From Measurement to Action: How Modernizing Health Literacy Measurements Significantly Improves Care Quality

The Problem with Traditional Health Literacy Measurements

Healthcare professionals have long recognized that low health literacy significantly contributes to poor patient outcomes. In response, various measurement tools were developed to assess a patient’s ability to read, comprehend, and act upon health information. While these tools provide data on literacy levels, they present a glaring problem—what’s next? Once you have a patient’s health literacy score, what actionable steps can you take to help them?

For providers, the process often ends at measurement. Traditional health literacy assessments are time-consuming, costly, and offer little beyond a numeric score. Meanwhile, the real issue persists—patients leave appointments without the skills or understanding they need to effectively manage their care, leading to errors in medication use, mismanagement of chronic conditions, and unnecessary hospital visits. The current approach leaves providers without practical solutions and patients without the support they need.

Why Traditional Health Literacy Tools Fall Short

Health literacy measurement tools were designed to help healthcare professionals identify patients who may struggle to understand health-related information. On paper, this sounds like a step in the right direction. In practice, however, it creates a one-dimensional process:

1. The patient takes the test.
2. The provider receives a score.
3. …And nothing changes.

Providers often face a difficult reality—they’ve identified the problem but have no mechanism to fix it. With limited time, rising costs, and increasingly complex healthcare environments, it’s unrealistic to expect providers to spend additional time educating each patient individually. As a result, low health literacy continues to be a pervasive issue, contributing to higher rates of hospitalization, medication misuse, and poor chronic disease management.

Moreover, while these tools assess different facets of health literacy—such as reading comprehension, numeracy, and eHealth skills—they don’t provide a clear pathway to improve the patient’s ability to manage their care. Without actionable solutions, measurement becomes an exercise in futility. Providers are left with data, but no roadmap, and patients are left feeling overwhelmed by a system they don’t fully understand.

Historical Tools Used for Measuring Health Literacy

Historically, healthcare professionals used various tools to measure patients’ health literacy. These tools helped assess how well patients understood medical instructions, but they were often complex and required professional involvement.

1. Test of Functional Health Literacy in Adults (TOFHLA) – Developed in 1995 by Parker, Baker, Williams, and Nurss, TOFHLA measures a patient’s ability to read and understand healthcare-related texts, including prescription labels and medical forms. The primary motive was to assess how functional health literacy affects patient outcomes in clinical settings.
2. Rapid Estimate of Adult Literacy in Medicine (REALM) – Created in 1991 by Davis, Crouch, Long, and colleagues, REALM assesses a patient’s ability to pronounce and understand common medical terms. It was designed as a quick screening tool for clinicians to estimate a patient’s literacy level and adjust communication accordingly.
3. Newest Vital Sign (NVS) – Introduced in 2005 by Weiss et al., NVS evaluates health literacy by using a nutrition label from an ice cream container. The motive behind its creation was to provide a brief, easy-to-administer tool that could quickly identify patients at risk of low health literacy.
4. Health Literacy Questionnaire (HLQ) – Developed in 2013 by Osborne et al., the HLQ was designed to capture a more comprehensive view of health literacy. It assesses multiple dimensions, such as the ability to actively manage health, engage with healthcare providers, and find good health information. Its motive was to provide a broader, multidimensional approach to health literacy measurement for use in both clinical and community settings.
5. eHealth Literacy Scale (eHEALS) – Created in 2006 by Norman and Skinner, eHEALS measures a person’s perceived ability to find, evaluate, and apply health information from electronic sources. The motivation was to address the growing importance of digital health information and assess individuals’ capacity to engage with online health resources.
6. Short Assessment of Health Literacy (SAHL) – Developed in 2010 by Lee, Stucky, Lee, Rozier, and Bender, SAHL was created to provide a quicker alternative to traditional assessments like TOFHLA and REALM. It evaluates a person’s ability to understand and pronounce common medical terms in both English and Spanish. The motive behind SAHL was to offer a brief, reliable tool for healthcare professionals and researchers to assess health literacy efficiently, without requiring significant time or resources., NVS evaluates health literacy by using a nutrition label from an ice cream container. The motive behind its creation was to provide a brief, easy-to-administer tool that could quickly identify patients at risk of low health literacy.

Moving Beyond Measurement: A New Approach to Health Literacy

Health literacy measurement is just the starting point. What healthcare professionals truly need is a system that goes beyond identifying gaps and instead actively helps patients bridge them. Measuring health literacy without offering a clear, actionable solution is like diagnosing a condition without prescribing treatment—it acknowledges a problem but leaves it unresolved.

That’s where the next generation of health literacy solutions comes in—a system developed in 2024 to meet the evolving needs of today’s healthcare professionals. Unlike traditional tools that only assess inside the clinic, this solution offers a hands-free approach for clinicians requiring minimal provider oversight, ensuring no disruption to valuable face-to-face time in the exam room or additional administrative burdens afterward. For patients, this program can be considered as "self-guided" because it is infused with meaningful learning, meeting individuals where they are at and enabling them to succeed regardless of their starting literacy level. Furthermore, the program needed to be completed in the comfort of the patient’s home, allowing them to focus on learning at their own pace without the stress of being in a clinical environment.

