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The tools available from ������Ƶare the:

• Short Assessment of Health Literacy–Spanish and English
• Rapid Estimate of Adult Literacy in Medicine–Short Form
• Short Assessment of Health Literacy for Spanish Adults

These tools are free and do not require permission to use. Please credit ������Ƶas the source. (Users of the tools who publish their findings can find a link listed with each tool to the paper that describes its initial development and validation.) These tools have largely been used for research. Only the Rapid Estimate of Adult Literacy in Medicine–Short Form was developed to identify patients with limited literacy in clinical settings.

The AHRQ-supported tools are for the assessment of personal health literacy in speakers of English and Spanish, the languages most frequently spoken in the United States. Translation of these tools into another language may not produce a valid assessment of personal health literacy in the new language. Please contact AHRQ's for permission and to be put in contact with a technical expert before attempting a translation.

For additional measures of personal health literacy, go to the , funded by the U.S. National Libraries of Medicine.

Short Assessment of Health Literacy–Spanish and English (SAHL-S&E)

The Short Assessment of Health Literacy–Spanish and English (SAHL–S&E) consists of comparable tests in English and Spanish, with good reliability and validity in both languages. You present people being assessed with 18 test terms, one at a time. You ask people to read the test term aloud and choose the word closer in meaning to the test term from two options – a key word with a related meaning and a distractor word unrelated in meaning to the test term. This tests the subject’s comprehension as well as pronunciation of health-related terms. Administration of the test takes only 2-3 minutes and requires minimal training. Using laminated 4”-by-5” flash cards makes administering the test easier. Each card contains a medical test term printed in boldface on the top and the two options—i.e., the key and the distracter words —at the bottom.

SAHL–S&E validation study:
Lee S.-Y. D., Stucky B.D., Lee J. Y. et al. Short assessment of health literacy–Spanish and English: A comparable test of health literacy for Spanish and English speakers HSR 2010 August;45(4):1105–20. Pub Med ID (PMID): 20500222 [Full text available in PubMedCentral]

Contents:

SAHL-S Test Form & User’s Guide (Select for PDF [36.33 KB])
SAHL-E Test Form & User’s Guide (Select for PDF [53.04 KB])

SAHL-S Test Form

The 18 items of SAHL-S, rank-ordered according to difficulty (keys and distracters are listed in the same random order as in the field interview)

The answers can be found by selecting the SAHL-S Answer Key.

Instruction for Administering SAHL-S

Here are directions for using SAHL-S with flash cards, as described earlier. The subjects should not be shown the whole list at one time.

SAHL-E Word Sets & User's Guide

The 18 items of SAHL-S, rank-ordered according to item difficulty (keys and distracters are listed in the same random order as in the field interview).

The answers can be found by selecting the SAHL-E Answer Key.

Instructions for Administering SAHL-E

Here are directions for using SAHL-E with flash cards, as described earlier. The subjects should not be shown the whole list at one time.

Rapid Estimate of Adult Literacy in Medicine—Short Form (REALM-SF)

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 settings, and has excellent agreement with the 66-item REALM instrument in terms of grade-level assignments.

REALM-SF Validation study: Arozullah AM, Yarnold PR, Bennett CL, et al. Development and validation of a short-form, rapid estimate of adult literacy in medicine. Med Care 2007 November;45(11):1026–33. PMID: 18049342

REALM-SF Score Sheet

Select for PDF Version [179 KB]

Patient ID #: _______________    Date: _______________    Examiner Initials: ____________

Behavior   _____
Exercise   _____
Menopause   _____
Rectal   _____
Antibiotics   _____
Anemia   _____
Jaundice   _____

TOTAL SCORE   ______

Administering the REALM-SF:

Scores and Grade Equivalents for the REALM-SF

Short Assessment of Health Literacy for Spanish Adults (SAHLSA-50)

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. Administration of the test takes 3-6 minutes. 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. However, it is important to note that SAHLSA-50 results are not comparable with REALM results. Users who are interested in comparing the health literacy ability of English and Spanish speakers are advised to adopt SAHL-S&E.

SAHLSA-50 Validation Study: Lee S.-Y. D., Bender D.E., Ruiz R.E., et al. Development of an easy-to-use Spanish health literacy test. HSR 2006 Aug;41(4, Part I); 1392–412. PMID: 16899014 [Full text available in PubMedCentral]

Select for PDF Version [131.77 KB].

SAHLSA-50 Form

Scoring Key to SAHLSA-50 Form

(Correct answers are bolded)

Instructions for Administering SAHLSA-50

Administration of the test could be facilitated by using laminated 4" x 5" flash cards, with each card containing a medical term printed in boldface on the top and the two association words—i.e., the key and the distracter—at the bottom.

Directions to the Interviewer:

1. Before the test, the interviewer should say to the examinee: "Le voy a mostrar tarjetas con 3 palabras en ellas. Primero, me gustaría que usted lea la palabra arriba en voz alta. Entonces, yo leeré las dos palabras debajo a usted y me gustaría que usted me dijera cuál de las dos palabras es más similar a la palabra arriba. Si usted no sabe la respuesta, por favor diga, 'No sé'. No adivine."
2. Show the examinee the first card.
3. The interviewer should say to the examinee: "Ahora, por favor, lea la palabra arriba en voz alta."
4. The interviewer should have a clipboard with a score sheet to record the examinee's answers. The clipboard should be held such that the examinee cannot see or be distracted by the scoring procedure.
5. The interviewer will then read the key and distracter (the two words at the bottom of the card) and then say: "Cuál de las dos palabras es más similar a la palabra arriba? Si usted no sabe la respuesta, por favor diga, 'No sé'.
6. The interviewer may repeat the instructions so that the examinee feels comfortable with the procedure.
7. Continue the test with the rest of the cards.
8. A correct answer for each test item is determined by both correct pronunciation and accurate association. Each correct answer gets one point. Once the test is completed, the interviewer should tally the total points to generate the SAHLSA-50 score.
9. A score between 0 and 37 suggests the examinee has inadequate health literacy.