Health Literacy is defined in the Institute of Medicine report, Health Literacy: A Prescription to End Confusion,, 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." More recent definitions focus on specific skills needed to navigate the health care system and the importance of clear communication between health care providers and their patients. Both health care providers and patients play important roles in health literacy. The number of different definitions of health literacy demonstrate that the field is evolving. Health literacy is not simply the ability to read. It requires a complex group of reading, listening, analytical, and decision-making skills, and the ability to apply these skills to health situations. For example, it includes the ability to understand instructions on prescription drug bottles, appointment slips, medical education brochures, doctor's directions and consent forms, and the ability to negotiate complex health care systems. [National Network of Libraries of Medicine/Health Literacy http://nnlm.gov/outreach/consumer/hlthlit.html]

Maintained by: Katherine Chew chewx002@umn.edu

Last updated August 21, 2018

On this page:

Focus groups : from structured interviews to collective conversations

George Kamberelis and Greg Dimitriadis. -- Location: TC Wilson Library H61.28 .K36 2013

Guidelines : writing for adults with limited reading skills

[developed by Nancy Gaston and Patricia Daniels ; edited by Lillie Sheehan]. -- Location: TC Magrath Library Gov Pub A 98.2:G 941x (1988)

Patient education and counseling.

Electronic available to U of Minnesota students, staff and faculty. Print from 1983-2003. Location: TC Bio-Medical Library Periodicals stack no.181

Agency For Healthcare Research and Quality (AHRQ): Health Literacy

The Agency for Healthcare Research and Quality's (AHRQ) mission is to produce evidence to make health care safer, higher quality, more accessible, equitable, and affordable, and to work within the U.S. Department of Health and Human Services and with other partners to make sure that the evidence is understood and used.

Agency for Healthcare Research and Quality's Health Literacy Universal Precautions Toolkit

This toolkit provides information on designing easy-to-read materials and strategies for addressing health literacy issues.

The Patient Education Materials Assessment Tool (PEMAT) and Users Guide: An Instrument To Assess the Understandability and Actionability of Print and Audiovisual Patient Education Materials

The Patient Education Materials Assessment Tool (PEMAT) is a systematic method to evaluate and compare the understandability and actionability of patient education materials. It is designed as a guide to help determine whether patients will be able to understand and act on information. Separate tools are available for use with print and audiovisual materials.

Health Literacy Measurement Tools

he AHRQ-supported tools are for the assessment of health literacy in speakers of English and Spanish, the languages most frequently spoken in the United States.

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

he Short Assessment of Health Literacy–Spanish and English (SAHL–S&E) is a new instrument, consisting of comparable tests in English and Spanish, with good reliability and validity in both languages. Persons being examined in English or Spanish are presented with 18 test terms. For each term 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 (decoding) of health-related terms. Administration of the test takes only 2-3 minutes and requires minimal training. Administration of these instruments could be facilitated by using laminated 4"-by-5" flash cards, with each card containing a medical test term printed in boldface on the top and the two association words"”i.e., the key and the distracter"”at the bottom.

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 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)

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.

Assessing and Developing Health Materials

(Harvard School of Public Health: Health Literacy Website) by Rima E. Rudd. Health Literacy Studies.

ATOS for Text

"ATOS for Text is used to calculate the readability level for shorter text passages such as magazine and newspaper articles, test items, and other classroom materials. The resulting ATOS level does not include any adjustment for overall length (word count) and is expressed as ATOS Level."

Beyond the Brochure: Alternative Approaches to Effective Health Communication: A Guidebook

(1994)The AMC Cancer Research Center, with collaboration and support of the Centers for Disease Control and Prevention (CDC), Division of Cancer Prevention and Control, has developed Beyond the Brochure to assist health educators and health communicators in conceiving and producing educational materials and activities that do not rely solely on the printed word. [80 p.]

CDC's Gateway to Health Communication & Social Marketing Practice: Tools & Templages

Centers for Disease Control & Prevention's online portal for health communication. The Tools & Templates section contains links to health literacy resources, social medial tools, images and interactive media

Centers for Disease Control and Prevention's Plain Language Thesaurus for Health Communications

(2007). This Plain Language Thesaurus has been put together by the Centers for Disease Control and Prevention's National Center for Health Marketing. Our aim is to help make health information clear and easy to understand. This thesaurus offers plain language equivalents to medical terms, phrases, and references that we often use. The technical terms found in health information can be confusing

Center for Disease Control and Prevention"s Simply Put: A Guide to Creating Easy-to-Understand Materials

(2009) The guidance in Simply Put helps you transform complicated scientific and technical information into communication materials your audiences can relate to and understand. The guide provides practical ways to organize information and use language and visuals. This guide will be useful for creating fact sheets, FAQ's, brochures, booklets, pamphlets, and other materials, including web content.

