Welcome to the Health Literacy Tool Shed! This website helps you:
- Learn about health literacy measurement tools
- Find tools that meet your needs
This website includes tools (measures, instruments, and items) that:
- Measure an individual’s health literacy.
- Are published in peer-reviewed journals — the published articles describe the measure and its development process, along with the report validation procedures that include at least 100 participants.
We did not exclude tools on the basis of accessibility, so some tools may require payment or author permission.
The number of available tools to assess an individual’s health literacy has increased during the past decade. There are more than 100 tools available on this site, and we review the Tool Shed quarterly so we can continue to add measures that meet our criteria. Please let us know if you have suggestions to improve the Tool Shed, such as adding tools or more information on the listed measures. To make a suggestion, you can use the Contact Us web form.
Michael Paasche-Orlow, MD, MA, MPH, the lead academic partner for this project, will incorporate your suggestions in future site updates.
Note: Some of the health literacy tools that are not included assess the complexity of the health care system, provider communication skills, or other facets of organizations or materials. We hope to include tools of this nature in the future.
Current Limitations and Considerations in Tool Selection
Instrument validation is an ongoing process. The Tool Shed includes the most common type of validation information available in research published to date. However, before selecting a tool, we suggest you contact the author(s) of the tool (identified in the Tool Shed), or read the full paper and contact the corresponding author.
Authors: If your contact information is inaccurate or is not listed, please send us your current contact information so others can reach out to you. This helps everyone learn from and expand on your work.
When selecting a tool for your project, please keep these limitations in mind:
- Despite the overall large number of tools, there may be only a few instruments to assess some of health literacys conceptual domains. Similarly, some health literacy domains are assessed by a few (or sometimes only one) item.
- The validation evidence presented for multiple tools focuses on concurrent validity, which is commonly reported in journals. Construct validity is less frequently reported. The prominence of a few measures as the basis of concurrent validity (i.e., TOFHLA and REALM) has led to something of an interdependent validation churn.
- While tools (measures) based upon self-reports are easier to administer, they lack firm empirical grounding. For example, some participants do not have accurate insight about their own skill level. Accordingly, user caution is suggested when using such tools to assess individual care or services. Also, while contemporary test item and scale development methods remedy some of the problems inherent in classical test theory, only a small but growing number of tools are based on these methods. To view these tools, please filter the list by Modern Approach for Tool Development.
Opportunities for Future Research
In developing the Tool Shed, we found gaps within some health literacy measures. We suggest future researchers close these gaps by:
- Aligning health literacy measurement with theory and conceptual models
- Developing methods of objective measurement that approximate the convenience of self-report measures
- Conducting comparative assessment of self-reported and objective measures
About the Health Literacy Tool Shed Team
This project is a collaboration among:
- CommunicateHealth, Inc.
- Boston University (Lead contact: Michael Paasche-Orlow, MD, MA, MPH)
- RTI International (Lead contact: Lauren McCormack, PhD, MSPH)
Funding is provided by the National Institutes of Healths National Library of Medicine (Lead contact: Robert A. Logan, PhD).
About Health Literacy
In the U.S., health literacy is often defined as "the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions" (Health Literacy: A Prescription to End Confusion, Institute of Medicine, 2004). However, the field of health literacy is evolving, and a number of different definitions of health literacy are currently in use (Berkman, et al., 2010; Sorenson, et al., 2012).
More recent definitions focus on specific skills needed to navigate the health care system and on the importance of clear communication between health care providers and their patients. Health care providers and patients both play important roles in health literacy, but most measures focus on an individual’s health literacy level. More recently, the Vanderbilt Center for Effective Health Communication has published an assessment process for measuring health literacy at the organizational level.
- NIH Office of Communications and Public Liaison (OCPL) — Clear Communication
- This page provides information on NIH communication initiatives, including a resource library of health literacy research and NIH educational products.
- NIH Office of Behavioral and Social Sciences Research (OBSSR) — Health Literacy
- Learn more about existing health literacy research supported by NIH, as well as funding opportunities and topics of interest for future research.
- HHS Office of Disease Prevention and Health Promotion — Health Literacy Online
- Use this research-based guide to learn how to design health websites and other digital health information tools for all users, including those with limited literacy or health literacy skills.
- National Library of Medicine — Medline Plus: Health Literacy
- About 9 out of 10 American adults have some problems with health literacy. This page provides links to consumer resources, multimedia, and research information.
- National Library of Medicine — Health Services and Sciences Research Resources (HSRR)
- This searchable database provides information about research datasets, instruments/indices, and software for use in health services research, the behavioral and social sciences, and public health.
- National Library of Medicine — PubMed Health Literacy Search
- PubMed provides a curated gateway to search health literacy literature, as well as a library of links to relevant resources for health literacy research.
- National Network of Libraries of Medicine: Health Literacy
- This page addresses key health literacy topics, including the economic impact of low health literacy, initiatives to improve patient communication, and the role of librarians in consumer health initiatives.
- Agency for Healthcare Research & Quality — Literacy and Health Outcomes
- This page summarizes the results of a systematic review outlining the relationship between health literacy and health outcomes, as well as interventions to mitigate the effects of low health literacy on health outcomes.
- Agency for Healthcare Research & Quality — Health Literacy Universal Precautions Toolkit, 2nd edition
- This toolkit can help primary health care practices reduce the complexity of health care, increase patient understanding of health information, and enhance support for patients at all health literacy levels.
- Centers for Disease Control & Prevention (CDC) — Health Literacy
- This page provides information and tools to improve health literacy and public health for organizations that interact and communicate with people about health.
- Journal of the American Medical Association (JAMA) — Patient Page: Health Literacy
- This page provides tips for patients on self-advocacy at doctor visits and on identifying reliable health information online.
- Berkman, N.D., Davis, T.C., & McCormack, L. (2010). Health literacy: What is it? Journal of Health Communication, 15(S2), 9-19.
- Sorensen, K., Broucke S.V., Fullam, J., Doyle, G., Pelikan J., Slonska, A., & Brand, H., HLS-EU Consortium Health Literacy Project European (2012).
- Health literacy and public health: A systematic review and integration of definitions and models. BMC Public Health, 12:80, doi:10:1186/1471-2458-12-80.