Supplemental Items for the CAHPS Hospital Adult Survey: Health Literacy

Population version: Adult

These supplemental items address various issues related to patients' health literacy in hospital settings. For more information about these items and the measures they produce, read About the CAHPS Health Literacy Item Set for Hospitals (PDF, 479 KB).

Learn more about the CAHPS Health Literacy Item Sets.

Related topic: Interpreter Services. Hospitals interested in items that assess health literacy may also want to review and use supplemental items that ask about interpreter services.

Use with HCAHPS: The items were designed to be added to the Adult version of HCAHPS, which is implemented nationally by the Centers for Medicare & Medicaid Services (CMS). While users of HCAHPS are free to incorporate supplemental items in order to meet the needs of their organizations, local markets, and/or audiences, the use of these supplemental items is not part of the national implementation requirements. Additionally, some items cover events that occur with low frequency in the general population. You should include them only if your sample design is likely to yield a sufficient number of responses to those questions for statistical analysis and reporting.

Important instructions regarding the placement of supplemental items in the core questionnaire: Under CMS's rules for national implementation of HCAHPS, you must:

Place all supplemental items after the "About You" section of the survey.
Add a transition statement to indicate a transition from the HCAHPS questions. To find CMS’s mandatory transition statement, please refer to the HCAHPS Quality Assurance Guidelines on HCAHPS and search for “mandatory transition statement.” The statement is available in multiple languages.
Add new subheadings as instructed in the table below. The need for a subheading depends on which questions you choose to use.
Format the subheading(s) to be consistent with existing subheadings.

