모든 템플릿

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.

샘플 질문

템플릿에 포함된 내용을 미리 확인해 보세요. 모든 질문은 설문 공개 전에 자유롭게 수정할 수 있습니다.

질문 25개 · 약 11분
Q01
메시지

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
객관식

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

  • Yes
  • No
Q03
의견 척도

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

척도: 17
최소:Not at all confident최대:Extremely confident
Q04
객관식

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

  • Yes
  • No
Q05
객관식

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
순위 매기기

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
드래그하여 순위 지정
Q07
장문형

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

Q08
드롭다운

What is your age?

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

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

Q10
객관식

Which language do you prefer for health information?

  • English
  • Spanish
  • Chinese
  • Vietnamese
  • Arabic
  • Other (please specify)
Q11
의견 척도

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

척도: 17
최소:Very difficult최대:Very easy
Q12
의견 척도

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

척도: 17
최소:Not at all clear최대:Extremely clear
Q13
객관식

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
객관식

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 인터뷰

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
객관식

How do you describe your gender?

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

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
객관식

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

  • Yes
  • No
Q19
객관식

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
드롭다운

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
장문형

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

Q22
의견 척도

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

척도: 17
최소:Never최대:Always
Q23
순위 매기기

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
드래그하여 순위 지정
Q24
드롭다운

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
드롭다운

In which country do you currently live?

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

포함된 기능

  • AI 후속 질문

    정형화된 설문이 놓치는 세부 내용을, 주관식 답변에 맞춰 AI가 심층 질문으로 끌어냅니다.

  • 주의력 확인 장치

    성의 없는 답변과 저품질 응답자를 걸러내는 내장 안전장치입니다.

  • AI가 작성한 문안

    문구, 질문 순서, 분기 로직까지 AI가 연구 목표에 맞춰 작성합니다.

  • 자동 리포트

    응답이 모이면 주요 주제, 인용문, 이해하기 쉬운 요약이 자동으로 작성됩니다.

다른 서비스와 비교

다른 설문 도구의 가장 유사한 템플릿을 검토했습니다. 그 도구들이 잘하는 점과, 이 템플릿이 한발 더 나아가는 지점을 정리했습니다.

이 템플릿을 선택하는 이유

  • 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.

잘하는 점

  • 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

아쉬운 점

  • 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

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