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Quizzify's Health Literacy Matrix

Updated: Jan 14


We recently announced our revolutionary Health Risk Assessment (HRA), which brings an old tool into a new era. Our HRA design:

  • Addresses a wide range of overlooked risk factors (opioids, health illiteracy, everyday hazard avoidance).

  • Offers pertinent but overlooked advice (shingles vaccines, tick bites, texting while driving).

  • Creates an honest approach to employee assessment.

Now, Quizzify is bringing coaching strategy into a new era. Similar to HRAs, current coaching technique has stagnated. The advice is some variation of “eat less and exercise more.”

That’s because current tools measure only biometric and self-assessed cardiometabolic risk, which turns out to be a small fraction of what drives employer health care spending. The findings are therefore narrow, even though the tools are expensive.

But what if, for not much more than the cost of screening alone, you could dramatically increase the effectiveness of the coaching that follows it? Instead of the solitary data stream of risk scores, consider what happens if you merge risk scores with a second data stream—health literacy.


Suddenly, you have insight. Two streams of very complementary data offer far more than double the insight than a single data stream. For instance, suppose you’re watching a show with the volume off. No matter the action you see onscreen, you can’t really decipher the plot until you turn up the sound (with the possible exception of The Three Stooges). The second data stream makes all the difference.

Our four-square matrix was inspired by Sustainable Health Index (SHI), a next-generation coaching company. Their model generates an intervention tailored both to health risk and health literacy (and is validated by the Validation Institute, as we are). We learned from SHI that a raw Quizzify score isn’t enough to determine literacy. The questions to ask are: How did they get to that score? How many quizzes did they take? How often did they hit the “learn more” key after a question? Did they earn their “bonus points” for timeliness?

SHI (at times incorporating Quizzify) scores their horizontal axis based on additional variables, but the implication is the same: the coaching conversation should be tailored to both dimensions, not risk scores alone.

Let’s examine Quizzify’s matrix, quadrant by quadrant, starting with the highest-risk and lowest-literacy group, the red quadrant.

In the red quadrant, the conversation protocol is the same: people are high-risk because they may not know any better–they may be high-risk specifically because they are low-literacy. If people genuinely don’t know what to do, standard coaching would help. If anything, a more intensive standard intervention is called for, versus what is provided now.

Yet that very same coaching protocol backfires when used on employees who already know the protocols, the top-right yellow quadrant. They just get annoyed. Imagine doing everything you can to lose weight, only to have a coach tell you to lose weight. Imagine trying to squeeze in time for exercise between your job, commute and family obligations, only to have a coach tell you to exercise more.

At best, conventional coaching is wasted on that employee. At worst, it stirs resentment. The opposite approach, such as: “We see how hard you’re trying. What can we do to help?” may be more effective. At the very least it would not backfire. It could even spark a conversation that might uncover stumbling blocks that can readily be addressed. (SHI’s coaching specifically focuses on these.)

Meanwhile, the bottom-left yellow quadrant is an accident waiting to happen. Using the conventional solitary assessment of risk, few wellness vendors would propose coaching and few companies would pay for it. And yet, the lower-left is likely the largest quadrant, because most people are not high risk, and only 12% are health literate. Vendors with concerns about diabetes can use this argument to focus their coaching to get ahead of diabetes risks…and employers whose employees have long tenures should readily agree.

That leaves the green quadrant, where we’d ultimately like all employees to reside. Not many do…but Quizzify offers a solution for them, too. Unlike wellness “challenges,” in which, typically, only the people who are already healthy compete and collect the incentives, both employees with low health literacy and high health literacy can learn from Quizzify, each month.

For instance, you yourself are likely health-literate because you have the job you’re in, you’ve generally recognized the value of health literacy, and you’ve self-selected to read this posting–all the way through, no less. But despite your self-evident health literacy, there is still much you can learn. For instance, we’ll bet you didn’t know that most of the 4 million cavities children get every year don’t need to be filled, avoiding considerable expense and trauma (you’ll learn more about that in a future blog post).

Try out a sample quiz to see for yourself how Quizzify increases health literacy.