Evaluation Strategies and Considerations for Health Literacy Programs
To capture the effects of a program that aims to improve health literacy, rural communities may need to consider
a range of evaluation strategies. Depending on the focus of the intervention, these strategies can measure
health literacy at the personal or individual patient level as well as aspects of health literacy at the
organizational or system level.
When designing any evaluation of health literacy program, certain considerations may help tailor the approach to
best fit the community, such as:
Including members of the community and population of focus in the evaluation design process
Engaging other organizations and champions in the community with similar goals
Remembering that context matters, including experiences of the population of focus and aspects of rural
The Rural Community Health Toolkit provides an overview of evaluation considerations for rural
communities designing an evaluation plan. In addition, the Conducting Rural Health Research, Needs
Assessment, and Program Evaluation Topic Guide provides information and resources about the importance
of program evaluation and considerations for evaluating rural programs.
Evaluating Personal Health Literacy
An evaluation of a program focused on improving personal health literacy can be designed to allow for a better
understanding of whether a program is helping individuals find, comprehend, and use health information to make
informed decisions for themselves and others. Some evaluations may also measure whether an individual's health
outcomes are improving due to changes in health literacy.
Evaluations to assess the impact of health literacy programs on personal health literacy can include both
process and outcome measures. Frameworks or
theoretical approaches can be applied to measure behavioral change through concepts such as
self-efficacy, autonomy, readiness, and empowerment. In addition, a logic model can help describe how the
program works and expected results, which can help with creating an overall evaluation plan.
Programs focused on improving personal health literacy often evaluate outcomes such as changes in health
literacy levels. Changes in health literacy levels can be measured using a personal health literacy scale
included within a survey or questionnaire that assesses personal health literacy.
In addition, programs focused on improving personal health literacy may choose to also evaluate changes in
personal numeracy skills as a component of health literacy. Measuring numeracy skills assesses an
individual's ability to understand numbers and concepts such as probabilities and percentages related to
diagnoses and health conditions, treatment regimens, and medication adherence.
Evaluating Organizational Health Literacy
Programs designed to improve organizational health literacy can use evaluation to measure program activities and
services and assess changes in organizational characteristics. This information may help assess successes of the
organizational health literacy program.
Health literate organizations are organizations that understand the nuances of communication and that find ways
to effectively improve individuals' health by addressing systems-level factors to ensure people have all the
information they need in the most accessible and understandable format. According to the Ten
Attributes of Health Literate Health Care Organizations, programs can embed evaluation aspects while
incorporating health literacy characteristics at the organizational level such as:
Integrate health literacy expertise in the workforce to ensure the organization's mission and operations
align with goals of improving health literacy
Provide trainings to staff and evaluate the impact of trainings on staff health literacy levels
Bring in outside health literacy professionals to augment in-house training resources
Create and disseminate appropriate health literacy curricula
Work in partnership with patients and staff who can provide anecdotal stories and evidence-based
Resources to Learn More
Evaluating Community-Based Health Literacy
Summary of a session during a National Academies workshop about interventions that specifically focus on
strategies and considerations for evaluating community-based health literacy programs.
Organization(s): National Academies of Sciences, Engineering, and Medicine
Provides guidelines and a framework for program evaluation and offers a summary of the steps that individuals
and organizations can take to evaluate their program.
Organization(s): Centers for Disease Control and Prevention (CDC)
Health Literacy: A Prescription to End Confusion
Describes, defines, and highlights the importance of health literacy measures and nuances of measuring health
literacy in different contexts.
Organization(s): The National Academies Press, Institute of Medicine (IOM)
to Develop the Right Research Questions for Program Evaluation
Addresses the importance of identifying appropriate research questions for program evaluation. Includes four
basic steps for developing research questions and offers an example of a logic model for a health literacy
Organization(s): Corporation for National and Community Service, AmeriCorps