すべてのテンプレート
Healthcare & Clinical

Patient Health Literacy & Plain Language Assessment

Measures how well patients understand medical information across print, digital, and telehealth channels. Designed for healthcare communicators seeking to identify comprehension barriers and optimize plain-language materials.

設問の例

テンプレートの内容をプレビューできます。すべての設問は公開前に自由に編集できます。

全25問・約11分
Q01
メッセージ

Thank you for taking part in this survey about understanding health information. Your responses are voluntary and confidential — you may stop at any time. There are no right or wrong answers; we are interested in your honest opinions. Your answers will be combined with those of other participants and reported only in aggregate. This survey takes approximately 8 minutes. Please think about your most recent clinic, hospital, or telehealth visit in the last 12 months as you answer.

Q02
選択式

In the last 12 months, have you had at least one clinic, hospital, or telehealth visit?

  • Yes
  • No
Q03
オピニオンスケール

How confident are you in your ability to fill out medical forms by yourself?

スケール: 1 – 7
最小:Not at all confident最大:Extremely confident
Q04
選択式

In the last 12 months, did you use a patient portal or app to view your health information?

  • Yes
  • No
Q05
選択式

Which of the following do you currently have access to? (Select all that apply)

  • Smartphone
  • Computer or tablet
  • Home internet or Wi-Fi
  • Screen reader or text-to-speech software
  • None of these
Q06
ランク付け

Please rank the following from most to least preferred for receiving important health instructions or results.

  1. Printed handout
  2. Text or SMS
  3. Patient portal or app
  4. Email
  5. Phone call or voicemail
  6. Short video
  7. In-person demonstration
ドラッグして順位を付ける
Q07
自由回答(長文)

Based on your responses in this survey, is there anything else that would make health information easier for you to understand?

Q08
プルダウン

What is your age?

  • 18–24
  • 25–34
  • 35–44
  • 45–54
  • 55–64
  • 65–74
  • 75 or older
  • Prefer not to say
Q09
メッセージ

Thank you for participating. Your feedback helps us make health information clearer and easier to use for everyone.

Q10
選択式

Which language do you prefer for health information?

  • English
  • Spanish
  • Chinese
  • Vietnamese
  • Arabic
  • Other (please specify)
Q11
オピニオンスケール

Overall, how easy or difficult was it to understand the written health information you received in the last 12 months?

スケール: 1 – 7
最小:Very difficult最大:Very easy
Q12
オピニオンスケール

How clear was the health information displayed on the patient portal or app?

スケール: 1 – 7
最小:Not at all clear最大:Extremely clear
Q13
選択式

Which of the following would help you when reading health information? (Select all that apply)

  • Larger text or print
  • Audio versions or text-to-speech
  • Captions on videos
  • High-contrast colors
  • None of these
Q14
選択式

Which of the following formats help you understand health information best? (Select all that apply)

  • Bullet-point lists
  • Step-by-step checklists
  • Pictures or diagrams
  • Simple real-life examples
  • Medical term with plain-language definition
  • Translated materials in my language
  • Large print
Q15
AIインタビュー

We'd like to learn a bit more about your experience. An AI interviewer will ask you a couple of follow-up questions about understanding health information.

Q16
選択式

How do you describe your gender?

  • Woman
  • Man
  • Non-binary
  • Prefer to self-describe
  • Prefer not to say
Q17
選択式

In the last 12 months, which types of health information were difficult for you to understand? (Select all that apply)

  • Appointment reminders
  • Consent forms
  • Discharge or visit instructions
  • Bills and statements
  • Lab or test results
  • Medication labels or instructions
  • Insurance or coverage documents
  • None of these were difficult
Q18
選択式

In the last 12 months, did you have any telehealth (video or phone) visits?

  • Yes
  • No
Q19
選択式

Which of the following materials would you most like to have available in your preferred language? (Select all that apply)

  • Appointment reminders
  • Consent forms
  • Visit or discharge instructions
  • Bills and statements
  • Lab or test results
  • Medication labels
Q20
プルダウン

What is the highest level of education you have completed?

  • Less than high school
  • High school or GED
  • Some college or trade school
  • Associate degree
  • Bachelor's degree
  • Graduate or professional degree
  • Prefer not to say
Q21
自由回答(長文)

Please list any medical words, phrases, or sections of documents that were confusing to you in the last 12 months.

