The CAHPS Health Literacy Item Sets focus on assessing providers' activities to foster and improve the health literacy of patients. Health literacy is commonly defined as patients' ability to obtain, process, and understand the basic health information and services they need to make appropriate health decisions. While health literacy depends in part on individuals' skills, it also depends on the complexity of health information and how it is communicated.

There are three Health Literacy Item Sets designed to work with different CAHPS surveys:

  • CAHPS Health Literacy Item Set for Clinicians and Groups
  • CAHPS Health Literacy Item Set for Hospitals (released October 2015)
  • CAHPS Health Literacy Item Set for Health Plans (available on request; contact

The primary goal of these supplemental items for the CAHPS surveys is to measure, from the patients' perspective, how well health information is communicated to them by health care professionals. The development and dissemination of these item sets  is part of a larger effort by the Agency for Healthcare Research and Quality to encourage a greater emphasis in the provider community on patient-centered care.

Where to Find These Item Sets

The Health Literacy Item Sets are incorporated into the general set of supplemental items for each survey, which also includes instructions for placing the items into the core questionnaire. The items are available in English and Spanish. A description of the topics addressed by each item set and the composite measures that can be reported is also provided with each survey.

To download the supplemental items and the descriptive document, go to:

Using These Item Sets To Improve Health Literacy

The Health Literacy Item Sets provide health care providers with information that can help them improve their health literacy practices. The survey can be used to:

  • Identify specific topic areas for quality improvement (e.g., communication about test results, medications, and forms).
  • Recognize particular behaviors that inhibit effective communication (e.g., talking too fast, using medical jargon).
  • Assist in designing a safer, shame-free environment where patients feel comfortable discussing their health care concerns (e.g., showing interest in questions, explaining forms).
  • Measure the effect of behaviors that promote effective communication (e.g., confirming understanding through teach-back, using visual aids).

Learn more from a CAHPS Webcast: Using CAHPS Item Sets that Address Cultural Competence and Health Literacy (April 5, 2011)