Questions and Response Options	Placement and Other Instructions
H-HL1. During this hospital stay, did hospital staff ask you to describe how you were going to take your medications when you were at home? ¹ __ Yes ² __ No	Note: Before items H-HL1 – H-HL2, add a new subheading: "Information About Medications" Note: Add a new instruction before H-HL1: "If you were not given any medication when you left the hospital, go to Question X." Replace X with the number used for H-HL3, or the next question in your survey.
H-HL2. During this hospital stay, did hospital staff tell you who to call if you had questions about your medications? ¹ __Yes ² __ No	After H-HL1
H-HL3. During this hospital stay, how often were nurses hard to understand because of the way they spoke your language? ¹ __ Never ² __ Sometimes ³ __ Usually ₄ __ Always	After H-HL2 Note: Before items H-HL3 – H-HL9, add a new subheading: "Talking With Nurses"
H-HL4. During this hospital stay, how often did nurses use medical words you did not understand? ¹ __ Never ² __ Sometimes ³ __ Usually ⁴ __ Always	After H-HL3
H-HL5. During this hospital stay, how often did nurses talk too fast when talking with you? ¹ __ Never ² __ Sometimes ³ __ Usually ⁴ __ Always	After H-HL4
H-HL6. During this hospital stay, how often did nurses interrupt you when you were talking? ¹ __ Never ² __ Sometimes ³ __ Usually ⁴ __ Always	After H-HL5
H-HL7. During this hospital stay, how often did nurses answer all your questions to your satisfaction? ¹ __ Never ² __ Sometimes ³ __ Usually ⁴ __ Always	After H-HL6
H-HL8. During this hospital stay, how often did nurses use a condescending, sarcastic, or rude tone or manner with you? ¹ __ Never ² __ Sometimes ³ __ Usually ⁴ __ Always	After H-HL7
H-HL9. During this hospital stay, how often did you feel nurses really cared about you as a person? ¹ __ Never ² __ Sometimes ³ __ Usually ⁴ __ Always	After H-HL8
H-HL10. During this hospital stay, how often were doctors hard to understand because of the way they spoke your language? ¹ __ Never ² __ Sometimes ³ __ Usually ⁴ __ Always	After H-HL9 Note: Before items H-HL10 – H-HL18, add a new subheading: "Talking With Doctors"
H-HL11. During this hospital stay, how often did doctors use medical words you did not understand? ¹ __ Never ² __ Sometimes ³ __ Usually ⁴ __ Always	After H-HL10
H-HL12. During this hospital stay, how often did doctors talk too fast when talking with you? ¹ __ Never ² __ Sometimes ³ __ Usually _{4 __ Always}	After H-HL11
H-HL13. During this hospital stay, how often did doctors use pictures, drawings, models, or videos to explain things to you? ¹ __ Never ² __ Sometimes ³ __ Usually ⁴ __ Always	After H-HL12
H-HL14. During this hospital stay, how often did doctors interrupt you when you were talking? ¹ __ Never ² __ Sometimes ³ __ Usually ⁴ __ Always	After H-HL13
H-HL15. During this hospital stay, how often did doctors answer all your questions to your satisfaction? ¹ __ Never ² __ Sometimes ³ __ Usually ⁴ __ Always	After H-HL14
H-HL16. During this hospital stay, how often did doctors make sure you understood all the information you were given? ¹ __ Never ² __ Sometimes ³ __ Usually ⁴ __ Always	After H-HL15
H-HL17. During this hospital stay, how often did doctors use a condescending, sarcastic, or rude tone or manner with you? ¹ __ Never ² __ Sometimes ³ __ Usually ⁴ __ Always	After H-HL16
H-HL18. During this hospital stay, how often did you feel doctors really cared about you as a person? ¹ __ Never ² __ Sometimes ³ __ Usually ⁴ __ Always	After H-HL17
H-HL19. During this hospital stay, did you have a blood test, x-ray, or other test? ¹ __Yes ² __ No → If No, go to H-HL24	After H-HL18 Note: Before items H-HL19 – H-HL23, add a new subheading: "Talking About Tests"
H-HL20. During this hospital stay, before you had a blood test, x-ray, or other test, how often did hospital staff explain what it was for? ¹ __ Never → If Never, go to H-HL22 ² __ Sometimes ³ __ Usually ⁴ __ Always	After H-HL19 Note: Use with H-HL19
H-HL21. How often was the explanation of what the test was for easy to understand? ¹ __ Never ² __ Sometimes ³ __ Usually ⁴ __ Always	After H-HL20 Note: Use with H-HL20
H-HL22. During this hospital stay, when you had a blood test, x-ray, or other test, how often did hospital staff explain the results to you? ¹ __ Never → If Never, go to H-HL24 ² __ Sometimes ³ __ Usually ⁴ __ Always	After H-HL21 Note: Use with H-HL19
H-HL23. How often were the results of your blood test, x-ray, or other test easy to understand? ¹ __ Never ² __ Sometimes ³ __ Usually ⁴ __ Always	After H-HL22 Note: Use with H-HL22
H-HL24. During this hospital stay, did you have to sign any forms? ¹ __Yes ² __ No → If No, go to H-HL26	After H-HL23 Note: Before items H-HL24 – H-HL31, add a new subheading: "Communication About Forms"
H-HL25. During this hospital stay, how often did hospital staff explain the purpose of a form before you signed it? ¹ __ Never ² __ Sometimes ³ __ Usually ⁴ __ Always	After H-HL24 Note: Use with H-HL24
H-HL26. During this hospital stay, did you have to fill out any forms? ¹ __Yes ² __ No → If No, go to H-HL32	After H-HL25
H-HL27. During this hospital stay, how often did hospital staff offer you help to fill out a form? ¹ __ Never ² __ Sometimes ³ __ Usually ⁴ __ Always	After H-HL26 Note: Use with H-HL26
H-HL28. During this hospital stay, how often were the forms easy to fill out? ¹ __ Never ² __ Sometimes ³ __ Usually ⁴ __ Always	After H-HL27 Note: Use with H-HL26
H-HL29. During this hospital stay, how often were you given enough time to fill out forms? ¹ __ Never ² __ Sometimes ³ __ Usually ⁴ __ Always	After H-HL28 Note: Use with H-HL26
H-HL30. During this hospital stay, did you ever need forms in a language other than English? ¹ __Yes ² __ No → If No, go to H-HL32	After H-HL29 Note: Use with H-HL26
H-HL31. During this hospital stay, how often were the forms that you had to fill out or sign available in your language? ¹ __ Never ² __ Sometimes ³ __ Usually ⁴ __ Always	After H-HL30 Note: Use with H-HL30
H-HL32. After you left the hospital, did you go directly to your own home, to someone else's home, or to another health facility? ¹__ Own home ² __ Someone else's home ³ __ Another health facility → If Another, go to core question 26	After H-HL31 Note: Before items H-HL32 – H-HL39, add a new subheading: "Information About How to Care for Yourself" Note: H-HL32 repeats question 18 in the Adult HCAHPS Survey in order to set up the subsequent questions. Add the following instruction before H-HL32:"We need you to answer the following question again although you have already answered it in the first part of the survey."
H-HL33. During this hospital stay, did hospital staff give you a telephone number to call if you had problems after you left the hospital? ¹ __Yes ² __ No	After H-HL32 Note: Use with H-HL32
H-HL34. During this hospital stay, did hospital staff tell you how to take care of yourself at home? ¹ __Yes ² __ No → If No, go to H-HL36	After H-HL33 Note: Use with H-HL32
H-HL35. Was this information about how to take care of yourself at home easy to understand? ¹ __Yes ² __ No	After H-HL34 Note: Use with H-HL34
H-HL36. During this hospital stay, did you get instructions in writing about how to take care of yourself at home? ¹ __Yes ² __ No → If No, go to core question 26	After H-HL35 Note: Use with H-HL32
H-HL37. Were the written instructions about how to take care of yourself at home easy to understand? ¹ __Yes ² __ No	After H-HL36 Note: Use with H-HL36
H-HL38. Did you need written instructions about how to take care of yourself at home in a language other than English? ¹ __Yes ² __ No → If No, go to core question 26	After H-HL37 Note: Use with H-HL32
H-HL39. Were the written instructions about how to take care of yourself at home available in your language? ¹ __Yes ² __ No	After H-HL38 Note: Use with H-HL38

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Supplemental Items for the CAHPS Hospital Adult Survey: Health Literacy