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Agency for Healthcare Research Quality

Health Literacy Measurement Tools

Health literacy is the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. AHRQ-funded researchers have developed two tools to measure an aspect of health literacy—individuals' reading comprehension in a medical context. These tools can be used for research, clinical, or program planning purposes.

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.

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Patient name _______________ Date of birth _______________ Reading level _______________

Date ________________ Examiner _______________ Grade completed _______________


Instructions for Administering the REALM-SF

  1. Give the patient a laminated copy of the REALM-SF form and score answers on an unlaminated copy that is attached to a clipboard. Hold the clipboard at an angle so that the patient is not distracted by your scoring. Say:
    "I want to hear you read as many words as you can from this list. Begin with the first word and read aloud. When you come to a word you cannot read, do the best you can or say, 'blank' and go onto the next word."
  2. If the patient takes more than five seconds on a word, say "blank" and point to the next word, if necessary, to move the patient along. If the patient begins to miss every word, have him or her pronounce only known words.

Scores and Grade Equivalents for the REALM-SF

Score   Grade range
0 Third grade and below; will not be able to read most low-literacy materials; will need repeated oral instructions, materials composed primarily of illustrations, or audio or video tapes.
1-3 Fourth to sixth grade; will need low-literacy materials, may not be able to read prescription labels.
4-6 Seventh to eighth grade; will struggle with most patient education materials; will not be offended by low-literacy materials.
7 High school; will be able to read most patient education materials.

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. 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.

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SAHLSA-50 Form

Stem Key or Distracter "no se"
(Don't know)
  1. próstata
__glándula __circulación __no se
  1. empleo
__trabajo __educación __no se
  1. menstrual
__mensual __diario __no se
  1. gripe
__sano __enfermo __no se
  1. avisar
__medir __decir __no se
  1. comidas
__cena __paseo __no se
  1. alcoholismo
__adicción __recreo __no se
  1. grasa
__naranja __manteca __no se
  1. asma
__respirar __piel __no se
  1. cafeína
__energía __agua __no se
  1. osteoporosis
__hueso __músculo __no se
  1. depresión
__apetito __sentimientos __no se
  1. estreñimiento
__bloqueado __suelto __no se
  1. embarazo
__parto __niñez __no se
  1. incesto
__familia __vecinos __no se
  1. pastilla
__tableta __galleta __no se
  1. testículo
__óvulo __esperma __no se
  1. rectal
__regadera __inodoro __no se
  1. ojo
__oír __ver __no se
  1. irritación
__rígido __adolorido __no se
  1. abnormal
__diferente __similar __no se
  1. estrés
__preocupación __feliz __no se
  1. aborto espontáneo
__pérdida __matrimonio __no se
  1. ictericia
__amarillo __blanco __no se
  1. papanicolaou
__prueba __vacuna __no se
  1. impétigo
__pelo __piel __no se
  1. indicado
__instrucción __decisión __no se
  1. ataque
__herida __sano __no se
  1. menopausia
__señoras __niñas __no se
  1. apéndice
__rascar __dolor __no se
  1. comportamiento
__pensamiento __conducta __no se
  1. nutrición
__saludable __gaseosa __no se
  1. diabetes
__azúcar __sal __no se
  1. sífilis
__anticonceptivo __condón __no se
  1. inflamatorio
__hinchazón __sudor __no se
  1. hemorroides
__venas __corazón __no se
  1. herpes
__aire __sexo __no se
  1. alérgico
__resistencia __reacción __no se
  1. riñón
__orina __fiebre __no se
  1. calorías
__alimentos __vitaminas __no se
  1. medicamento
__instrumento __tratamiento __no se
  1. anemia
__sangre __nervio __no se
  1. intestinos
__digestión __sudor __no se
  1. potasio
__mineral __proteína __no se
  1. colitis
__intestino __vejiga __no se
  1. obesidad
__peso __altura __no se
  1. hepatitis
__pulmón __hígado __no se
  1. vesícula biliar
__arteria __órgano __no se
  1. convulsiones
__mareado __tranquilo __no se
  1. artritis
__estómago __articulación __no se

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 se'. 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 se'.
  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.

Current as of January 2009

Internet Citation:

Health Literacy Measurement Tools. January 2009. Agency for Healthcare Research and Quality, Rockville, MD.


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