CAHPS Health Literacy Item Sets

The CAHPS Health Literacy Item Sets ask about providers' efforts to foster and improve the health literacy of patients. Health literacy is commonly defined as patients' ability to obtain, process, and understand the basic health information and services they need to make appropriate health decisions.¹ While health literacy depends in part on individuals' skills, it also depends on the complexity of health information and how it is communicated. Learn more about health literacy.

Supplemental items related to health literacy are available for three CAHPS surveys:

• Health Literacy Items for the Clinician & Group Survey 3.0²
• Health Literacy Items for the Health Plan Survey 5.0
• Health Literacy Items for the Hospital Survey (Adult version)

The primary goal of these supplemental items is to capture the patients' perspective on how well health information is communicated to them by health care professionals. They are intended to serve as both a measure of whether health care professionals have succeeded in reducing the health literacy demands they place on patients, and as a tool for quality improvement.

Topics Addressed by the Health Literacy Item Sets

The items address the following five topic areas:

• Communication with providers
• Communication about self-management of diseases and conditions
• Communication about medicines
• Communication about tests and test results
• Communication about forms

Users of these item sets can report the results for individual items as well as a few composite measures.

Using These Item To Improve Health Literacy

Providers can use patients' responses to the Health Literacy Items to identify factors that may be affecting their scores on the survey's communication measure and to improve their health literacy practices. For example, based on their survey results, providers could do the following:

• Identify specific topic areas for quality improvement (e.g., communication about test results, medications, and forms).
• Recognize particular behaviors that inhibit effective communication (e.g., talking too fast, using medical jargon).
• Assist in designing a safer, shame-free environment where patients feel comfortable discussing their health care concerns (e.g., showing interest in questions, explaining forms).
• Measure the effect of behaviors that promote effective communication (e.g., confirming understanding through teach-back, using visual aids).

Related Resources

• CAHPS Ambulatory Care Improvement Guide, AHRQ
• Health Literacy Measurement Tools, AHRQ
• Health Literacy Universal Precautions Toolkit, AHRQ
• National Action Plan to Improve Health Literacy, Office of Disease Prevention and Health Promotion.

Development of the Health Literacy Item Sets

AHRQ commissioned members of the CAHPS team from the RAND Corporation to create the Health Literacy Item Sets for CAHPS surveys. The original CAHPS Item Set for Addressing Health Literacy was developed for the Clinician & Group Survey and released in 2011. Those items were revised slightly in 2012 to align the questions and placement instructions with the 2.0 version of the Clinician & Group Survey, and revised once more in 2017 to align concepts, structures, and placement with the 3.0 version of the Clinician & Group Survey. A similar item set designed to be administered as part of the CAHPS Health Plan Survey was also released in 2017.

The Health Literacy Item Set for Hospitals was released in 2015.  For more information about this item set, read About the CAHPS Health Literacy Item Set for Hospitals (PDF, 291 KB).

1. Health literacy is part of the Healthy People 2030 framework’s foundational principles and goals.

2. The Health Literacy Item Set for the Clinician & Group Survey (CG-CAHPS) 3.0 includes some questions about patient-provider communication that were also in the Cultural Competence Item Set for the 2.0 version of CG-CAHPS. The remaining questions from the Cultural Competence Item Set are not recommended for use with the 3.0 version of the survey.