validated scales to use
for measuring health literacy.
Similarly, there are assessments such as the Consumer Assessment of
Healthcare Providers and Systems (CAHPS) Surveys that include questions focused on measuring providers'
activities and interactions with patients to improve health literacy. There are many CAHPS surveys that measure
patient experiences with different types of providers, health plans, facilities, and experiences with
condition-specific care. The CAHPS Health Literacy Item Sets ask patients to comment on their providers' efforts
to foster and improve health literacy. Topics addressed by the health literacy items in this survey include
questions about communication with providers, patient self-management of health conditions, medications, tests
and results, and medical forms.
The CDC Clear Communication Index Score
Sheet is a tool that can be used for evaluating whether organizational health literacy program materials
are health literate. The index has 4 introductory questions and 20 scored items. Organizations can use the tool
to score printed materials, messages, and scripts to assess whether the main message is understandable and
actionable for the population of interest. The Index helps evaluate the language and terms used as well as the
The Patient Education Materials
Assessment Tool (PEMAT) is a systematic tool to evaluate and compare the understandability and
actionability of print and audiovisual patient education materials. Materials are scored on six topic areas:
- Overall content
- Word choice and style
- Use of numbers
- Organization of material
- Layout and design of content
- Use of visual aids
The response options for the scale are agree (1) or disagree (0). Based on the total points and total possible
points, a percentage is calculated, which indicates whether the materials are easily understandable by the
population of interest and easily actionable.
Resources to Learn More
Health Literate Organizational Assessment
An assessment tool to assist when evaluating health literacy in an organization. Offers a method for scoring
before and after implementation of health literacy activities in 3 broad categories: leadership, integration,
and operations; preparation and communication; and information and navigation.
Organization(s): Pennsylvania Health Literacy Coalition
State of the Science of Health Literacy Measurement
An overview and history of health literacy (HL) measurement at the individual level. Focuses on the association
between HL definitions and measurement, methods to develop and identify stronger measures, characteristics of
participants in HL studies, and considerations when administering HL measures. Discusses a strategy for
advancing scientific study of HL measurement.
Author(s): Nguyen, T., Paasche-Orlow, M., & McCormack, L.
Citation: Information Services & Use, 37(2), 189-203