Literacy Assessment Instruments

Numerous well-validated instruments are available for assessing patient health literacy. While some are well suited for research, others are especially useful in a clinic setting. Listed below are several of the assessments most commonly applied by researchers and clinical personnel in gauging patient-participant health literacy levels.

ABLE (Adult Basic Learning Examination)

The ABLE is designed to measure the functional abilities in adults, specifically those whose education does not exceed the 8th grade level. No time limits have been set for this test, which is divided into levels based on the years of formal education the patient has completed.

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LAD (Literacy Assessment for Diabetes)

The LAD is a diabetes-specific literacy assessment. Specifically, it is a word recognition test that has 3 graded word lists ordered by difficulty for the patient. It measures the patients’ ability to pronounce terms related to healthcare. The terms are on a 4th grade level, or on a 6th to 16th grade reading level. It can be administered in 3 minutes or less.

To obtain a copy: Contact Charlotte Reese Nath at

NVS (Newest Vital Sign)

The NVS consists of a nutrition label with 6 accompanying questions to assess literacy. It takes approximately 3 minutes to administer, and is meant to allow healthcare providers to make a quick assessment of patients’ literacy, which can then allow them to adapt communication to achieve better outcomes. It assesses literacy and numeracy, and is available in both English and Spanish versions.

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NLS (Nutritional Literacy Scale)

The NLS consists of 24 questions, and is designed to evaluate patients’ understanding of current nutrition labels; the test includes actual nutritional labels that the patients refer to. The first 12 questions are open-ended in nature, and the last 12 require the patient to decide between two response options. It can be administered without a time limit.

To obtain a copy: Contact James J. Diamond at

REALD (Rapid Estimate of Adult Literacy in Dentistry)

The REALD is a test used to measure medical-related literacy, specifically dentistry. It is based on the REALM, and is scored on a 0-99 (REALD-99) scale, with higher scores indicating better literacy. It is designed to rapidly assess the approximate literacy levels of patients as relates to dentistry.

To obtain a copy: Contact Dr. Jessica Y. Lee at

REALM (Rapid Assessment of Adult Literacy in Medicine)

The REALM is a screening tool designed to measure adults’ ability to read common medical words or lay terms that correspond to anatomy or illnesses. As a word recognition test, the REALM does not assess comprehension. However, it is highly correlated with other tests of comprehension. It takes approximately 3 minutes to administer and score.

To obtain a copy: Contact Dr. Terry C. Davis at

REALM-R (Rapid Assessment of Adult Literacy in Medicine-Revised)

The REALM-R is a shortened version of the REALM, which is used to help identify literacy levels of adult patients. It consists of 8 items, and is used to measure how well individuals can read words they will encounter in a medical setting.

To obtain a copy: Contact Dr. Terry C. Davis at

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

The SAHLSA consists of a word-recognition section, designed after the REALM, in addition to a comprehension test that employs multiple choice questions. It was designed to assess the health literacy for adults who speak Spanish.

To obtain a copy: Contact Dr. Shoou-Yih D. Lee at

SILS (Single Item Literacy Screener)

The SILS is a single item instrument designed to identify patients who need help with reading health-related information. The instrument asks one question “How often do you need to have someone help you when you read instructions, pamphlets, or other written material from your doctor or pharmacy?” with possible responses ranging from “1” (never) to “5” (always). The authors identified the cut-off point as “2” in order to capture all patients potentially in need of assistance.

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Slosson Oral Reading Test

The Slosson consists of tests from preschool to adult levels, and is meant to be a quick estimate to target word recognition levels for children and adults. It takes 3-5 minutes to complete, and assesses the level of oral word recognition, word calling, or reading level. It is not a comprehensive test; it is only meant to measure certain aspects of literacy.

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TABE (Test of Adult Basic Education)

The TABE is an exam divided into three sections, and determines the skill of a test taker in each one of these areas. The results aid in placement of test takers into adult education programs. The exam consists of questions relating to English language, math, and reading; it measures academic skill up to the 12th grade.

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TOFHLA (Test of Functional Health Literacy in Adults)

The full TOFHLA consists of a reading comprehension section as well as a numeracy section. The former is composed of 50 questions, the latter of 17 items. The entire test usually takes up to 22 minutes to administer. The reading passages and numeracy question are taken from common medical scenarios. The s-TOFHLA is a truncated version that only uses questions from the reading comprehension subsection of the full test. There are 36 items that are administered in 7 minutes. The scoring categorizes respondents into inadequate, marginal or adequate levels of health literacy.

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WRAT (Wide Range Achievement Test)

The WRAT measures literacy in three categories: reading recognition, spelling, and arithmetic computation. It takes 20-30 minutes to complete. There is a level for children ages 5-11 (level I) and another level for ages 12-64 (level II). In health-related research most investigators have only used the reading recognition sub-test which takes about 5 minutes to administer.

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