Q22
オピニオンスケール

During your telehealth visits, how often did you fully understand what to do after the visit ended?

スケール: 1 – 7
最小:Never最大:Always
Q23
ランク付け

If we could simplify only a few areas of health information, which would help you the most? Please rank from most to least important.

  1. Medication instructions
  2. Test and lab results
  3. Insurance and billing
  4. Consent and legal forms
  5. Discharge and follow-up instructions
  6. Appointment scheduling
ドラッグして順位を付ける
Q24
プルダウン

What is your current employment status?

  • Full-time
  • Part-time
  • Self-employed
  • Homemaker or caregiver
  • Student
  • Retired
  • Not currently employed
  • Prefer not to say
Q25
プルダウン

In which country do you currently live?

  • United States
  • United Kingdom
  • Canada
  • Australia
  • Other
  • Prefer not to say

含まれる機能

  • AIによる深掘り

    自由回答に合わせてAIが追加で質問し、固定のフォームでは拾えない具体的な内容を引き出します。

  • 注意確認設問

    急いだ回答や質の低い回答者を除外する仕組みを標準で備えています。

  • AIが作成する設問文

    文言、設問の順序、条件分岐をAIが調査の目的に合わせて作成します。

  • 自動レポート

    回答が集まると、テーマ、引用、わかりやすい要約が自動で作成されます。

他ツールとの比較

ほかのアンケートツールで最も近いテンプレートを調べました。それぞれの優れている点と、このテンプレートがさらに踏み込んでいる点をまとめています。

このテンプレートを選ぶ理由

  • Combines structured comprehension checks (opinion scales on form-filling confidence, understanding written materials, telehealth follow-up instructions) with an open-text question asking patients to name specific confusing words or document sections
  • Segments understanding across print, patient portal/app, and telehealth channels separately, rather than treating 'health information' as one undifferentiated category
  • Uses ranking questions to prioritize which formats and topics patients most want simplified, giving healthcare communicators an actionable priority list, not just satisfaction scores
  • Closes with an AI follow-up interview that can probe deeper into a patient's specific comprehension barriers, something no static form in this space offers

Jotform

600+ Healthcare Assessment Forms

This is a broad category/index page listing hundreds of healthcare-related form templates (intake, consent, screening, satisfaction, etc.), not a dedicated health literacy or plain-language comprehension assessment. A researcher would need to search within the library and likely build a comprehension-specific survey from scratch or heavily customize an existing form. Useful as a starting point for generic healthcare data collection, not for measuring patient understanding of medical language.

優れている点

  • Very large template library covering many healthcare use cases
  • Drag-and-drop form builder likely allows customization to add literacy-related questions
  • Established platform with broad healthcare-sector adoption

物足りない点

  • No template specifically designed to measure health literacy or plain-language comprehension across print, portal, and telehealth channels
  • Static form fields only — no adaptive AI follow-up questioning to probe why a patient found information confusing
  • No built-in automated quality scoring or transparent prompt methodology for interpreting comprehension gaps

よくあるご質問

「Patient Health Literacy & Plain Language Assessment」テンプレートにはどのような設問が含まれていますか?

すぐに使える設問が25問含まれており、最初の設問は次のとおりです:「Thank you for taking part in this survey about understanding health information. Your responses are voluntary and confi…」・「In the last 12 months, have you had at least one clinic, hospital, or telehealth visit?」・「How confident are you in your ability to fill out medical forms by yourself?」。すべての設問は上でプレビューでき、自由に編集できます。

このアンケートの回答にはどのくらい時間がかかりますか?

回答者は通常、25問を約11分で回答し終えます。

テンプレートは編集できますか?

はい。公開前であれば、すべての設問、選択肢、順序を編集できます。設問の追加や削除のほか、調査の目的に合わせた作り直しをAIエディターに依頼することもできます。

このテンプレートは無料で使えますか?

はい。エディターで開けば、すぐに編集を始められます。お試しにアカウントは不要で、無料プランでアンケートを公開できます。

公開の準備はできましたか?

このテンプレートをエディターで開いてみてください。最初の回答者が目にする前に、すべてを自由に変更できます。

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