Supplemental Items for the CAHPS Hospital Survey: Health Literacy

Population version: Adult

Download these items: English: ( Word [ Microsoft Word file - 38.44 KB])

These supplemental items were developed and tested together to 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 [ PDF file - 290.37 KB] )

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 before the "About You" section of the survey.

  • After the last item before the "About You" section, begin a new page and add the following text (bolded):

    Now we would like to gather some additional detail on topics we have asked you about before.

  • 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 so that it is 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

Page last reviewed April 2017
Page originally created April 2016
Internet Citation: Supplemental Items for the CAHPS Hospital Survey: Health Literacy. Content last reviewed April 2017. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/cahps/surveys-guidance/item-sets/literacy/suppl-healthlit-items.html