Form #3 Form #3 Health Literacy Assessment Questions

Form Approved
OMB No. 0935-XXXX
Exp. Date XX/XX/20XX

Attachment E: Health Literacy Assessment Questions

Health Literacy Assessment Questions

Have several staff members complete the questions on their own, and then come together for a group discussion to review the results. Please refer to Tool 2: Assess Your Practice for more information.

Please select one answer that most accurately describes your practice:
Doing Well	Our practice is doing this well
Needs Improvement	Our practice is doing this, but could do it better
Not Doing	Our practice is not doing this
Not Sure N/A	I don’t know the answer to this question This is not applicable to our practice

Importance: * Beneficial ** More Beneficial *** Most Beneficial

1. Improve Spoken Communication
	Doing Well	Needs Improvement	Not Doing	Not Sure or N/A	Importance	Tools to Help
1. Staff members have received awareness and sensitivity training about health literacy issues.					***	1-Form Team 3-Raise Awareness
2. All levels of practice staff have agreed to support changes to improve patient understanding.					***	1-Form Team 3-Raise Awareness
3. Staff offers everyone help regardless of appearance (e.g., filling out forms, giving directions).					***	3-Raise Awareness 11-Design Material
4. Staff members who have patient contact can identify behaviors that may indicate literacy problems.					*	3-Raise Awareness
5. Staff uses clear oral communication techniques (e.g., uses plain, everyday words, limit to 3-5 main points, and information is specific and concrete).					***	3-Raise Awareness 4-Commun. Clearly
Public reporting burden for this collection of information is estimated to average 30 minutes per response, the estimated time required to participate in this survey.  An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Form Approved: OMB Number 0935-XXXX Exp. Date xx/xx/20xx. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: AHRQ Reports Clearance Officer Attention: PRA, Paperwork Reduction Project (0935-XXXX) AHRQ, 540 Gaither Road, Room # 5036, Rockville, MD 20850. 6. Staff does not use medical jargon when communicating with patients (e.g., not using words like anticoagulant, hypertension, NPO).					***	3-Raise Awareness 4-Commun. Clearly
7. Staff does not talk too fast when communicating with patients.					**	4-Commun. Clearly
8. Staff uses audio/video materials and/or visual aids to promote better understanding and enhance communication with patients (e.g., food models for portion sizes, model of body part, and instructional health videos).					**	4-Commun. Clearly 12-Use Health Ed. Material
9. Clinical staff talks with patients about any education materials they receive during the visit and emphasizes the important information.					***	12-Use Health Ed. Material
10. Staff asks patients to state key points in their own words (i.e., teach-back method) to assess understanding of care instructions.					***	5-Teach Back Method
11. Staff encourages patients to ask questions by using these words: “What questions do you have?” instead of “Do you have any questions?”					**	5-Teach Back Method 14-Enc. Questions
12. Staff uses trained interpreters or language services with patients who do not speak English well.					***	9-Language Differences
13. When staff gives directions for finding the office, they refer to familiar landmarks and public transportation routes as needed.					*	7-Telephone
14. If there is an automated phone system, one option is to speak with a person.					**	7-Telephone
15. If there is an automated phone system, one option is to repeat menu items.					*	7-Telephone
16. When a phone call is answered (either by person or an automated phone system), there is an option to hear information in a language other than English (if appropriate to the needs of your community).					**	7-Telephone

Please select one answer that most accurately describes your practice:
Doing Well	Our practice is doing this well
Needs Improvement	Our practice is doing this, but could do it better
Not Doing	Our practice is not doing this
Not Sure or N/A	I don’t ’know the answer to this question This is not applicable to our practice

