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Annotated Bibliography

Updated February 2010

 

Topics on this page

Articles

  • Baker DW, Wolf MS, Feinglass J, Thompson J, Gazmararian JA, Huang J. “Health literacy and mortality among elderly persons.” Archives of Internal Medicine. 2007 Jul 23;167(14):1503-9A.

    The authors wanted to determine “whether low health literacy levels independently predict overall and cause-specific mortality.” Understanding that those with low health literacy have low health knowledge, self-management of chronic disease, and use of preventive services, the authors discovered that reading fluency “independently predicts all-cause mortality and cardiovascular death among community-dwelling elderly persons” (article abstract).

  • Bennett IM, Chen J, Soroui JS, White S. “The contribution of health literacy to disparities in self-rated health status and preventive health behaviors in older adults.” Annals of Family Medicine. 2009; 7: 204-11.

  • Health Literacy Innovations:understanding health literacy/Health literacy
    http://www.healthliteracyinnovations.com/information/

  • Houts PS, Doak CC, Doak LG, Loscalzo MJ. “The role of pictures in improving health communication: a review of research on attention, comprehension, recall, and adherence." Patient Education and Counseling. 2006 May; 61(2):173-90.

    The goal of this article was to assess the effects of pictures on health communications. The authors found that “pictures closely linked to written or spoken text can, when compared to text alone, markedly increase attention to and recall of health education information. All patients can benefit, but patients with low literacy skills are especially likely to gain. Patients with very low literacy skills can be helped by spoken directions plus pictures to take home as reminders, or by pictures plus very simply worded captions” (article abstract).

  • Osborne, Helen. A compilation of health literacy articles. Health Literacy Consulting: Articles. http://www.healthliteracy.com/articles.asp

  • Safeer, Richard S. and Jann Keenan. “Health Literacy: The Gap Between Physicians and Patients.” American Family Physician. 2005 Aug 1; 72(3): 463-468. http://www.aafp.org/afp/2005/0801/p463.html

    Arguing that inadequate health literacy can result in “difficulty accessing health care, following instructions from a physician, and taking medication properly,” this article offers suggestions to health professionals on how to help patients who struggle with low literacy (article abstract).

  • Vernon, John A (lead author). Low Health Literacy Implication for National Health Policy
    http://www.npsf.org/askme3/pdfs/Case_Report_10_07.pdf

Booklets and Brochures Available on the Web

  • American Medical Association. Health Literacy and patient safety: Help patients understand. 2nd edition. May 2007. http://www.ama-assn.org/ama1/pub/upload/mm/367/healthlitclinicians.pdf

    This booklet “reviews the problem of health literacy, its consequences for the health care system, and the likelihood that a clinician’s practice includes patients with limited literacy” (p. 7). The booklet also offers practical suggestions to clinicians and concludes with case discussions.

  • Barrett SE, Puryear JS, Westpheling K. Health Literacy Practices in Primary Care Settings: Examples from the Field. January 2008. http://www.commonwealthfund.org/Content/Publications/Fund-Reports/2008/Jan/Health-Literacy-Practices-in-Primary-Care-Settings--Examples-From-the-Field.aspx

  • Berkman ND, DeWalt DA, Pignone MP, Sheridan SL, Lohr KN, Lux L, Sutton SF, Swinson T, Bonito AJ. Literacy and Health Outcomes. Evidence Report/Technology Assessment No. 87. Rockville, MD: Agency for Healthcare Research and Quality. January 2004. http://www.ahrq.gov/downloads/pub/evidence/pdf/literacy/literacy.pdf

    This report on literacy and health outcomes was requested by the American Medical Association and funded by the AHRQ. The report addresses two key questions:
    1: Are literacy skills related to: (a) Use of health care services? (b) Health outcomes? (c) Costs of health care? (d) Disparities in health outcomes or health care service use according to race, ethnicity, culture, or age?
    2: For individuals with low literacy skills, what are effective interventions to: (a) Improve use of health care services? (b) Improve health outcomes? (c) Affect the costs of health care? (d) Improve health outcomes and/or health care service use among different racial, ethnic, cultural, or age groups? (p. 5)

  • Center for Health Care Strategies, Inc. Health Literacy Fact Sheets, 1-9. http://www.chcs.org/usr_doc/Health_Literacy_Fact_Sheets.pdf

    This series of nine fact sheets was created for those who are designing patient education materials for consumers with low health literacy skills. The sheets define health literacy, describe its impact on health outcomes, provide strategies to prepare appropriate educational materials to assist low-literate consumers, and provide resources for additional health literacy information and publications.