Centers for Medicare and Medicaid Services: Toolkit for Making Written Materials Clear and Effective

This eleven part toolkit emphasizes using a reader-centered approach to develop and test patient education material and includes information on developing materials for the internet.

Clear & Simple: Developing Effective Print Materials for Low-Literate Readers

Updated and expanded “Clear & Simple” for contemporary use by NIH.

Clear & Simple outlines a process — five standard steps — for developing health information materials for people with limited-literacy skills. The 2003 National Assessment of Adult Literacy found that about 14 percent of 18,500 adult Americans surveyed could not read, or understand text written in English and could only comprehend basic, simple text.

Designing Print Materials: A Communications Guide for Breast Cancer Screening

(International Cancer Screening Network) Includes worksheets, checklists, tables and audience assessment. 2007

Developing Easy-to-Read Patient Education Materials

(Breast Health Connection of Georgia) PDF of a slide presentation by Kara L. Jacobson and Felicia J. Morton of the Breast Health Connection of Georgia

Everyday Words for Public Health Communication

Centers for Disease Control and Prevention

Everyday Words for Public Health Communication offers expert recommendations from CDC's Health Literacy Council and other agency communicators on how to reduce jargon and replace problematic terms to improve comprehension. "Everyday Words" provides:

  • Substitute terms,
  • Real-life examples of difficult public health passages
  • Revised wording
  • Tips to reinforce meaning and avoid other common pitfalls <\li>

  • A Guide to Creating and Evaluating Patient Materials: Guidelines for Effective Print Communication

    (MaineHealth.org) Includes step-by-steps instructions for developing patient education materials, checklists and readability. [16 p.] 2010

    Guide to Providing Effective Communication and Language Assistance Services

    (HHS) The Guide is designed to help you and your organization communicate effectively with patients with diverse communication needs and preferences.

    Requires one-time free registration to view the guide.

    Guidelines for easy-to-read materials

    (International Federation of Library Association and Institutions IFLA Professional Reports, No. 120) 2010

    Health Literacy: A Toolkit for Communicators

    (AHIP: America's Health Insurance Plans) Resource handbooks with numerous links. [12 p.] 2010

    The Health Literacy & Plain Language Resource Guide

    (Health Literacy Innovations) 2008.

    Health Literacy Fact Sheets

    (Center for Health Care Strategies) Series of fact sheets on various aspects of health literacy.

    • What Is Health Literacy?y
    • How Is Health Literacy Identified?
    • Health Literacy and the Role of Culture
    • Improving Print Communication to Promote Health Literacy
    • Improving Oral Communication to Promote Health Literacy
    • Health Literacy: Policy Implications and Opportunities

    Health Literacy Online A Guide for Simplifying the User Experience

    U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion.

    2nd ed.

    "This research-based guide discusses why and how to design health websites and other digital health information tools for all users, including the millions of Americans who don’t have strong reading or health literacy skills—as well as those who don’t have a lot of time to find, process, and use complex health information."

    "In this second edition, we’ve updated the recommendations to reflect findings from a more robust body of literature related to the cognitive processing and online behavior of adults with limited literacy skills (see section 1), as well as additional original ODPHP research conducted during the past 5 years. As with the first edition, we build on the principles of web usability described in the Research-Based Web Design and Usability Guidelines developed by HHS in partnership with the General Services Administration. In addition, we’ve included new considerations for mobile devices."

    The Health Literacy Style Manual

    Prepared for Covering Kids & Families, Southern Institute on Children and Families. [98 p.] 2005

    Health Literacy Tool Shed

    The Health Literacy Tool Shed is an online database of health literacy measures. The site contains information about measures, including their psychometric properties, based on a review of the peer-reviewed literature.

    Patient Education

    From U-Write.com. Handy tips section that covers illustrations, readability, design layout, effectiveness and costs of in-house production.

