A database of health literacy measures

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Modern approach for tool development (i.e., IRT or Rasch)
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This tool may not display all health literacy measures. Read more about the Tool Shed and how measures were selected.

Measure Name

Main Article Reference

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Corresponding Author Information

Description of Measure

Describe the measure, not the research study. Do not include a list of items or refer to related measures.


Choose "No" if the measure is available free of charge.

About This Measure

Specify whether the measure is in the style of TOFHLA (modified-Cloze) or REALM (word pronunciation).

Measures that assess demonstrated performance are considered to be objectively scored; measures capturing subjective self-assessment are considered to be self-reported.

Categorical scoring

Indicate "Yes" if the measure uses categories (e.g., low, medium, high) to categorize responses.

List each category separately. Include a numerical score and description, as applicable.

Health literacy domains measured

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Specific contexts

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Use commas to list multiple contexts.

About the Validation of This Measure

If the measure is validated in multiple languages, submit a separate measure entry for each one.

    Modern approach for tool development
    Validation sample population age

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    Validation sample: Race
      Validation sample: Ethnicity
        Modes of administration in validation study

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        Indicate the extent to which the results of this tool are similar to performance on other measures administered concurrently.

        Indicate the extent to which the results of this tool are related to an independent phenomenon.

        Indicate the percentage comparison between scores on the measure from the initial to repeat administration.

        Indicate the measure of internal consistency.

        Additional Submission Information

        Include additional information about the measure, not mentioned in previous fields.

        Add links to additional articles
        Upload additional article files



        Domains assessed:

        Specific context:

        Validation sample population age:

        Modes of administration in validation study:


        Number of items:

        Sample size in validation study:

        Approximate administration time in validation study (minutes):

        Language of validated version:

        Modern approach for tool development:

        Main article reference

        View reference

        Corresponding author

        Email: email address



        Year measure first published:


        Download admininistration instructions:

        About This Measure

        Measure style:


        Time cut-off:

        Categorical scoring:

        Scoring categories:

        About the Validation of this Measure

        Country where validated:

        Validation sample: Race:

        Validation sample: Ethnicity:

        Content validity:

        Concurrent criterion validity:

        Predictive criterion validity:

        Reliability: Test-retest correlation:

        Reliability: Cronbach's alpha:

        Reliability notes:

        Validity notes:

        Download additional articles

        We would love your feedback on this measure.

        Please send your comments or questions to the Tool Shed.

        The Health Literacy Tool Shed Glossary

        The Health Literacy Tool Shed Glossary includes vocabulary and terminology used to talk about features and aspects of the Health Literacy Tool Shed.

        Modes of administration in validation study
        How the validation study was administered (e.g., computer-based, face-to-face, paper and pencil, phone-based, mailed survey)
        Categorical scoring (yes/no)
        If the measure uses categories (e.g., low, medium, 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, 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, Asian participants in validation study. Note: in some instances, authors have not distinguished between Race and Ethnicity.

        Thank you!

        Your Health Literacy Tool Shed submission
        will be reviewed shortly

        About the Health Literacy Tool Shed

        Welcome to the Health Literacy Tool Shed! This website helps you:

        1. Learn about health literacy measurement tools
        2. Find tools that meet your needs

        Inclusion Criteria

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

        1. Measure an individual’s health literacy, or an organization’s ability to facilitate health literacy.
        2. 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.1

        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.

        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:

        1. 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.
        2. 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.
        3. 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:

        1. Aligning health literacy measurement with theory and conceptual models
        2. Developing methods of objective measurement that approximate the convenience of self-report measures
        3. Conducting comparative assessment of self-reported and objective measures

        About the Health Literacy Tool Shed Team

        The Health Literacy Tool Shed was developed in collaboration with: CommunicateHealth, Boston University, and RTI International. Funding was provided by the National Institutes of Health’s National Library of Medicine.

        The Tool Shed is maintained by Tufts Medicine | Tufts Medical Center | Center for Health Literacy Research & Practice.

        About Health Literacy

        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). Health literacy for many years was 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).

        More recent definitions focus on specific skills needed to navigate health information and systems and on the attributes of health organizations and systems to enable understanding and action (U.S. Department of Health and Human Services, 2020):

        1. Personal health literacy: the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.
        2. Organizational health literacy: the degree to which organizations equitably enable individuals to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.

        Recommended References

        NIH Office of the Director — Clear Communication — Health Literacy
        This page provides a resource library of NIH and HHS health literacy research, resources, training, and toolkits.
        NIH National Cancer Institute Behavioral Research Program (BRP) — 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.
        HHS Office of Disease Prevention and Health Promotion – Healthy People 2030 Initiative
        Learn about health literacy as an overarching goal for improving the health and well-being of a nation and the process for developing an expanded definition.
        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.

        1 Access to the instruments 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.