  • Crea, Kathleen. Health Literacy Sources: A Guide for Health Professionals. Jan. 2006. http://library.uchc.edu/eduoff/healthliteracy.pdf

    Kathleen Crea compiled a list of websites of health literacy resources for health professionals and patients and families.

  • Federal Drug Administration (FDA): Quick Information for Your Health.
    http://www.fda.gov/ForConsumers/default.htm

    The FDA provides easy-to-read health brochures in English and Spanish. Brochures are available in both HTML and PDF formats and topics include keeping food safe, diabetes, losing weight safely, giving medication, etc.

  • Institute of Medicine. Health Literacy, eHealth, and Communication: Putting the Consumer First. Workshop Summary. http://www.iom.edu/Reports/2009/Health-Literacy-eHealth-and-Communication-Putting-the-Consumer-First-Workshop-Summary.aspx

  • Jacobson KL, Gazmararian JA, Kripalani S, McMorris KJ, Blake SC, Brach C. Is Our Pharmacy Meeting Patients’ Needs? A Pharmacy Health Literacy Assessment Tool User’s Guide. (Prepared under contract No. 290-00-0011 T07.) AHRQ Publication No.07-0051. Rockville, MD: Agency for Healthcare Research and Quality. October 2007. http://www.ahrq.gov/QUAL/pharmlit/pharmlit.pdf

    This assessment tool was designed for use in a specific environment—the outpatient pharmacies of large, urban, public hospitals that primarily serve a minority population with a high incidence of chronic disease and limited health literacy skills. Users wishing to assess a different type of organization or pharmacy environment may use this assessment tool as a template and add, omit, and adapt items as appropriate.

  • The Joint Commission. “What did the Doctor say?:” Improving health literacy to protect patient safety. 2007. http://www.jointcommission.org/NR/rdonlyres/D5248B2E-E7E6-4121-8874-99C7B4888301/0/improving_health_literacy.pdf

    This booklet is the culmination of a roundtable discussion addressing health literacy. Believing that many people play a role in improving health literacy, the roundtable discussion offers methods for tackling the underlying problems of health literacy, the impact of low health literacy and patient safety, and the current state of health care communication.

  • MAXIMUS and CFK National Program Office. The Health Literacy Style Manual: covering kids and families. 2005. http://coveringkidsandfamilies.org/resources/docs/stylemanual.pdf

    This booklet has suggestions for developing and improving print materials related to government programs. Strategies include writing and formatting specifically for clients, many of whom have limited literacy skills.

  • Medical Library Association. Deciphering Medspeak Brochures. July 2007. http://www.mlanet.org/resources/medspeak/index.html. Brochures.

    These brochures help consumers translate "medspeak," the specialized language of health professionals. Written in English and Spanish, these brochures address HIV/AIDS, stroke, eye disease, heart disease, diabetes, and breast cancer.

  • National Center for Education Statistics. The Health Literacy of America’s Adults: Results from the 2003 National Assessment of Adult Literacy. September 2006. http://nces.ed.gov/pubsearch/pubsinfo.asp?pubid=2006483.

    The Health Literacy of America’s Adults is the first release of the National Assessment of Adult Literacy (NAAL) health literacy results. The results are based on assessment tasks designed specifically to measure the health literacy of adults living in the United States. Health literacy was reported using four performance levels: Below Basic, Basic, Intermediate, and Proficient. The majority of adults (53 percent) had Intermediate health literacy. About 22 percent had Basic and 14 percent had Below Basic health literacy. Relationships between health literacy and background variables (such as educational attainment, age, race/ethnicity, where adults get information about health issues, and health insurance coverage) were also examined and reported.

  • U.S. Department of Health and Human Services Office of Disease Prevention and Health Promotion. Quick Guide to Health Literacy. http://www.health.gov/communication/literacy/quickguide/Quickguide.pdf

    This guide contains a basic overview of key health literacy concepts and techniques for improving health literacy through communication, navigation, knowledge-building, and advocacy. It provides the information needed to become an effective advocate for improved health literacy.