    Minnesota Health Literacy Partnership

    The mission of the Minnesota Health Literacy Partnership is to improve the health of all Minnesotans through clear health communication.

    Founded in 2006 to encourage and support health literacy efforts across the state, the Minnesota Health Literacy Partnership is an independently funded program of the Minnesota Literacy Council. Most support is provided through membership contributions.

    Resources include:

    Minnesota Health Literacy Partnership: An Overview

    PowerPoint presentation, which includes slides as well as speaker notes, is designed to help educate individuals and organizations about the Minnesota Health Literacy Partnership. It can be used on its own or as part of Health Literacy 101.

    Training Materials

  • Health numeracy toolkit
  • Teach Back Program
  • Health Literacy 101: Focusing on Clear Health Communications
  • HeLP MN Seniors
  • PlainLanguage.gov

    Plain Writing Act of 2010; plain writing guidelines, examples and health literacy.

    Quick Guide to Health Literacy

    (U.S. Department of Health and Human Services) Fact sheets, strategies, resources.

    Readability Test

    "This free online software tool calculate various readability measurements like Coleman Liau index, Flesh Kincaid Grade Level, ARI (Automated Readability Index), SMOG. Document readability is the indication of number of years of education that a person needs to be able to understand the text easily on the first reading. Comprehension tests and skills training. Tool is made primary for English texts but might work also for some other languages. It displays also complicated sentences (with many words and syllables) as suggestion what you might do to improve its readability." From Online-Utility.org

    Ten Attributes of Health Literate Health Care Organizations

    By Cindy Brach, Debra Keller, Lyla M. Hernandez, Cynthia Baur, Ruth Parker, Benard Dreyer, Paul Schyve, Andrew J. Lemerise, Dean Schillinger. (27 p.) June 19, 2012

    A wide range of organizations have recognized that having health literate health care organizations benefits not only the 77 million Americans who have limited health literacy, but also the majority of Americans who have difficulty understanding and using currently available health information and health services. This paper presents 10 attributes that exemplify a health literate health care organization. Each attribute includes a brief elaboration of the meaning of and basis for the attribute, followed by a set of implementation strategies that can be used to achieve the attribute.

    Attributes of a Health Literal Organization

    The Institute of Medicine report outlining 10 attributes of a health literate organization, defined as one that makes it easier for patients to understand and use health information. (4 p.)

    Translating Materials for Non-English Speaking Audiences

    (Center for Medicare Education) 2000

    Issue brief vol.1 no. 3

    WordsCount

    The WordsCount Service is a free service created by Alain Trottier to help language workers, and anyone looking for a better way to communicate. Includes the Readability calculator, SMOG calculator and the CLEAR calculator.

    Health Literacy: A prescription to End Confusion

    (Academy for Educational Development for the Institute of Medicine). Extended video (11.02 minutes) on the Institute of Medicine report

    Health Literacy Basics for Health Professionals

    Published on Jun 2, 2014 (6:10 minutes)

    Brought to you by Vancouver Coastal Health, the BC College of Family Physicians and the BC Ministry of Health.

    Health Literacy Video

    (American College of Physicians Foundation). 6 1/2 minute video gives an illustration of the problem of low health literacy, combining interviews with actual patients, commentary from practicing physicians, and health communication statistics. Can be viewed from the website.

    Health Literacy for Student Healthcare Professionals: A Tool for Better Health Outcomes

    Published on Nov 5, 2014 (5:08 minutes)

    The video was created by 5 student Occupational Therapists at University of Manitoba to be used as an advocacy tool in order to provide student healthcare professionals information that would assist in ensuring better outcomes for clients.

    Health Literacy: Learning is the best medicine

    (British Columbia, CA) " Literacy can be a major determinant of health. Health literacy is the ability to access, understand, evaluate and communicate information as a way to promote, maintain and improve health in a variety of settings across the life course."

    Culture, Health and Literacy: a guide to health education materials for adults with limited English literacy skills.

    Authored by Julie McKinney and Sabrina Kurtz-Rossi.

    Developed by World Education in collaboration with the National Institute for Literacy with a generous grant from Metropolitan Life Foundation

    Health Information Translations

    Provides plain language health education resources for health care professionals and others working in communities with limited English proficient populations. The website is a collaboration of health education specialists from the four health systems in Central Ohio,.

