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Table 1 A short list of some selected instruments for measuring general health literacy

From: Development and validation of a short and easy-to-use instrument for measuring health literacy: the Health Literacy Instrument for Adults (HELIA)


Authors (publication Year), [ref]


The most important advantages

The most important disadvantages

Rapid Estimate of Adult Literacy in Medicine (REALM)

Davis et l. (1991), [10].


Quick and easy to administer, short version available

Only measures reading ability, has problems when administering to patients with limited reading ability.

Test of Functional Health Literacy in Adults (TOFHLA)

Parker et al. (1995), [11].


Available in Spanish, German, French, and Italian. Short version available. Has been validated in several samples representing diverse populations.

The use of the instrument is limited to health service settings. The short-TOFHLA is only a test of reading comprehension and might prove useful as a screening instrument to identify patients with very limited reading ability rather than health literacy

Newest Vital Sign (NVS)

Weiss et al. (2005), [12].


Quick functional health literacy assessment that includes numeracy.

The scoring description lack precision. With high sensitivity, the NVS might misclassify patients with adequate health literacy, while the specificity might result in overestimating the percentage of patients with limited literacy

Screening Questions for Limited Health Literacy (SILS)

Morris et al. (2006), [19], Chew et al. (2008), [20]

People with limited literacy

Very easy and short (3 items)

Only measures reading, understanding and filling out medical forms

Medical Term Recognition Test (METER)

Rawson et al. (2010), [21].


Quick and easy to administer

It is a one-dimensional instrument

Health Literacy Skills Instrument (HLSI)

McCormack et al. (2010), [22].


Assesses multiple health literacy domains with a skills-based approach. Available in short form.

Primarily focusing on functional health literacy using different means such as documents, oral communication and Internet making it relatively difficult to admister

Health Literacy Assessment Using Talking Touchscreen Technology (Health LiTT)

Hahn, et al. (2011), [23].


Self-administered, computer adapted

Not able to distinguish higher levels of health literacy. Health literacy assessment might be influenced by computer literacy and skills

Canadian Self-Report Health Literacy Skills

Begoray and Kwan(2012), [24]


Short instruments that includes nine self-reported items

Uses very general items and cannot provide accurate estimation of health literacy

Health Literacy Questionnaire HLQ)

Osborne et al. (2013), [16].


Contains multiple domains of health literacy, relatively well developed

Not identified yet.

European Health Literacy Questionnaire (HLS-EU-Q47)

Sørensen et al. (2013), [17].

Age 15+

Comprehensive, available in more than 10 languages.

Developed in European context. However, ccurrently the Asian version also was developed.


Sørensen et al. (2015), [25].

Age 15+

Comprehensive instrument

Developed in European context.

All Aspects of Health Literacy Scale (AAHLS):

Chinn and McCarthy, (2013) [26]

Age 15+

Measuring functional, communicative and critical health literacy

Although short, it is not useful for population studies since it might be confusing for people with limited education and literacy.