Cognitive Progression Sets

Transforming health education instruction to improve health literacy in the 21st century requires students to use higher order thinking skills to apply their health knowledge in relevant ways.

Using the HEAP skill cues developed for the National Health Education Standards, the HEAP Health Literacy project developed sets of assessment items that demonstrate a progression of cognitive complexity. The cognitive progression sets ("Cog Sets") have been developed for middle and high school grade levels and are based on the 6 levels in Bloom's Revised Taxonomy (Remembering, Understanding, Applying, Analyzing, Evaluating, and Creating). Cog Sets address health skills such as accessing information, decision-making, goal-setting, and advocacy.

The Cog Sets are used to support teachers' professional development in improving their instructional practices. They are also used by teachers to help students delve deeper into the process of health skills.

Example of a Cognitive Complexity Progression:

Health Skill Being Assessed: Accessing Information
Grade Level: High School

Scenario: Maria and Michael are talking about HIV and she is concerned that Michael has many misconceptions about the transmission of this disease. She wants to provide Michael with accurate information. She identifies the local health department, the Centers for Disease Control and Prevention, and the library, as three sources she could use. She has also identified the following criteria to determine if these sources are valid and reliable:

  • Currency – the timeliness of the information
  • Relevance – the importance of the information for your needs
  • Authority – the source of the information
  • Accuracy – the reliability, truthfulness, and correctness of the information content
  • Purpose – the reason the information exists.

The following assessment progressions build upon the above scenario:

  1. Remembering: The first level of Bloom's revised taxonomy, "remembering", is incorporated into the scenario above to ensure students have the basic content needed to answer questions requiring higher cognitive demand.
  2. Understanding: In your own words, explain the meaning of each criterion Maria chose to determine the validity of the sources.
  3. Applying: Illustrate how Maria would use validity criteria to determine if the three sources she chose are valid.
  4. Analyzing: Use validity criteria to compare and contrast three sources of information on HIV information.
  5. Evaluating: Evaluate each source in terms of their validity and justifying your judgment.
  6. Creating: Develop a poster, web-page, or school newspaper article that informs the student body about the facts of HIV/AIDS. Include valid sources of information and the types of services that students can access to prevent HIV. Write a report on how you identified these sources and the process you went through to establish the validity of these sources.


As trained teachers begin to understand and use these progressions, the hope is that they will be able to create personalized assessments that can build towards higher levels of cognitive demand.

Example of Classroom Use:

"I can already see myself using these prompts as journal entries, building on the complexity day-to-day, and then having my students identify the differences in the levels of the prompts."

"The cognitive complexity component is a very rich resource that repeatedly illustrates the depth of teaching and learning. This can be a strong component to our Standards and Assessment II training in South Dakota. The participants are shown illustrations of assessment results using selected response items and constructed response items. The degree of richness in the students' evidence of knowledge and skills gained becomes increasingly clear as the test author becomes more assessment-savvy with regard to cognitive complexity.

– Rhonda Kemmis, Health Teacher, South Dakota