    Developing, Translating and Reviewing Spanish Materials

    North Carolina Department of Health & Human Services. How to on developing Spanish language materials.

    Ethnomed

    EthnoMed contains information about cultural beliefs, medical issues and other related issues pertinent to the health care of recent immigrants to the US. Has links to patient education materials in a wide variety of languages

    HealthReach: Health Information In Many Languages

    HealthReach is a national collaborative partnership that has created a resource of quality multilingual, multicultural public health information for those working with or providing care to individuals with limited English proficiency.

    Resources include:

  • Health education materials in various languages and formats (brochures, fact sheets, videos)
  • Provider tools (including best practices, cultural information, and effective use of interpreters)
  • Special collections on Emergency and Disaster, Women's Health and Mental Health

    The HealthReach offers easy access to quality health information to individuals for whom English is not their primary language. It is also an important resource for health professional as well as public health administrators. HealthReach grew out of the Refugee Health Information Network (RHIN) when it became apparent that the information resources in the database are useful to all those who have limited English proficiency, not just refugees and asylees.

  • Multi-cultural Resources for Health Information

    (National Library of Medicine: Specialized Information Services (SIS))Includes cultural competency; dictionaries/glossies; health resources in multiple languages; interpreting in healthcare; limited English proficiency; law/policy/standards; health literacy

    New South Wales (NSW) Multicultural Health Communication Service

    (NSW Department of Health). Search for resources by either topic or language. Also includes a multicultural phrasebook.

    S*P*I*R*A*L: Selected Patient Information Resources in Asian Languages

    Joint initiative of the South Cove Community Health Center and Tufts University Hirsh Health Sciences Library. Materials available in Chinese, Cambodian, Hmong, Korean, Laotian, Thai and Vietnamese.

    PubMed Search for Patient Education AND Health Literacy

    PubMed search using the MeSH subject headings Patient Education AND Health Literacy, limited to English and humans. The search is done in real-time, so results will change as the database is updated.

    PubMed Search for Patient Education and Cultural Diversity

    PubMed search using the MeSH subject headings Patient Education AND Cultural Diversity, limited to English and humans. The search is done in real-time, so results will change as the database is updated.

    PubMed Search for Patient Education and Teaching Materials

    PubMed search using the MeSH subject headings Patient Education AND Teaching Materials, limited to English and humans. The search is done in real-time, so results will change as the database is updated.

    PubMed Search for Health Literacy AND Teaching Materials

    PubMed search using the MeSH subject headings Health Literacy AND Teaching Materials, limited to English and humans. The search is done in real-time, so results will change as the databases is updated.

    Illustrations and Other Media

    Clipart and other ways of illustrating patient education materials. Keep in mind that some of these images may be copyrighted and will need permission for use.

    "Free" Clipart

    These are image collections that are free for educational use. Please carefully read the copyright notices and disclaimers before use - some sites have detailed instructions and conditions on use of the images.

    Food Clipart, Illustrations - Graphics

    Classroomclipart.com/. Clipart available free of charge for educational purposes.

    A variety of Food related clipart such as Fruits, Vegetables, Seafood, Fast Food, Dairy Clipart, Ice cream, desserts and more.Also view related Food Clipart categories.

    Be sure to read the copyright agreement before using.

    HEAL: Health Education Assets Library

    The Health Education Assets Library (HEAL) is a digital library that provides freely accessible digital teaching materials. Requires free registration.

    Health & Safety Clip Art

    From the Discovery Channel -- Education section. There is also clipart on science, food and technology

    Medical Clipart and Graphics

    Classroomclipart.com/Medical. Clipart available free of charge for educational purposes. Be sure to read the copyright agreement before using.

    National Cancer Institute Visuals Online

    Images with captions from the National Cancer Institute

    National Eye Institute: Photos, Images & Video

    Items here are not copyrighted. However, credit as follows: National Eye Institute, National Institutes of Health (except where indicated otherwise).

    National Institute of General Medical Sciences (NIGMS) Image Gallery

    View and search the NIGMS database of photos, illustrations, and videos. All images are available for download free of charge.

    National Institute of Mental Health Image Library

    A searchable database of photographs and illustrations that are available, copyright free, to the public at no cost.

    National Library of Medicine : Images From the History of Medicine

    Over 60,000 images including portraits, pictures of institutions, caricatures, genre scenes, and graphic art in a variety of media

    Nursing Graphics

    The Student Nurse Forum

    Public Health Image Library

    Public Health Image Library (PHIL) is an extensive collection of still images, image sets, and multimedia files related to public health.