Books

  • Committee on Health Literacy Board on Neuroscience and Behavioral Health. Health Literacy: A Prescription to End Confusion. Washington, D.C.: The National Academies Press, 2004. http://www.iom.edu/?id=19723&redirect=0

    Taking social, cultural, and educational issues into consideration, the Committee on Health Literacy demonstrates the problems of health literacy, its origins, consequences, and solutions. The report defines health literacy 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” (p. 2). The committee also suggests a strategy to improve health literacy in the United States.

  • The Medical Library Association guide to health literacy / edited by Marge Kars, Lynda M. Baker, and Feleta L. Wilson. Published/Created: New York : Neal-Schuman Publishers, c2008. Description: xiv, 314 p. : ill. ; 23 cm.

    This seminal work is densely packed with thorough literature reviews but also many practical suggestions. A valuable reference work giving medical librarians and other health professionals the state of the research in this field. Case studies illustrate best practices, including ways to partner with health care providers and other organizations to create and fund health literacy programming in your community and make your library a vital player in this increasingly important information needs area.

  • Photonovels Through Critical Pedagogy: A Consciousness Raising Health Literacy Project With ESL Speaking Immigrant Women Laura Nimmon  VDM Verlag, Germany 2009

    The author a PhD student at the University of British Columbia where she works towards improving the health literacy levels of marginalized groups. This study was awarded a Canadian Population and Public Health Masters Research Award. To post your photonovel go to http://www.photonovela.com

  • Toward Health Equity and Patient-Centeredness: Integrating Health Literacy, Disparities Reduction, and Quality Improvement: Workshop Summary, by Roundtable on Health Disparities, Forum on the Science of Health Care Quality Improvement and Implementation, Roundtable on Health Literacy, and Institute of Medicine (Paperback - Feb. 25, 2009) http://www.nap.edu/catalog.php?record_id=12502

  • Osborne, Helen. Health Literacy from A to Z: Practical Ways to Communicate Your Health Message. Sudbury, Massachusetts: Jones and Bartlett Publishers, 2005.

    Osborne argues that health providers face two problems: “recognizing when patients do not understand written words . . . [and] knowing how to communicate through words, pictures, computers screens, and other visual media” (p. xiii). She focuses on helping solve these two issues and providing practical suggestions to health providers and others who communicate health information. Designed as a “tool of action,” Each chapter provides the reader with starting points, strategies, ideas, solutions, and sources to learn more about health literacy. Chapters include consumer health libraries, hearing and communicating with people who are deaf and hard of hearing, language and culture, pictographs, plain language, signs, stories, website design, and word choice.

  • Zarcadoolas, Christina, Andrew F. Pleasant, and David S. Greer. Advancing Health Literacy: A Framework for Understanding and Action. San Francisco, California: Jossey-Bass, 2006.

    Acknowledging the consequences of low health literacy and the complexity of medicine and health, the goal of this book is to answer the following question: “How can this model of health literacy and the literacy principles it outlines improve the daily performance of health professionals and health programs in their efforts to advance individual and public health literacy?” (p. xvi). The authors define health literacy as “the ability to understand, evaluate, and act on spoken, written, and visual health information to reduce risk and live a healthier life” (p. xvi).

Culture, Diversity, Language, and working with minority communities

Presentations

  • Agency for Healthcare and Research Quality (AHRQ) Quick Tips—When Talking with Your Doctor
    http://www.ahrq.gov/consumer/quicktips/doctalk.htm and research has shown that patients who have good relationships with their doctors tend to be more satisfied with their care—and to have better results. The above sites discuss tips to help consumers and their doctor become partners in improving health care. The Video on Communicating with Your Doctor can be found at http://www.ahrq.gov/consumer/commdrvid.htm.

  • Centers for Disease Control and Prevention

    Health Literacy for Public Health Professionals is a training program introducing participants to the fundamentals of health literacy and demonstrating the importance of health literacy within public health practice. The content spurs students to think about the significance of health literacy in the work done as public health professionals.  It provides practical steps to apply the principles and strategies of health literacy in your daily activities.- http://www.cdc.gov/healthmarketing/healthliteracy/training/

  • Health Literacy Podcasts: http://www.healthliteracyoutloud.com/

    This site contains podcast interviews with those in-the-know about health literacy. Examples include health literacy and chronic disease, hospital interest in health literacy, and use humor and graphics in conveying health information.

