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Library Research Guides

Improving Health Literacy: Training Resources

Provides resources for training, evaluation, and writing for those who teach and advocate for health literacy. Also provides sources of information on quantitative health literacy research and methods.

Why Screen for Literacy?

There are two central reasons to identify patients with low literacy:

1.  To let you know which patients may require more attention paid to communication.

2.  To identify patients who may benefit from referral to local literacy agency.

Literacy Assessment Tools

REALM is the Rapid Estimate of Adult Literacy in Medicine. (sample test)

TOHFLA is the Test of Functional Health Literacy in Adults. (more information about the Robert Wood Johnson grant)

The Newest Vital Sign is a bilingual (English and Spanish) screening tool that identifies patients at risk for low health literacy. The tool can be administered in a clinical setting in just three minutes. The test result provides information about the patient that will allow providers to appropriately adapt their communication practices in an effort to achieve better health outcomes.This tool is free and easily available through the Pfizer Clear Health Communication Initiative.  That site also provides information on the development and validation of the tool.


Observation--What to Look/Listen For

There are several web sites which describe the types of behaviors which could signal low ability to read -- behaviors you can observe in a typical encounter, without any formal testing. In addition to Pfizer's Clear Health Communication site listed above, the Florida ABE Practitioners' Task Force Committee provides this useful site: "If your patient can't read".

Other signs to look for include:

  • Patients may ask to take paperwork home to complete.
  • Patients may say that they forgot their glasses at home.
  • Patients may always bring a friend or family member to appointments to complete paperwork.

If you are aware of other signs, please add them to the Comments.

Health Literacy for Everyone

Some well-developed approaches to health literacy do not necessarily require formal identification of persons with low literacy. On the sites listed below, you will find information on identifying persons with low literacy and tools to assist them, but you will also find discussions of how health information can be confusing for anyone.  Understanding health information is everyone's right; improving clear health communication is everyone's responsibility. Adopting a "clear" or "plain" language approach has wide applicability.

The Pfizer Clear Communication Initiative       

Ask Me 3

Plain Language

Clear & Simple: Developing Effective Print Materials for Low-Literate Readers

The Single Item Literacy Screener

One tool has been shown to perform moderately well in identifying patients who should be futher assessed.   Morris, N. S., C. D. MacLean, et al. (2006). "The Single Item Literacy Screener: evaluation of a brief instrument to identify limited reading ability." BMC Family Practice 7: 21, available at


Michigan Health Literacy Awareness Training Program

"This project has been funded in whole or in part with Federal funds from the National Library of Medicine, National Institutes of Health, Department of Health and Human Services, under Contract No. N01-LM-6-3503 with the University of Illinois at Chicago.”