Health Literacy Tool Shed

This website includes tools (measures, instruments and items) that:

• Measure an individual’s health literacy, or an organization’s ability to facilitate 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. Access and costs may vary as mandated by the investigator(s) or publisher. The Tool Shed is not responsible for individuals or organizations that charge for the use of health literacy tools or if rates have changed since being posted on this site.

The number of available tools to assess an individual’s health literacy has increased during the past decade. There are hundreds of 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 [link to contact use 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.

Modes of administration in validation study
How the validation study was administered (e.g., computer-based, face-to-face, paper and pencil, phone-based or mailed survey)
 

Categorical scoring (yes/no)
If the measure uses categories (e.g., low, medium or high) to categorize responses

Criterion validity: Concurrent
The extent to which the results from this tool correspond to results from other health literacy assessments done at the same time (i.e., how similar the results are)

Criterion validity: Predictive
The extent to which the results from this tool are associated with an independent defined outcome (i.e., how well the results can predict an outcome assessed at a later time)

Health literacy domains measured
Sub-categories of health literacy assessed by the measure (e.g., Prose: pronunciation, Prose: Comprehension, Document, Numeracy, Communication: Speaker, Communication: Listener, Information seeking: Interactive media navigation, Information seeking: Document or Application/function)

Measurement style
Whether the instrument items are designed in the style of TOFHLA (modified-Cloze test items in which a person selects the most logical word from a list of options to complete a sentence) or in the style of REALM (word pronunciation)
 

Objectively scored or self-reported assessment
Objectively scored measures assess demonstrated performance; self-reported measures capture subjective self-assessment
 

Reliability: Cronbach’s alpha
The extent to which there is internal consistency among the test items, expressed with an alpha
 

Reliability: Test-retest correlation
If applicable, percentage comparison between scores on measure from the initial to repeat administration
 

Sample size in validation study
Number of participants in validation study
 

Validation sample: Ethnicity
Percent Hispanic participants in validation study
 

Validation sample: Race
Percent white, Black and Asian participants in validation study. Note: in some instances, authors have not distinguished between Race and Ethnicity

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 literacy’s 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.’

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