Table 4 List of health literacy skill

S1. demonstrates ability to use common familiar lay terms, phrases and concepts, and appropriately define unavoidable jargon, and avoid using acronyms in oral and written communication with patients

S2. demonstrates ability to follow best-practice principles of easy-to-read formatting and writing in written communication with patients

S3. demonstrates the ability to put information into context by using subject headings in both written and oral communication with patients

S4. demonstrates ability to interpret or write information from a non-plain language format into a scientifically accurate 5th-6th grade reading level

S5. demonstrates ability to speak slowly and clearly with patients

S6. demonstrates ability to use verbal and non-verbal active listening techniques when speaking with patients

S7. demonstrates the ability to use action oriented statements to help patients know what they need to do

S8. demonstrates ability to select culturally and socially appropriate and relevant visual aids, including objects and models, to enhance and reinforce oral and written communication with patients

S9. demonstrates ability to make instructions interactive, such that patients engage the information, to facilitate retention and recall

S10. demonstrates ability to negotiate a mutual agenda for the encounter at the outset of the encounter

S11. demonstrates ability to elicit patients’ prior understanding of their health issues in a non-shaming manner (e.g., asks “what do you already know about high blood pressure?”)

S12. demonstrates ability to non-judgmentally elicit root causes of non-adherent health behaviors

S13. demonstrates effective use of a teach back or “show me” technique for assessing patients’ understanding

S14. demonstrates ability to effectively elicit questions from patients through a “patient-centered” approach (e.g., asks “what questions do you have?” rather than “do you have any questions?”)

S15. demonstrates ability to orally communicate accurately and effectively in patients’ preferred language, using medical interpreter services

S16. demonstrates ability to use written communication to reinforce important oral information

S17. demonstrates ability to emphasize one to three “need-to-know” or “need-to- do” concepts during a given patient encounter

S18. demonstrates the ability to convey numeric information, such as risk, using low numeracy approaches, such as through examples, in oral and written communication

S19. demonstrates ability to write or re-write (“translate”) unambiguous medication instructions (e.g., “take 1 tablet by mouth every morning and evening for high blood pressure,” rather than “take one tablet by mouth twice daily.”

S20. demonstrates ability to ask patients about their learning style preferences (e.g., ask patients, “what is the best way for you to learn new information?”

S21. demonstrates ability to use examples or analogies to improve patients’ comprehension

Items not retained

 • demonstrates ability to recognize, avoid and/or constructively correct the use of medical jargon, as used by others in oral and written communication with patients. (merged with S1)

 • demonstrates ability to recognize plain language principles in written materials produced by others. (merged with S4)

 • demonstrates ability to write in Chinese Mandarin at approximately the 5th-6th grade reading level. (merged with S4)

 • demonstrates ability to elicit the patient’s full set of concerns at the outset of the encounter. (merged with S14)

 • demonstrates ability to “Chunk and check” by giving patients small amounts of information and checking for understanding before moving to new information

 • demonstrates the ability to assess the usability of web-based patient resources