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Health Literacy

Rapid Estimate of Adult Literacy in Medicine (REALM)

125-item test to assess prose and pronunciation; quick screening tool to assist providers in identifying patients with limited reading skills and estimate reading levels.

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Rapid Estimate of Adult Literacy in Medicine (Short) (REALM-R)

8-item list of common medical terms for patients to read aloud; used to assess literacy and estimate reading level.

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Newest Vital Sign (NVS)

6-item general questions based on a nutrition label; used to assess comprehension and numeracy.

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Single Item Screener (SILS)

1-item self-assessment question on ability to understand information from health care providers; used to identify inadequate health literacy.

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Subjective Numeracy Scale (SNS)

8-item self-assessment scale; used to assess general numeracy skills (fractions, percentages, etc.).

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Personal Health Literacy Measurement Tools

Several tools available from AHRQ to quickly assess health literacy in English and Spanish.

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Literacy Assessment for Diabetes (LAD)

60-item list of common diabetes terms for patients to read aloud; used to assess literacy and estimate reading level.

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Diabetes Numeracy Test (DNT)

43-item objective nutrition label and diabetes word problems; used to assess diabetes literacy and numeracy.

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Agency for Healthcare Research and Quality (AHRQ) Health Literacy Universal Precautions Toolkit (2024)

Toolkit that includes evidence-based practices to improve health care professionals’ ability to provide health literate communication.

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  1. Health literacy tool shed. Boston University, CommunicateHealth, NIH NLM. Updated November 28, 2020. Available at: https://healthliteracy.bu.edu. Accessed November 28, 2020.
  2. Caruso R, Magon A, Baroni I, et al. Health literacy in type 2 diabetes patients: A systematic review of systematic reviews. Acta Diabetol. 2018;55(1):1-12. doi:10.1007/s00592-017-1071-1
  3. Davis TC, Crouch MA, Long SW, et al. Rapid assessment of literacy levels of adult primary care patients. Fam Med. 1991;23(6):433-435.
  4. Bass PF 3rd, Wilson JF, Griffith CH. A shortened instrument for literacy screening. J Gen Intern Med. 2003;18(12):1,036-1,038. doi:10.1111/j.1525-1497.2003.10651.x
  5. Weiss BD, Mays MZ, Martz W, et al. Quick assessment of literacy in primary care: The newest vital sign. Ann Fam Med. 2005;3(6):514–522. doi:10.1370/afm.405
  6. Morris NS, MacLean CD, Chew LD, Littenberg B. The single item literacy screener: Evaluation of a brief instrument to identify limited reading ability. BMC Fam Pract. 2006;7:21. doi:10.1186/1471-2296-7-21
  7. Fagerlin A, Zikmund-Fisher BJ, Ubel PA, Jankovic A, Derry HA, Smith DM. Measuring numeracy without a math test: Development of the Subjective Numeracy Scale. Med Decis Making. 2007;27(5):672–680. doi:10.1177/0272989X07304449
  8. McNaughton CD, Cavanaugh KL, Kripalani S, Rothman RL, Wallston KA. Validation of a short, 3-item version of the Subjective Numeracy Scale. Med Decis Making. 2015;35(8):932-936. doi:10.1177/0272989X15581800
  9. Huizinga MM, Elasy TA, Wallston KA. Development and validation of the Diabetes Numeracy Test (DNT). BMC Health Serv Res. 2008;8:96. doi:10.1186/1472-6963-8-96
  10. Cornett S. Assessing and addressing health literacy. J Issues Nurs. 2009;14(3):2. doi:10.3912/OJIN.Vol14No03Man02
  11. Agency for Healthcare Research and Quality. Health literacy universal precautions toolkit. 3rd ed. U.S. Department of Health and Human Services; 2020. Available here. Accessed May 27, 2026.
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