I have reviewed multiple health literacy instruments. The most popular are REALM, TOFHLA, Newest Vital Sign (NVS), and HLS-EU-Q (and their modifications/lingual adaptations).

I've noticed that health literacy tests were mostly focused on reading and numeracy skills. However, there are multiple aspects of health literacy, including noticing/tracking symptoms, remembering and applying newly-acquired medical knowledge, patient's capability of discussing (or sometimes arguing) with a doctor or insisting on taking some tests. Of course, it is not possible to measure all of the aspects of health literacy given the shortage of time for healthcare personnel.

I would appreciate it if you share some methods or techniques you use to understand a patient's health literacy (or identify low-literate patients).

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