Patient Better was designed with this goal in mind. Unlike traditional literacy measurement tools, Patient Better is built on a proactive framework that gives patients step-by-step guidance on how to manage their health. Through structured education, practical tools, and real-world applications, patients learn how to:

1. Navigate their patient portals and health records.
2. Prepare for appointments by articulating their chief complaints and questions.
3. Complete pre-appointment paperwork with confidence.
4. Manage and track their medications accurately.
5. Communicate more effectively with healthcare providers.

For healthcare professionals, this approach provides a dual benefit:

• Improved patient engagement and outcomes – Educated patients are more likely to follow care plans, resulting in better clinical outcomes.
• Enhanced efficiency and workflow – With patients better prepared and informed, providers can spend less time explaining basic processes and more time delivering care.

By shifting from passive measurement to active engagement, healthcare providers can transform health literacy from a static score into a dynamic process that leads to better outcomes. In short, Patient Better offers a practical solution to a long-standing problem—empowering providers to not only measure but also meaningfully improve patient literacy and, ultimately, their health.

Benefits of an Action-Oriented Health Literacy Solution

The shift from traditional health literacy measurement to a proactive, hands-free solution brings measurable benefits for both patients and healthcare providers. While traditional assessments focus on diagnosing literacy gaps, an action-oriented approach like Patient Better offers a clear path toward closing those gaps, resulting in better healthcare delivery, improved patient outcomes, and increased provider efficiency. Best of all, Patient Better is free, making it the most accessible health literacy tool on the market today.

Here are some key benefits:

1. Improved Patient Engagement and Compliance

When patients are provided with the right tools and education, they feel more confident navigating the healthcare system. Empowered patients are more likely to engage actively in their care—completing pre-appointment paperwork, preparing relevant questions for providers, and adhering to prescribed treatments. As engagement increases, so does compliance, reducing the risk of complications and hospital readmissions.

2. Better Health Outcomes

Health literacy plays a critical role in patient outcomes. Patients who understand their care instructions are better equipped to manage chronic conditions, recognize early warning signs, and make informed decisions. By transforming passive recipients of care into active participants, this solution helps drive significant improvements in clinical outcomes across a range of conditions.

3. Enhanced Efficiency and Reduced Provider Burden

With patients coming into appointments prepared—having completed necessary paperwork, organized their medical history, and articulated their chief complaints—providers can deliver care more efficiently. Less time is spent on repetitive explanations or clarifying basic processes, freeing up valuable time for more in-depth consultations and higher-level care. Additionally, by minimizing administrative burdens, this system reduces burnout risk for clinicians and staff.

4. Higher Patient Satisfaction and Retention

Patients who feel informed and supported throughout their healthcare journey are more likely to trust their providers, leading to higher satisfaction scores. In a competitive healthcare landscape where online reviews and word-of-mouth influence patient choice, a solution that enhances the patient experience can be a key differentiator. Satisfied, well-educated patients are also more likely to remain loyal to a practice, increasing retention rates.

5. Strengthened Provider Reputation and Quality Metrics

Incorporating a health literacy improvement system can positively impact a provider’s reputation, not only through patient satisfaction but also via improved quality metrics. Programs like MIPS (Merit-based Incentive Payment System) reward providers for improving outcomes and patient engagement. By addressing health literacy effectively, providers can achieve better scores in areas such as patient communication, care coordination, and chronic disease management—leading to financial incentives and an enhanced standing within the healthcare community.

Summary: From Measurement to Action—A New Era in Health Literacy

Traditional health literacy measurement tools have long helped providers assess patients' understanding of health information. However, they often fall short by offering no practical way to improve patient outcomes. Without actionable solutions, healthcare professionals are left with data but no means to bridge literacy gaps effectively.

Patient Better offers a groundbreaking solution—a completely free health literacy measurement tool designed for today’s healthcare landscape. Developed by The Patient Better Project Inc., a 501(c)(3) public health educational program, this tool is hands-free for providers, requiring minimal oversight and creating no additional burden during patient visits or administrative tasks. For patients, it’s self-guided and completed at home, providing personalized, meaningful learning at their own pace. This approach encourages stronger provider-patient collaboration, leading to improved engagement, better health outcomes, and enhanced workflow efficiency.

By moving beyond passive assessment to active engagement, Patient Better empowers providers to not only measure health literacy but also meaningfully improve it. As a result, both patients and providers benefit from more efficient, effective care and stronger health outcomes.

We invite you to explore and use this innovative tool in your practice. Visit The Healthcare Proficiency Challenge to see for yourself and to share it as you see fit. Together, we can redefine health literacy and improve healthcare for all.

If you have any further questions, don't hesitate to reach out to me: https://calendly.com/thepatientbetterproject/initial-hcp-discovery-demo