    Using Symbols [Universal Healthcare symbols]

    (Hablamos Juntes: Language policy & practice in healthcare). Downloadable symbols in either EPS or PDF format (zip files). Also links to Universal Symbols in Health Care Workbook.

    USP Pictograms

    USP Pictograms are standardized graphic images that help convey medication instructions, precautions, and/or warnings to patients and consumers. Pictograms are particularly helpful in passing on important information to patients with a lower level reading ability and patients for whom English is a second language. USP offers 81 pictograms in .gif or .eps format. You can download the entire pictogram library after accepting our license agreement.

    Wellcome Images

    Wellcome Images is one of the world's richest and most unique collections, with themes ranging from medical and social history to contemporary healthcare and biomedical science. All our images are available on demand in digital form. Search online or use the expertise of our professional scientific and historical researchers. Whether it's medicine or magic, the sacred or the profane, science or satire - you'll find more than you expect. This unrivalled collection contains historical images from the Wellcome Library collections, Tibetan Buddhist paintings, ancient Sanskrit manuscripts written on palm leaves, beautifully illuminated Persian books and much more. The Biomedical Collection holds over 40 000 high-quality images from the clinical and biomedical sciences. Selected from the UK's leading teaching hospitals and research institutions, it covers disease, surgery, general healthcare, sciences from genetics to neuroscience including the full range of imaging techniques. Wellcome Images is one of the Wellcome Library's major visual collections. Part of Wellcome Collection, a major new ः30 million public venue developed by the Wellcome Trust, the Library has over 750 000 books and journals, an extensive range of manuscripts, archives and films, and more than 250 000 paintings, prints and drawings.

    All low res images on this site are freely available for download for personal, academic teaching or study use, under one of two Creative Commons licences. For further details please see our Terms of Use. Hi-res historical images are also available to download from this site free of charge, for any usage, under a Creative Commons Attribution Only – CC-BY license.

    Requires creation of account

    Fee-Based Clipart

    Commercial images available on a fee-based service. This is not an endorsement of these companies, just a representation of some of the larger one available via the web. Please check copyright notices and disclaimers before use

    Can Stock Photo

    "over 25,000 new files added each day"

    ClipArt.com

    Largest subscription based royality-free graphics website. Thousands of illustrations.

    Images @ Wolters Kluwer Health

    A website with high-quality medical images to that can be licensed for brochures, presentations and websites. Image collections from the Anatomical Chart Company, and Lippincott Williams and Wilkins' LifeArt and MediClip collections.

    Medical Imagery: Medical Arts & Graphics

    Medical Imagery provides an on-line catalog of images that can be used as stock art.

    Nucleus Medical Art

    Nucleus Medical Art, Inc. is a full-service creative studio specializing in developing and licensing medical illustrations, medical animations, interactive media and other communications tools for the healthcare market. The company maintains a proprietary database of more than 15,000 highly detailed, expert reviewed medical illustrations and animations.

    Copyright Information and Education (U of M Libraries)

    The site of the University of Minnesota Libraries' Copyright Information and Education Initiative, which supports an informed and educated University community on matters of copyright and its application in teaching, research, and scholarship. Includes tools such as the Fair Use Analysis Tool and the Copyright Decision Map.

    Copyright & Fair Use

    Prepared by Stanford University Libraries this is a very useful site.

    Copyright Crash Course

    The Copyright Crash Course Online Tutorial will help you learn about how ownership of copyrighted materials works, what is fair use and when and how to get permission to use someone else's materials.

    Copyright Permissions Office, U of M

    This office, secures permission for copyrighted materials use for instructional or other academic purposes by U of M faculty and staff. Photocopying guidelines are also provided.

    Copyright Website

    This site endeavors to provide real world, practical and relevant copyright information of interest to infonauts, netsurfers, webspinners, content providers, musicians, appropriationists, activists, infringers, outlaws, and law abiding citizens. (Website text.)

    U.S. Copyright Office: The Library of Congress

    An essential site for copyright information for both those who what to obtain copyright and those who want to use copyrighted materials. The Copyright Basics section and the FAQ are especially helpful.

    Printing Services -,University of Minnesota

    Wide variety of printing options, along with copy service and graphic design