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Patient Education

Health Literacy

As outlined by the Health Resources & Services Administration (HRSA), health literacy is best understood as the "[d]egree to which individuals have the capacity to obtain, process, and understand basic health information needed to make appropriate health decisions."

Recently, a proposal to expand the definition of health literacy was put forth by the Secretary's Advisory Committee on National Health Promotion and Disease Prevention Objectives for 2030, the group tasked with the revising the Healthy People Initiative, also known as Health People 2030. This new proposed definition identified two separate components that make up the wider subject of health literacy. They are:

Personal health literacy: the degree to which individuals have the ability to find, understand, and use information and services to make informed health-related choices and actions for themselves and others.

Organizational health literacy: the degree to which organizations equitably enable individuals to find, understand, and use information and services to make informed health-related choices and actions for themselves and others.

Personal health literacy requires a collection of skills associated with reading, listening, analytical, and decision-making, along with the ability to appropriately apply these skills to relevant health scenarios.

In terms of organizational health literacy, health-based institutions can provide support to their employees that will allow healthcare professionals to positively enable their patients to find, understand, and use information and services to make informed health-related choices and actions for themselves and others. Examples of what healthcare professionals can do include...

  • Identify patients with limited or notice literacy skills
  • Utilize simple or plain language, short sentences, and offer definitions for technical terms when appropriate
  • Supplement instruction with visual materials such as videos, models, or pictures
  • Ask patients to explain provided instructions back to the physician (also known as the teach back method) or demonstrate a procedure
  • Ask questions that begin with "how" and "what: rather than relying solely on yes or no questions
  • Structure information so that the most essential points stand out and frequently repeat the same information
  • Have information available in multiple non-English languages to accomodate limited English proficiency patients (LEP)
  • Improve environments through the use of universal symbols
  • Offer assistance with competing forms

Skills associated with health literacy 

  • Visual literacy -- the user is able to understand and interpret visual information such as graphs and charts
  • Computer literacy -- the user able to operate a computer or smart device 
  • Information literacy -- the user is able to obtain, interpret, evaluate, and apply relevant information 
  • Computational literacy -- the user is able to calculate or reason numerically
  • Oral language skills -- the user is able to describe their symptoms, articulate health concerns, ask pertinent questions, and understand spoken medical advice or directions

With these skills, patients should be able to....

  • Access health care services
  • Analyze relative risks and benefits
  • Calculate appropriate dosages
  • Communicate needs and wants with healthcare providers
  • Evaluate information for credibility, quality, and relevancy
  • Interpret and test results
  • Locate appropriate, quality health information

Numerous well-validated instruments are available for assessing patient health literacy.  It is important to provide a shame-free environment with patients with low health literacy, so interacting with everyone as if they are at risk of not understanding health information is the best approach. The U.S. Department of Health & Human Services Agency for Healthcare Research and Quality (AHRQ) recommends a Universal Precautions approach. These precautions are aimed at:

  • Simplifying communication with and confirming comprehension for all patients, so that the risk of miscommunication is minimized.
  • Making the office environment and health care system easier to navigate. 
  • Supporting patients’ efforts to improve their health.