  • McCormick, Don. Plain & Simple: Health Communication Workshop. Iowa Department of Public Health.
    http://www.idph.state.ia.us/health_literacy/common/pdf/psworkshop.pdf

    The objectives of this presentation include learning about health literacy, plain language, and suggestions for improving sample documents.

  • The Michigan Health Literacy Awareness Training Program

    MHLATP is a collaborative project between the University of Michigan Health Sciences Libraries and Washtenaw Literacy. Their goal is to raise awareness among health professionals of the issue of low literacy and poor health literacy among their patients, and to provide communication techniques and resources to improve patient care. http://www.slideshare.net/umhealthscienceslibraries/health-literacy-2361414

  • National Institute of Literacy. National Assessment of Adult Literacy. http://www.nifl.gov/webcasts/NAAL2003.html

    Sponsored by the National Center for Education Statistics, the 2003 National Assessment of Adult Literacy (NAAL) is a nationally representative assessment of English literacy among American adults age 16 and older. Webcasts are available on such topics as addressing low literacy and defining the goals and research behind the National Assessment of Adult Literacy.

  • Proceedings of the Surgeon General's Workshop on Improving Health Literacy. September 7, 2006, National Institutes of Health, Bethesda, MD
    http://www.surgeongeneral.gov/topics/healthliteracy/toc.html

    On September 7, 2006, Acting Surgeon General Kenneth Moritsugu held a Surgeon General's Workshop on Improving Health Literacy. The goal of the workshop was to present the state of the science in the field of health literacy from a variety of perspectives, including those of health care organizations and providers, the research community, and educators. During the course of the one-day workshop, participants identified the public health consequences of limited health literacy and established an evidence base for taking action.

  • Stableford, Sue. Write It Easy to Read: Vibrant Plain Language for Clear Health Communication. Biddleford, Maine: AHEC Health Literacy Center, 2004. Presentation. http://www.clearlanguagegroup.com

    Stableford focuses on the need for “plain language” and defines “limited health literacy” and “easy-to-read.” She argues that health literacy is critical to lowering health disparities and to increasing safety and quality care, chronic disease prevention, and bioterrorism preparedness. Using real world examples, she helps the student understand the importance of writing clearly, using “plain language,” and utilizing layout and design for reading ease. To contact Sue Stableford, email sstableford@une.edu or call 207-283-0170 ext 2205.

  • World Education. Health Literacy: New Field, New Opportunities. http://www.healthliteracy.worlded.org/docs/tutorial/SWF/flashcheck/main.htm

    This online tutorial is designed for health and literacy educators interested in getting more involved in health literacy work. Users learn about the challenges associated with low health literacy, meet some of the new health literacy practitioners in the field, hear about successful strategies and practices, and apply what they have learned to a challenging health literacy scenario. The tutorial was developed by World Education and funded by the National Network of Libraries of Medicine New England Region (NN/NL NER).

Toolkits

  • Agency for Healthcare Research and Quality, Effective Health Care Program  (2010)
    http://effectivehealthcare.ahrq.gov

    AHRQ is the lead Federal agency charged with improving the quality, safety, efficiency, and effectiveness of health care for all Americans. As one of 12 agencies within the Department of Health and Human Services, AHRQ supports health services research that will improve the quality of health care and promote evidence-based decision making. AHRQ’s Effective Health Care Program reviews and synthesizes published and unpublished scientific evidence, generates new scientific evidence and analytic tools, and compiles research findings that are synthesized and/or generated and translates them into useful formats for clinicians, consumers, and policy makers.  Consumer guides are written in plain language and summarize research reviews, which are also available. 

  • Agency for Healthcare Research and Quality, Strategies to Improve Communication Between Pharmacy Staff and Patients (2007): http://www.ahrq.gov/qual/pharmlit/pharmtrain.htm

    This training program is designed to introduce pharmacists to the problem of low health literacy in patient populations and to identify the implications of this problem for the delivery of health care services. The program also explains techniques that pharmacy staff members can use to improve communication with patients who may have limited health literacy skills.

