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。
In the last 12 months, have you had at least one clinic, hospital, or telehealth visit?
- Yes
- No
How confident are you in your ability to fill out medical forms by yourself?
In the last 12 months, did you use a patient portal or app to view your health information?
- Yes
- No
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
Please rank the following from most to least preferred for receiving important health instructions or results.
- Printed handout
- Text or SMS
- Patient portal or app
- Phone call or voicemail
- Short video
- In-person demonstration
Based on your responses in this survey, is there anything else that would make health information easier for you to understand?
What is your age?
- 18–24
- 25–34
- 35–44
- 45–54
- 55–64
- 65–74
- 75 or older
- Prefer not to say
Thank you for participating. Your feedback helps us make health information clearer and easier to use for everyone.
Which language do you prefer for health information?
- English
- Spanish
- Chinese
- Vietnamese
- Arabic
- Other (please specify)
Overall, how easy or difficult was it to understand the written health information you received in the last 12 months?
How clear was the health information displayed on the patient portal or app?
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
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
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.
How do you describe your gender?
- Woman
- Man
- Non-binary
- Prefer to self-describe
- Prefer not to say
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
In the last 12 months, did you have any telehealth (video or phone) visits?
- Yes
- No
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
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
Please list any medical words, phrases, or sections of documents that were confusing to you in the last 12 months.
During your telehealth visits, how often did you fully understand what to do after the visit ended?
If we could simplify only a few areas of health information, which would help you the most? Please rank from most to least important.
- Medication instructions
- Test and lab results
- Insurance and billing
- Consent and legal forms
- Discharge and follow-up instructions
- Appointment scheduling
What is your current employment status?
- Full-time
- Part-time
- Self-employed
- Homemaker or caregiver
- Student
- Retired
- Not currently employed
- Prefer not to say
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 FormsThis 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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