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Health Literacy Considerations for All Health Professionals

 October 2013

The Problem

Most healthcare professionals are aware of the problems patients have in deciphering the myriad instructional sheets, brochures, appointment slips, authorization forms and educational materials placed in their hands, but the extent to which patients have these problems is not so well understood. It is recommended that these health-related materials for patients do not exceed a fifth-grade level, yet most of these materials are written at a 10th-grade level.

Many people would be shocked to know that, according to the Institute of Medicine, nine out of 10 adults are unable to read and process information related to their own health status and healthcare! Health literacy is affected by basic literacy, English language proficiency, cognitive status, visual impairment and other issues. Health implications for these individuals include longer hospitalizations, more office visits and higher numbers of prescription medications—all the more reason to make certain that reading materials for patients meet their literacy needs.


At a time when the priority for healthcare consumers is to participate as fully as possible in the management of chronic health issues and prevent unnecessary trips to providers and admissions to hospitals, the lack of health literacy has enormous implications for health status, outcomes and costs. Amplifying this last point is a study done by Health Literacy Innovations, which found that the average annual cost of healthcare for those who are proficient in health literacy is $3,000, while the cost for those with limited health literacy is $13,000.

To address this crisis, the Institute of Medicine convened a roundtable on health literacy in 2010, the first of its kind to address this issue. The meeting raised issues for further work on health literacy, its relationship to health disparities, and how information technology might improve health literacy. A range of resources resulting from this meeting, and on the issue of health literacy, are available for free here

The Strategies

In order to address the health literacy of healthcare consumers, the healthcare professionals educating them and developing their educational resources should use the following basic process, recommended by Health Literacy Innovations, to increase the likelihood of successful messaging:

  • Write in the first person.Use simple language and words of one or two syllables.
  • Write in a conversational tone.
  • Use an active voice in communications.
  • Keep sentences and paragraphs short.
  • Consider vision impairments when selecting font and font size.
  • Lay out materials with sufficient white space to keep materials easy to read.
  • Add graphics that help simplify the message.
  • Evaluate materials for readability and literacy level.

The Resources

Abundant resources are available to help in the development and assessment of health educational materials for patients. Commercial products are available that can review texts for words that need to be replaced, and that can help in creating a design and layout that facilitates information uptake. Also, several educational institutions, independent organizations and federal government agencies, including the Agency for Healthcare Research and Quality, the Centers for Disease Control and Prevention, and the National Institutes of Health, provide a range of resources in both developing and assessing materials. A few of the most helpful online resources are listed below.

  • Agency for Healthcare Research and Quality: The AHRQ has developed many web resources for creating materials and messages that are more easily understood by those with low health literacy levels, including a guide for hospitals: "Improving Patient Safety Systems for Patients with Limited English Proficiency."
  • Centers for Disease Control and Prevention: The CDC has developed a Gateway to Health Communication and Social Marketing Practice webpage. Here you can access many resources to help build your health communication or social marketing campaigns and programs. One such resource, CDCynergy, is a multimedia CD-ROM used for planning, managing and evaluating public health communication programs. The planning model is designed to guide the user through systematically conceptualizing, planning, developing, testing, implementing and evaluating health communication activities, while promoting accountability and the importance of evaluation.
  • National Quality Forum: The NQF's report "Improving Patient Safety through Informed Consent for Patients with Limited Health Literacy" is designed to provide an overview of major issues related to informed consent for all patients, particularly those with limited health literacy.
  • Health Resources and Services Administration: The HRSA offers health professionals free, interactive, self-paced modules, including "Effective Communication Tools for Healthcare Professionals," a course designed to improve health literacy skills.
  • Harvard School of Public Health: The Harvard School of Public Health provides many health literacy materials, including one resource that may be of particular interest: a glossary of appropriate terminology to use when creating educational materials around health issues, such as arthritis, asthma and lupus.
  • National Center for Education Statistics: The NCES's report, "The Health Literacy of America's Adults: Results from the 2003 National Assessment of Adult Literacy" is based on assessment tasks designed specifically to measure the health literacy of adults living in the United States.
  • National Patient Safety Foundation: The NPSF's Ask Me 3 patient education program is designed to promote communication between healthcare providers and patients in order to improve health outcomes. Ask Me 3 is sponsored by the Partnership for Clear Health Communication, a national coalition of health organizations that are working together to promote awareness and solutions for low health literacy. The site includes presentation toolkits for professionals and patients, fact sheets, brochures, statistics, logos, guidelines and more.