  • American Medical Association, Health Literacy Kit (2007)
    http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/medical-student-section/community-service/health-literacy.shtml

    Using a multimedia approach focused on health professionals, the American Medical Association (AMA) uses real-life scenarios and statistics to address the problems of health literacy. They define health literacy as “the ability to read, understand, and act on medical information” (DVD). Understanding the need for more research on health literacy, the AMA gives several ideas to enable health professionals to help their patients understand the health information given. These suggestions include offering an open and shame free environment, an attitude of helpfulness, and a place where patients feel safe. The AMA Foundation Health Literacy Kit costs $35 and includes a manual, Continuing Medical Education credit, and two videos/DVDs, Low Health Literacy: You Can't Tell By Looking and Health Literacy: Help Your Patients Understand. Both videos can be viewed free of charge from: http://www.ama-assn.org/ama/no-index/about-ama/8035.shtml

  • Hablamos Juntos, It’s More Than Words: Developing Useful Health Care Materials for Spanish Speaking Patients: http://hablamosjuntos.org/pdf_files/HJMoreThanWords.pdf

    Hablamos Juntos is a project funded by the Robert Wood Johnson Foundation, and administered by the UCSF Fresno Center for Medical Education & Research. Its mission is to improve communication between health care providers and their patients with limited English proficiency.

  • Hablamos Juntos, Universal Symbols for Health Care
    http://hablamosjuntos.org/signage/default.index.asp

    Using symbols for health care signage can successfully meet the wayfinding needs of patients that speak hundreds of different languages. This site is designed for health care facilities and graphic designers interested in learning about and using newly developed health care symbols for wayfinding programs.

  • Harvard School of Public Health Health Literacy Studies, Health Literacy (2007)
    http://www.hsph.harvard.edu/healthliteracy/index.html

    Harvard School of Public Health’s Health Literacy Studies focuses on communication and literacy skills and are interested in exploring the pathways from education to health outcomes. Resources include a slide presentation, video, a chart about health literacy, literature, and how to create and access print materials.

  • Medical Library Association, Health Information Literacy (2006)
    http://www.mlanet.org/resources/healthlit/index.html

    This site offers a plethora of resources for health professionals and consumers and includes links and information to fact sheets, brochures, toolkits, and project ideas for health literacy. A corresponding CD version available from the Medical Library Association (MLA) also explains the resources from MLA and outside sources. Members of MLA can read more about the Health Information Literacy Research Project at: https://service.mlanet.org/mlassa/ssaauthmain.login_page

  • National Maternal and Child Oral Health Resource Center, Bright Futures Toolbox (2009)
    http://www.mchoralhealth.org/Toolbox/index.html

    This toolbox highlights materials that advance the Bright Futures philosophy of promoting and improving the oral health of infants, children, and adolescents. The toolkit is for Health Professionals and Families concerning Oral Health.

  • Public Health Information Partners, Health Literacy: Tools for Improving Health Communications (2007)
    http://library.nymc.edu/PHInformatics/hltoolkit.cfm

    Beginning 2004, the New York Medical College, School of Public Health and Health Sciences Library created Public Health Information Partners, an academic/local partnership with health professionals in the seven counties comprising the Hudson Valley Region of New York State. This toolkit is from a conference held May 30, 2007 at New York Medical College, Valhalla, NY. The conference goal was to provide health professionals and hospital staff with an educational opportunity to develop awareness of health literacy issues and improve communication skills with individuals throughout the Hudson Valley Region of New York. This toolkit offers links to websites that promote health literacy skills.

  • Covering Kids & Families, The Health Literacy Style Manual (2005)
    http://www.coveringkidsandfamilies.org/resources/docs/stylemanual.pdf

    Covering Kids & Families (http://www.coveringkidsandfamilies.org/) is a national program supported by the Robert Wood Johnson Foundation with direction provided by the Southern Institute on Children and Families. This style manual is designed for health and human service agencies that want to create easy-to-read materials about their organizations or programs. Included are useful images of before-and-after examples.

