Health Literacy Measurement Tools

Fact Sheet

Health literacy is the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. AHRQ-funded researchers have developed two tools to measure an aspect of health literacy—individuals' reading comprehension in a medical context. These tools can be used for research, clinical, or program planning purposes.

Rapid Estimate of Adult Literacy in Medicine—Short Form (REALM-SF)

The Rapid Estimate of Adult Literacy in Medicine—Short Form (REALM-SF) is a 7-item word recognition test to provide clinicians with a valid quick assessment of patient health literacy. The REALM-SF has been validated and field tested in diverse research setting, and has excellent agreement with the 66-item REALM instrument in terms of grade-level assignments.

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REALM-SF Form

Patient name _______________ Date of birth _______________ Reading level _______________

Date ________________ Examiner _______________ Grade completed _______________

Word 
Menopause
Antibiotics
Exercise
Jaundice
Rectal
Anemia
Behavior

Instructions for Administering the REALM-SF

  1. Give the patient a laminated copy of the REALM-SF form and score answers on an unlaminated copy that is attached to a clipboard. Hold the clipboard at an angle so that the patient is not distracted by your scoring. Say:
    "I want to hear you read as many words as you can from this list. Begin with the first word and read aloud. When you come to a word you cannot read, do the best you can or say, 'blank' and go onto the next word."
  2. If the patient takes more than five seconds on a word, say "blank" and point to the next word, if necessary, to move the patient along. If the patient begins to miss every word, have him or her pronounce only known words.

Scores and Grade Equivalents for the REALM-SF

Score   Grade range
0Third grade and below; will not be able to read most low-literacy materials; will need repeated oral instructions, materials composed primarily of illustrations, or audio or video tapes.
1-3Fourth to sixth grade; will need low-literacy materials, may not be able to read prescription labels.
4-6Seventh to eighth grade; will struggle with most patient education materials; will not be offended by low-literacy materials.
7High school; will be able to read most patient education materials.

Short Assessment of Health Literacy for Spanish Adults (SAHLSA-50)

The Short Assessment of Health Literacy for Spanish Adults (SAHLSA-50) is a validated health literacy assessment tool containing 50 items designed to assess a Spanish-speaking adult's ability to read and understand common medical terms. The SAHLSA was based on the Rapid Estimates of Adult Literacy in Medicine (REALM), known as the most easily administered tool for assessing health literacy in English.

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SAHLSA-50 Form

StemKey or Distracter"no se"
(Don't know)
  1. próstata
__glándula__circulación__no se
  1. empleo
__trabajo__educación__no se
  1. menstrual
__mensual__diario__no se
  1. gripe
__sano__enfermo__no se
  1. avisar
__medir__decir__no se
  1. comidas
__cena__paseo__no se
  1. alcoholismo
__adicción__recreo__no se
  1. grasa
__naranja__manteca__no se
  1. asma
__respirar__piel__no se
  1. cafeína
__energía__agua__no se
  1. osteoporosis
__hueso__músculo__no se
  1. depresión
__apetito__sentimientos__no se
  1. estreñimiento
__bloqueado__suelto__no se
  1. embarazo
__parto__niñez__no se
  1. incesto
__familia__vecinos__no se
  1. pastilla
__tableta__galleta__no se
  1. testículo
__óvulo__esperma__no se
  1. rectal
__regadera__inodoro__no se
  1. ojo
__oír__ver__no se
  1. irritación
__rígido__adolorido__no se
  1. abnormal
__diferente__similar__no se
  1. estrés
__preocupación__feliz__no se
  1. aborto espontáneo
__pérdida__matrimonio__no se
  1. ictericia
__amarillo__blanco__no se
  1. papanicolaou
__prueba__vacuna__no se
  1. impétigo
__pelo__piel__no se
  1. indicado
__instrucción__decisión__no se
  1. ataque
__herida__sano__no se
  1. menopausia
__señoras__niñas__no se
  1. apéndice
__rascar__dolor__no se
  1. comportamiento
__pensamiento__conducta__no se
  1. nutrición
__saludable__gaseosa__no se
  1. diabetes
__azúcar__sal__no se
  1. sífilis
__anticonceptivo__condón__no se
  1. inflamatorio
__hinchazón__sudor__no se
  1. hemorroides
__venas__corazón__no se
  1. herpes
__aire__sexo__no se
  1. alérgico
__resistencia__reacción__no se
  1. riñón
__orina__fiebre__no se
  1. calorías
__alimentos__vitaminas__no se
  1. medicamento
__instrumento__tratamiento__no se
  1. anemia
__sangre__nervio__no se
  1. intestinos
__digestión__sudor__no se
  1. potasio
__mineral__proteína__no se
  1. colitis
__intestino__vejiga__no se
  1. obesidad
__peso__altura__no se
  1. hepatitis
__pulmón__hígado__no se
  1. vesícula biliar
__arteria__órgano__no se
  1. convulsiones
__mareado__tranquilo__no se
  1. artritis
__estómago__articulación__no se

Instructions for Administering SAHLSA-50

Administration of the test could be facilitated by using laminated 4" x 5" flash cards, with each card containing a medical term printed in boldface on the top and the two association words—i.e., the key and the distracter—at the bottom.

Directions to the Interviewer:

  1. Before the test, the interviewer should say to the examinee: "Le voy a mostrar tarjetas con 3 palabras en ellas. Primero, me gustaría que usted lea la palabra arriba en voz alta. Entonces, yo leeré las dos palabras debajo a usted y me gustaría que usted me dijera cuál de las dos palabras es más similar a la palabra arriba. Si usted no sabe la respuesta, por favor diga, 'no se'. No adivine."
  2. Show the examinee the first card.
  3. The interviewer should say to the examinee: "Ahora, por favor, lea la palabra arriba en voz alta."
  4. The interviewer should have a clipboard with a score sheet to record the examinee's answers. The clipboard should be held such that the examinee cannot see or be distracted by the scoring procedure.
  5. The interviewer will then read the key and distracter (the two words at the bottom of the card) and then say: "Cuál de las dos palabras es más similar a la palabra arriba? Si usted no sabe la respuesta, por favor diga, 'no se'.
  6. The interviewer may repeat the instructions so that the examinee feels comfortable with the procedure.
  7. Continue the test with the rest of the cards.
  8. A correct answer for each test item is determined by both correct pronunciation and accurate association. Each correct answer gets one point. Once the test is completed, the interviewer should tally the total points to generate the SAHLSA-50 score.
  9. A score between 0 and 37 suggests the examinee has inadequate health literacy.
Current as of January 2009
Internet Citation: Health Literacy Measurement Tools: Fact Sheet. January 2009. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/literacy/index.html