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North Carolina Health Literacy: Research and Reading List

This guide serves as the information hub for health literacy resources and efforts at University of North Carolina at Chapel Hill, as well as throughout the state of North Carolina.

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There is a growing body of research and practice around the field of health literacy. Limited health literacy is associated with worse health outcomes, so it is important that health professionals be aware of best practices and to utilize strategies and resources to help improve health literacy skills for themselves and for their patients. This page is designed to help you continue your learning about health literacy and includes information about:

  • Assessing the health literacy of patients
  • Research tools and training materials
  • Health literacy videos and presentations
  • Scholarly articles about health literacy

Assessing the Health Literacy of Patients

Limited health literacy is common but can be hard to recognize. Experts recommend using health literacy universal precautions by always presenting health information to patients and their families in a clear and easy manner. The precautions also stress the importance of providing a shame-free environment. These precautions aim to:

  • Simplify communication and confirm comprehension to minimize miscommunication
  • Make the office environment and health care system easier to navigate
  • Support patients’ efforts to improve their health

Some health literacy instruments are best suited for research. Others are preferred in a clinical setting, as they can be administered quickly. The resources and tools below can help you identify which assessment tools will meet your needs.

Health Literacy Tool Shed

The Health Literacy Tool Shed by Boston University is an online database of health literacy measures. These measures, including their psychometric properties, are based on a review of the peer-reviewed literature. You can find health literacy measurement tools to meet your needs.

Newest Vital Sign

NVS is a valid and reliable screening tool available in English and Spanish that identifies patients at risk for low health literacy. It is easy and quick to administer, requiring just three minutes.

Single Item Literacy Screener

SILS is a simple instrument designed to identify patients with limited reading ability who need help reading health-related materials. The SILS performs moderately well at ruling out limited reading ability in adults and allows providers to target additional assessment of health literacy skills to those most in need. To obtain a copy, contact the corresponding author.


Rapid Assessment of Adult Literacy in Medicine

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

Rapid Assessment of Adult Literacy in Medicine-Revised

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

Short Assessment of Health Literacy for Spanish-speaking Adults:

SAHLSA consists of a word-recognition section, designed after the REALM, as well as a comprehension test that employs multiple choice questions. It was designed to assess the health literacy for adults whose native language is Spanish. To obtain a copy: Contact Dr. Shoou-Yih D. Lee at

Test of Functional Health Literacy in Adults:

TOFHLA consists of reading comprehension and numeracy sections. 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.Obtain a copy of the TOFHLA (Test of Functional Health Literacy in Adults) from the Health Literacy Tool Shed.


Research Tools

Health Literacy Research - Centers for Disease Control and Prevention (CDC)

Information and tools for planning health literacy research, identifying opportunities and barriers to improving health literacy in your organization, finding funding opportunities and learning about current research on health literacy topics.

Robert Wood Johnson Foundation - Universal Symbols in Health Care Workbook

Using symbols for health care signage can successfully meet the wayfinding needs of patients that speak hundreds of different languages. This workbook is designed for health care facilities and graphic designers interested in learning about and using newly developed health care symbols for wayfinding programs.

Health Literacy Videos

Health Literacy: A Prescription to End Confusion

Location: Freely Available Video presentation of the Institute of Medicine report with all findings and recommendations -- Video clips of patients discussing their health literacy experiences -- Video of Dr. Harvey Fineberg, President of the Institute of Medicine, discussing the implications of health literacy for health care in the United States


Members of the Health Literacy team at HSL have compiled the following collection of presentations on health literacy. We welcome you to use any of the presentation slides. Please credit the noted study authors and presentation creators as appropriate.

Health Literacy out Loud Podcast Interviews

Helen Osborne, M.Ed., is a health literacy expert and the founder of Health Literacy Month. In keeping with today’s trends and technology, Helen produces and hosts the podcast series Health Literacy Out Loud – podcast interviews with those in-the-know about health literacy. You will hear why health literacy matters and learn practical ways to help.

Health Literacy: Importance in Partners

Outlines the basics and importance of health literacy, including strategies on how to overcome communication barriers. It also highlights the Teach-Back method and Plain Language techniques, and provides examples.

Health Literacy: Hidden Barriers and Practical Strategies

Includes 30 slides that can be delivered in 30-45 minutes to a group or as a self-study program. It comes with speaker’s notes. The content promotes the understanding of what health literacy is and how it affects patients. It also covers select practical strategies that can help practices do a better job caring for people with low health literacy.

Health Literacy 101 – An Introduction

An introduction to the justifications, needs, history and impact health literacy plays within the complex facets of healthcare. This one hour video is from the 17th Annual Health Literacy Conference titled Strengthening Communities to Improve Health Equity and Health Literacy.

Keeping Current

The following journal articles on health literacy are listed in chronological order. They are automatically updated from PubMed.

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Training Resources for Librarians

NNLM Free Training

The Network of the National Library of Medicine provides free continuing education for librarians on a variety of topics including consumer health and health literacy.

Helping People Live Healthy Lives

Terri Ottosen from UNC Health Sciences Library presented at the NC Live Annual Conference in May 2022 about the role of librarians in Providing Good Health Information and Health Literacy Skills Development. Download the PDF Handout: Handout Helping People Live Healthy Lives

Engaging for health: Providing Consumer Health Information at Your Library

The University of North Carolina at Chapel Hill (UNC) Health Sciences Library (HSL), part of the University Libraries, implemented a training program for library staff, students, and the public using and adapting the NNLM Engage for Health curriculum, and the Middle Atlantic Region of NNLM’s class, entitled, “Patient Empowerment: Using Health Information Resources to Improve Health Communication.”

ALA partners with U.S. Department of Health and Human Services to share trusted vaccine information

This post from ALAnews shares information about the We Can Do This campaign about COVID-19 vaccines. The article includes links to resources librarians can share with their communities.

Mental Health Literacy (CDC)

This resource curated by the CDC provides links to trainings about Mental Health Literacy.

Terri Ottosen, MLIS, AHIP

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