  • Virginia Adult Learning Resource Center, Virginia Adult Education Health Literacy Toolkit (2004)
    http://www.valrc.org/

    Answering questions such as what is health literacy and what resources are available, this Toolkit is a resource to help adult education instructors and administrators better understand the problem of health literacy as it affects their learners. It is designed to support creative approaches to help learners increase health literacy as they engage in sound, productive adult literacy instruction. Information and resources are provided to educate the educator about health care in the United States and cultural issues relating to health, and to simplify creation of health lessons and curricula for teachers and programs. Many online and print resources are available.

Websites

  • Agency for Healthcare Research and Quality, Health Literacy and Cultural Competency http://www.ahrq.gov/browse/hlitix.htm

    Online resources and pathfinders relating to health literacy, cultural competency consumer decision aids, clinical information, and improving healthcare delivery. [English and Spanish]

  • Harvard School of Public Health: Clear and to the Point: Guidelines for Using Plain Language at NIH: http://www.hsph.harvard.edu/healthliteracy/how_to/clear.html

  • Health Literacy Consulting, Helping Organizations Communicate in Ways People Can Understand
    http://www.healthliteracy.com/default.asp

    Helen Osborne, the developer of this website, directs health care professionals and consumers to a variety of health literacy resources. Osborne also offers ideas on how to celebrate health literacy month.

  • National Network of Libraries of Medicine, Health Literacy
    http://nnlm.gov/outreach/consumer/hlthlit.html

    Funded by the National Library of Medicine, this website defines health literacy and lists health literacy organizations and websites.

  • MedlinePlus, Easy-to-Read
    http://www.nlm.nih.gov/medlineplus/easytoread/easytoread_a.html

    Developed by the National Institutes of Health and National Library of Medicine, MedlinePlus helps consumers find up-to-date, quality information about health topics, herbs and drugs. Information is available in English, Spanish, and Easy-to-Read versions. Also see health topic, “Talking to your doctor.”

  • National Institute on Aging, NLM, NIH, and USDHHS, NIH Senior Health
    http://nihseniorhealth.gov

    This website from the National Institute on Aging and National Library of Medicine has easy-to-read health information and videos for senior citizens.

  • Partnership for Clear Health Communication (PCHC), Ask Me 3
    http://www.npsf.org/askme3/

    This website helps consumers and providers learn how to communicate effectively with each other, address the problem of health literacy, and provide a solution to end health literacy. Ask Me 3 helps consumers ask three questions to their provider about their health: 1) What is my main problem? 2) What do I need to do? 3) Why is this important for me? This website, with printable materials, helps consumers.

  • Partnership for Clear Health Communication (PCHC), Partnership for Clear Health Communication
    http://www.npsf.org/pchc/

    The Partnership for Clear Health Communication (PCHC) is a national, nonprofit coalition of organizations working to build awareness and advance solutions to improve health literacy and positively impact health outcomes.

  • Popular topics: Improving Health Literacy
    http://www.plainlanguage.gov/populartopics/health_literacy/index.cfm

    PLAIN, the Plain Language Action and Information Network, sponsors this site and its goal is to promote the use of “plain language” for all government communications. Plain language (also called Plain English) is communication an audience can understand the first time they read or hear it.

  • World Education, Health & Literacy Special Collection: Tools and Resources for Health Literacy Initiatives
    http://healthliteracy.worlded.org

    The Health & Literacy Special Collection is created, compiled, and updated by World Education with support from the National Institute for Literacy (NIFL) and their LINCS Project. Information includes health lessons, easy-to-read material, multilingual health information, and health literacy research.

Useful Examples

  • American College of Physicians Foundation, ACPF Diabetes Guide: How We Did It and Why It Works (2007)
    http://www.acpfoundation.org/files/hcc2007/davis07.pdf

    A documentation of how ACPF created their popular Diabetes Guide (referenced below) – to aid others who are creating easy-to-read materials for patients.

  • American College of Physicians Foundation, Patient Guides, Videos and Health Tips (2007 and ongoing)
    http://acpfoundation.org/patients.htm

    ACPF has created free videos for patients on how to use various inhalers. New videos to be available soon will be on topics including how to take blood pressure, how to check feet, exercises for lower back pain and more. ACPF also offers free Health Tips pads on many health topics – English and Spanish versions can be printed online or ordered free of charge in packs of 50. Patient Guides on Living with Diabetes and Living with COPD are available in boxes of 25 or 50 for a charge plus shipping & handling. A new guide, Living with Heart Disease, will be available as of May 2010.

