Implications of Health Literacy for Public Health: Workshop Summary (2014)
Chapter: Appendix D: Revised Questions for Nebraska Survey
Appendix D
Revised Questions for Nebraska Survey
State Added 3: Health Literacy – Path A & B
Now I would like to ask you some questions about health forms that you fill out and health information that you read.
SA.3.1 Health forms include insurance forms, questionnaires, doctor’s office forms, and other forms related to health and healthcare. In general, how confident are you in your ability to fill out health forms yourself? Would you say…
Please read:
1. Extremely Confident
2. Somewhat Confident
3. Not at all Confident
Do not read:
7. Don’t know / Not sure
8. Do not fill out health forms
9. Refused
SA.3.2 You can find written health information on the internet, in newspapers and magazines, on medications, at the doctor’s office, in clinics, and many other places. How often is health information written in a way that is easy for you to understand? Would you say…
Please read:
1. Always
2. Nearly Always
3. Sometimes
4. Seldom
5. Never
Do not read:
7. Don’t know / Not sure
8. Have not gotten health information to read
9. Refused
SA.3.3 People who might help you read health information include family members, friends, caregivers, doctors, nurses, or other health professionals. How often do you have someone help you read health information? Would you say…
Please read:
1. Always
2. Nearly Always
3. Sometimes
4. Seldom
5. Never
Do not read:
7. Don’t know / Not sure
8. Have not gotten health information to read
9. Refused