Importance: * Beneficial ** More Beneficial *** Most Beneficial

2. Improve Written Communication
	Doing Well	Needs Improvement	Not Doing	Not Sure or N/A	Importance	Tools to Help
17. A sign identifies the location where patients checkin.					**	13-Welcome Patients
18. At least 1 staff member knows how to identify, prepare and simplify written materials so they are easier to read.					***	11-Design Material 12-Use Health Ed. Material
19. Staff pilot test new written materials for appeal and comprehension with a few patients.					***	11-Design Material 12-Use Health Ed. Material
20. Staff have reviewed all of our written materials to check how easy they are to read using a readability formula.					**	11-Design Material 12-Use Health Ed. Material
21. Patient education materials are concise, limit jargon, and are designed using standard techniques to make them easy to read.					***	12-Use Health Ed. Material
22. If appropriate, our written materials are available in languages other than English.					**	12-Use Health Ed. Material 9-Language Differences
23. All clinic forms intended for patient use/data collection are concise, limit jargon, and are designed using standard techniques to make them easy to read.					***	11-Design Material
24. Lab and test results letters are concise, limit jargon, and are designed using standard techniques to make them easy to read (e.g., avoid the use of “positive” or “negative” results).					***	11-Design Material
25. Appointment slips are clear and concise. They provide contact information for patients with questions and, when needed, include preparation instructions that are easy to understand.					***	11-Design Material
26. The name of the practice is clearly displayed on the outside of the building and front door.					*	13-Welcome Patients
27. Office signs use large, clearly visible lettering.					*	13-Welcome Patients
28. Signs are posted throughout the office to direct patients to find appropriate locations (e.g., restrooms, checkout, lab work, etc.).					*	13-Welcome Patients
29. The walls and bulletin boards are not covered with many printed notices. It is easy for anyone to pick out the important information.					*	13-Welcome Patients
30. Office signs use plain, everyday words such as “Walk‐In” and “Health Center” rather than formal words such as “Ambulatory Care” or “Primary Care Practice.”					*	13-Welcome Patients
31. Consistent symbols/graphics are used on signs throughout the facility.					*	13-Welcome Patients
32. Office signs are written in English and in the primary languages of the populations being served (e.g., if most of the patients speak English and Spanish, signs are written in English and Spanish).					*	13-Welcome Patients 9-Language Differences

Please select one answer that most accurately describes your practice:
Doing Well	Our practice is doing this well
Needs Improvement	Our practice is doing this, but could do it better
Not Doing	Our practice is not doing this
Not Sure or N/A	I don’t know the answer to this question This is not applicable to our practice

Importance: * Beneficial ** More Beneficial *** Most Beneficial

3. Improve Self-Management and Empowerment
	Doing Well	Needs Improvement	Not Doing	Not Sure or N/A	Importance	Tools to Help
33. Staff creates an environment that encourages our patients to ask questions and get involved with their care.					***	14 – Enc. Questions
34. Staff encourages patients to write down questions while waiting for their appointment.					*	14– Enc. Questions
35. Clinicians work with patients to discuss health care priorities and develop action plans to promote behavior change.					***	15-Make Action Plans
36. Clinicians and staff have clear roles and responsibilities about teaching patients self-management skills (e.g., dietary advice, using a glucometer or inhaler).					***	12-Use Health Ed. Material
37. Our staff reviews medications with patients at least annually, and after any significant medical event to ensure concordance between patient and clinical recommendations.					***	8-Brown Bag Review
38. Our staff discusses different methods for taking medications correctly and offers patients assistance setting up a system (e.g., pill box, pill chart).					***	16-Medication Adherence
39. Our staff contacts our patients between office visits to ensure understanding or to follow up on plans made during the visit.					***	6-Followup
40. Our practice requests feedback from patients.					***	1-FormTeam 17-Patient Feedback

Please select one answer that most accurately describes your practice:
Doing Well	Our practice is doing this well
Needs Improvement	Our practice is doing this, but could do it better
Not Doing	Our practice is not doing this
Not Sure or N/A	I don’t know the answer to this question This is not applicable to our practice

Importance: * Beneficial ** More Beneficial *** Most Beneficial

4. Improve Supportive Systems
	Doing Well	Needs Improvement	Not Doing	Not Sure or N/A	Importance	Tools to Help
41. Staff assesses patient’s language preference.					***	13-Welcome Patients 9-Language Differences
42. Staff assists patients to find affordable medications and fill out applications as needed.					***	20-Health & Literacy Resources
43. Staff asks patients if they would like help understanding their medical bills or insurance forms.					**	18-Non-Medical Support
44. Staff asks patients if they need extra support and offers to work together with them.					**	18-Non-Medical Support
45. Staff assesses patient’s non-medical barriers and takes initiative to address them and provide appropriate referrals or extra support as needed.					**	18-Non-Medical Support
46. Staff confirms (by mail or phone) patient followthrough after a referral is made.					**	6-Followup
47. Staff maintains an updated list of community resources and refers patients as needed.					**	20-Health & Literacy Resources 18-Non-Medical Support
48. Staff helps patients to access community-based programs (e.g., adult literacy, English for speakers of other languages, stop smoking, weight loss).					**	20-Health & Literacy Resources
49. Staff demonstrates knowledge and sensitivity to patients’ cultural beliefs and customs.					**	10-Culture & Other Consider.