  • Covering Kids & Families, The Health Literacy Style Manual (2005)
    http://www.coveringkidsandfamilies.org/resources/docs/stylemanual.pdf

    Covering Kids & Families (coveringkidsandfamilies.org) is a national program supported by the Robert Wood Johnson Foundation with direction provided by the Southern Institute on Children and Families. This style manual is designed for health and human service agencies that want to create easy-to-read materials about their organizations or programs. Included are useful images of before-and-after examples.

  • National Diabetes Information Clearinghouse, Diabetes Easy-to-Read Publications
    http://diabetes.niddk.nih.gov/dm/ez.asp

    These easy-to-read materials are written in English and Spanish and are available from the National Institute of Diabetes and Digestive and Kidney Diseases. Topics include information about diabetes and how it relates to medication, physical activity, and nutrition.

  • National Institutes on Aging, Understanding Alzheimer’s Disease (2006)
    http://www.nia.nih.gov/Alzheimers/Publications/UnderstandingAD

    Developed by Alzheimer’s Disease Education and Referral Center (ADEAR), this booklet offers easy-to-read information about Alzheimer’s Disease. ADEAR also offers an easy-to-read booklet on Understanding Memory Loss.

  • Medical University of South Carolina, Hands on Health, South Carolina
    http://www.handsonhealth-sc.org

    The purpose of Hands on Health South Carolina is to give South Carolinians a place to go to learn about health and wellness in an easy-to-read format. Health problems addressed include diabetes, heart disease, cancer, asthma, stroke, and suicide.

  • READ Saskatoon, Baby and Me (Second Edition - 2006)
    http://www.readsaskatoon.com/pubs/babyme/babyme.pdf

    Developed by READ Saskatoon, this easy-to-read book divides pregnancy into 3 trimesters. Each section explains what to expect for the mother and her growing baby.

  • South Carolina DHEC, Medical University of South Carolina, and REACH 2010, My Guide to Sugar Diabetes (Third Edition – 2004)
    http://etl2.library.musc.edu/reach/materials/booklet.pdf

    Developed by the South Carolina Diabetes Prevention and Control Program, the Diabetes Initiative of South Carolina, and the Enterprise/MUSC Neighborhood Health Program in collaboration with other public health and human service agencies, this guide has easy-to-read information about Sugar Diabetes.

  • US Dept. of Health & Human Services Office on Women’s Health, Tools to Help you build a Healthier life
    http://www.womenshealth.gov/Tools/

    From womenshealth.gov and available for women, girls, and moms-to-be in English and Spanish, this page offers health tools such as calculators, charts, checklists, and quizzes.

Tests to Assess Health Literacy

  • Agency for Healthcare Research and Quality, CAHPS Item Set for Addressing Health Literacy (2010)
    http://www.cahps.ahrq.gov/cahpskit/CG/CGChooseQx4P.asp

    The Item Set for Addressing Health Literacy consists of 29 supplemental items designed for use with the CAHPS Clinician & Group Survey. (The Spanish version of the item set has an additional item about the availability of forms in Spanish.) The items address the following six topic areas: communication with doctors, communication about health problems and concerns, communication about medicines, communication about tests, communication about forms, and disease self-management. [English and Spanish] The CAHPS Item Set for Addressing Health Literacy also includes a tool developed by AHRQ and the AMA called the Health Literacy Quality Improvement Crosswalk. It pairs CAHPS Item Set questions with AMA Recommendations for healthcare worker practices that will improve the health literacy of their patients: https://www.cahps.ahrq.gov/CAHPSkit/files/1311_About_Health_Lit.pdf

  • Agency for Healthcare Research and Quality, Is our Pharmacy Meeting Patients’ Needs? [Pharmacy Health Literacy Assessment Tool – User’s Guide]
    http://www.ahrq.gov/qual/pharmlit/

    This pharmacy health literacy tool was designed to get input from three critical audiences - objective auditors, pharmacy staff, and patients. The three parts of the assessment are complementary and designed to form a comprehensive assessment. Although the assessment was designed to be used in outpatient pharmacies of large, urban, public hospitals that primarily serve a minority population, it can be adapted for use in other pharmacy and non-pharmacy environments.

