Assessing Health Literacy

Magnifying glass over evlaluation report

Limited health literacy is common but can be hard to recognize. Experts recommend using health literacy universal precautions by always presenting health information to patients and their families in a clear and easy manner. The precautions also stress the importance of providing a shame-free environment. These precautions aim to:

  • Simplify communication and confirm comprehension to minimize miscommunication
  • Make the office environment and health care system easier to navigate
  • Support patients’ efforts to improve their health

Some health literacy instruments are best suited for research. Others are preferred in a clinical setting, as they can be administered quickly. The resources and tools below can help you identify which assessment tools will meet your needs.

For more information on universal precautions, see our page on Health Literacy Universal Precautions Toolkit.

Health Literacy Tool Shed

The Health Literacy Tool Shed by Boston University is an online database of health literacy measures. These measures, including their psychometric properties, are based on a review of the peer-reviewed literature. You can find health literacy measurement tools to meet your needs.

Select clinical assessments

  • Newest Vital Sign: NVS is a valid and reliable screening tool available in English and Spanish that identifies patients at risk for low health literacy. It is easy and quick to administer, requiring just three minutes.
  • Single Item Literacy Screener: SILS is a simple instrument designed to identify patients with limited reading ability who need help reading health-related materials. The SILS performs moderately well at ruling out limited reading ability in adults and allows providers to target additional assessment of health literacy skills to those most in need. To obtain a copy, contact the corresponding author.

Select research assessments

  • Rapid Assessment of Adult Literacy in Medicine: REALM is a screening tool designed to measure adults’ ability to read common medical words or lay terms that correspond to anatomy or illnesses. As a word recognition test, the REALM does not assess comprehension. However, it is highly correlated with other tests of comprehension. It takes approximately 3 minutes to administer and score. To obtain a copy: Contact Dr. Terry C. Davis at
  • Rapid Assessment of Adult Literacy in Medicine-Revised: REALM-R is a shortened version of the REALM, which is used to help identify literacy levels of adult patients. It consists of 8 items, and is used to measure how well individuals can read words they will encounter in a medical setting.  To obtain a copy: Contact Dr. Terry C. Davis at
  • Short Assessment of Health Literacy for Spanish-speaking Adults: SAHLSA consists of a word-recognition section, designed after the REALM, as well as a comprehension test that employs multiple choice questions. It was designed to assess the health literacy for adults whose native language is Spanish. To obtain a copy: Contact Dr. Shoou-Yih D. Lee at 
  • Test of Functional Health Literacy in Adults: TOFHLA consists of reading comprehension and numeracy sections. The former is composed of 50 questions, the latter of 17 items. The entire test usually takes up to 22 minutes to administer. The reading passages and numeracy question are taken from common medical scenarios. The s-TOFHLA is a truncated version that only uses questions from the reading comprehension subsection of the full test. There are 36 items that are administered in 7 minutes. The scoring categorizes respondents into inadequate, marginal or adequate levels of health literacy. Obtain a copy of the TOFHLA (Test of Functional Health Literacy in Adults) from the Health Literacy Tool Shed.
Last modified: 11/04/21