Health Literacy

What is Health Literacy?

The Health Resources and Services Administration (HRSA) defines health literacy as the degree to which individuals have the capacity to obtain, process and understand basic health information needed to make appropriate health decisions and services needed to prevent or treat illness.

mother and daughterThe National Network of the Libraries of Medicine (NNLM) expands this definition: "Health literacy includes the ability to understand instructions on prescription drug bottles, appointment slips, medical education brochures, doctor's directions and consent forms, and the ability to negotiate complex health care systems. Health literacy is not simply the ability to read. It requires a complex group of reading, listening, analytical, and decision-making skills, and the ability to apply these skills to health situations.

Health literacy varies by context and setting and is not necessarily related to years of education or general reading ability. A person who functions adequately at home or work may have marginal or inadequate literacy in a health care environment. With the move towards a more 'consumer-centric' health care system as part of an overall effort to improve the quality of health care and to reduce health care costs, individuals need to take an even more active role in health care related decisions. To accomplish this people need strong health information skills.

Why is Health Literacy Important?

NNLM (see above) notes "According to the American Medical Association, poor health literacy is "a stronger predictor of a person's health than age, income, employment status, education level, and race" (Report on the Council of Scientific Affairs, Ad Hoc Committee on Health Literacy for the Council on Scientific Affairs, American Medical Association, JAMA, Feb 10, 1999). In Health Literacy: A Prescription to End Confusion, the Institute of Medicine reports that ninety million people in the United States, nearly half the population, have difficulty understanding and using health information. As a result, patients often take medicines on erratic schedules, miss follow-up appointments, and do not understand instructions like "take on an empty stomach".


In addition to the effects of low health literacy on the individual patient, there are economic consequences of low health literacy to society. The National Academy on an Aging Society estimated that additional health care costs due to low health literacy were about $73 billion in 1998 dollars (Health Literacy Fact Sheet,


What can Providers do to Improve Health Literacy?

HRSA (see above) notes that health care professionals can improve communications with patients and families by:

  • Identifing patients with limited literacy levels
  • Using simple language, short sentences and define technical terms
  • Supplementing instruction with appropriate materials (videos, models, pictures, etc.)
  • Asking patients to explain your instructions (teach back method) or demonstrate the procedure
  • Asking questions that begin with “how” and “what,” rather than closed-ended yes/no questions
  • Organizing information so that the most important points stand out and repeat this information
  • Reflecting the age, cultural, ethnic and racial diversity of patients
  • For Limited English Proficiency (LEP) patients, providing information in their primary language
  • Improving the physical environment by using lots of universal symbols
  • Offering assistance with completing forms

What can Families do to Improve Health Literacy?

One approach that families/patients can use to improve communications with providers is  Ask Me 3, a patient education program designed to promote communication between health care providers and patients in order to improve health outcomes. The program encourages patients to understand the answers to three questions:

1. What is my main problem?
2. What do I need to do?
3. Why is it important for me to do this?

Patients should be encouraged to ask their providers these three simple but essential questions in every health care interaction. Likewise, providers should always encourage their patients to understand the answers to these three questions.