  • The Newest Vital Sign: A Health Literacy Assessment Tool
    http://www.clearhealthcommunication.com/physicians-providers/newest-vital-sign.html

    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.

  • Rapid Estimate of Adult Literacy in Medicine (REALM)
    http://www.hsph.harvard.edu/healthliteracy/doakAB.pdf

    The REALM is a medical-word recognition and pronunciation test comprising 66 medical terms, arranged in order of complexity by the number of syllables and pronunciation difficulty, starting with simple one-syllable words (e.g., pill, eye) and ending with multi-syllable words (e.g., antibiotics, potassium). Patients read down the list, pronouncing aloud as many words as they can while the examiner scores the number of words pronounced correctly using standard dictionary pronunciation as the scoring standard. Scores on the REALM vary from 0 (no words pronounced correctly) to 66 (all words pronounced correctly.) The score assigns health literacy skills into 4 categories of grade-equivalent reading level: 0–18 (3rd grade), 19–44 (4th to 6th grade), 45–60 (7th to 8th grade) and 61–66 (9th grade). It can be administered and scored in under 2 minutes by personnel with minimal training, making it easy to use in clinical settings.

    There are also other versions of REALM:

    REALM-R (Revised)
    http://www.adultmeducation.com/downloads/REALMR_INSTR.pdf

    The REALM-R is a brief screening instrument used to assess an adult patient’s ability to read common medical words. It is designed to assist medical professionals in identifying patients at risk for poor literacy skills. The REALM-R is a word recognition test – not a reading comprehension instrument. Adults are asked to de-code or pronounce words. The test takes less than 2 minutes to administer and score.

    REALM-SF (Short Form)
    http://www.ahrq.gov/populations/sahlsatool.htm

    The Rapid Estimate of Adult Literacy in Medicine—Short Form (REALM-SF) is a 7-item word recognition test to provide clinicians with a valid quick assessment of patient health literacy. The REALM-SF has been validated and field tested in diverse research setting, and has excellent agreement with the 66-item REALM instrument in terms of grade-level assignments.

  • Short Assessment of Health Literacy for Spanish Adults (SAHLSA-50)
    http://www.ahrq.gov/populations/sahlsatool.htm

    The Short Assessment of Health Literacy for Spanish Adults (SAHLSA-50) is a validated health literacy assessment tool containing 50 items designed to assess a Spanish-speaking adult's ability to read and understand common medical terms. The SAHLSA was based on the Rapid Estimates of Adult Literacy in Medicine (REALM), known as the most easily administered tool for assessing health literacy in English.

  • Test of Functional Health Literacy in Adults (TOFHLA)
    http://www.peppercornbooks.com/catalog/product_info.php?products_id=2514

    The TOFHLA measures the functional literacy level of patients, using real-to-life health care materials. These materials include patient education information, prescription bottle labels, registration forms, and instructions for diagnostic tests. The TOFHLA assesses two main constructs, numeric and reading comprehension; it has a total of 67 items. The numeric scale, used to measure the ability to read and understand numbers, includes 17 items; the reading comprehension scale, used to measure the patient’s ability to read and understand health care-related passages, contains 50 items. There is also a Spanish version called TOFHLA-S. A sample sheet in English can be found at: http://www.peppercornbooks.com/catalog/pdf/tofhla_eng_12pt_websmpl.pdf

  • Wide Range Achievement Test-Revised (WRAT-4 or WRAT-IV)
    Western Psychological Services: http://portal.wpspublish.com/portal/page?_pageid=53,118660&_dad=portal&_schema=PORTAL&cmp=20_google&kw=wrat%204&gclid=CIOds57FlZ8CFZZ75QoddRVlMw

    The Fourth Edition of this classic test measures the basic academic skills of reading, spelling, and mathematical computation necessary for effective learning, communication, and thinking. The latest edition features an entirely new subtest, Sentence Comprehension, to enhance the scope of the content assessed and to meet the need for a measure of reading comprehension. It is helpful in diagnosing learning disabilities, assessing academic progress over time, evaluating achievement/ability discrepancies, checking progress in remedial programs, determining instructional needs, and assessing children whose performance is below that of their peers.
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