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Adult literacy skills studies indicate that large percentage of adults in most industrialized nations have difficulty using print material to accomplish everyday tasks with accuracy and consistency. Words in signs, postings, and forms within health care settings establish a physical literacy environment and reflect the demands and expectations of the institutions. We report on an assessment of the literacy environment of 10 hospitals in Catalonia, Spain, to indentify factors that hinder or support the ability of people to make their way to and within, a hospital. The authors used standardized rating tools for the evaluation of navigation, specific readability tools for the assessment of written communication, and a patient survey for the evaluation of patients' perception of written and oral communication. Thematic analysis of results indicates insecurity and confusion in finding one's way throughout health care facilities. Readability assessment of selected health education materials and informed consent documents shows extensive use of scientific language that is inappropriate for the general public. Patients' assessment of oral communication was rated high although statistically significant differences exist between hospitals. This assessment offers insight into the literacy demands placed on patients and visitors. [ABSTRACT FROM AUTHOR]