10 Steps to Better Health Through Improved ‘Health Literacy’

Toni Cordell recounts the story of feeling comforted when told by her doctor that her medical concern could be solved with an easy surgery. She agreed to proceed without asking further questions and didn’t understand the medical consent forms because she didn’t read well. 

At a follow-up office visit a couple of weeks after the procedure, Cordell was shocked when the nurse asked, “How are you feeling since your hysterectomy?”

Cordell thought to herself, “How could I be so stupid as to allow somebody to take part of my body and I didn’t know it?” She admits that although she graduated high school, she only had a fifth-grade reading level, which she had always tried to hide from others.

Cordell’s story is well known and unfortunately all too common, and it reflects the widespread problem of limited “health literacy.” Other examples of health literacy difficulties include incorrect use of medicines, filling out medical forms incormpletely, failure to carry out health care instructions, and making unhealthy lifestyle choices like smoking, poor diet, and lack of exercise.

What is health literacy?

Health literacy is defined as “obtaining, processing, understanding, and communicating health-related information to make informed health decisions.” It is related to overall academic ability, but even very intelligent, well-educated persons can have significant difficulties understanding health information.

How big is the problem?

A large US national survey found that more than one-third (36%) of adults lack sufficient literacy to adequately understand and carry out basic health care instructions and medical treatments and nearly 9 out of 10 (88%) have at least some difficulty with everyday health information routinely used in our health care system.

Who is at highest risk?

Health literacy is affected by a person’s age, culture, native language, academic abilities and a host of other factors. Past experiences with the health care system, how complex the health information is, and how the information is communicated all impact someone’s understanding. Higher-risk groups for poor health literacy include people over age 65, those with less than a high school education, ethnic minority groups, and persons with no health insurance.

What are the consequences?

People with poor health literacy not only don’t understand health information well, they are more prone to unhealthy behaviors, more medication errors and poorer overall health. In fact, a person’s level of health literacy is the single best predictor of their overall health status. Longer term effects include more chronic illness and disability, lost wages and poorer quality of life. All of these consequences from limited health literacy translate into extra health care costs, estimated at upwards of $200 billion dollars per year.

How can you tell if someone is struggling?

Poor health literacy has been referred to as a “hidden epidemic” because you can’t tell just by looking at someone that they are having difficulties. Most people go to great lengths to conceal their limitations and will not usually say they are having trouble understanding health information. Silence, shame, fear, anxiety and low self-esteem are common psychological reactions when someone has limited health literacy.

There are a few noticeable “red flags” which can indicate limited health literacy. These include poor grammar, incomplete or misspelled paperwork, lack of follow through with health care instructions or appointments, and statements like “I forgot my glasses” when given written information. Inability to name medications or state their purpose, and referring to pills by shape or color instead of by name can be other possible clues.

What are health care providers doing to address health literacy issues?

Many health care professionals are well aware of the problems associated with poor health literacy. In basic training on this issue, they are encouraged to do the following to have more clear and effective communication about health information:

  • Ask everyone if they have any difficulty understanding health information
  • Speak clearly and at a moderate pace
  • Use plain, non-technical language
  • Use concrete, simple examples
  • Use written materials developed at about a 6th grade reading level
  • Use graphics or illustrations for further clarity
  • Create a shame-free environment
  • Make people feel comfortable asking questions
  • Offer assistance in completing written forms
  • Ask about patients’ questions and concerns
  • Have patients repeat or “teach back” the health instructions
  • Limit the amount of information and repeat key points as needed

What can you do to improve your health literacy?

Clear communication between you and your health care professionals is critical. Here are 10 simple but incredibly important steps you should take when you see your doctor, pharmacist or other health care providers to help you improve your health literacy:

  1.   Bring a list of all medicines, vitamins & supplements with you to the visit.
  2.   Ask for an interpreter if you don’t understand the native language well.
  3.   Bring along a list of questions.
  4.   Listen carefully.
  5.   Take notes.
  6.   Bring a family member to help you.
  7.   Ask about anything you don’t understand.
  8.   Repeat back the provider’s instructions to see if you have them right.
  9.   Do your best to follow through with the recommended health instructions.
  10.   Use pill organizers and reminders for complicated medication schedules.

What are the benefits of improved health literacy?

There are several significant benefits from better comprehension of health information. Former U.S. Surgeon General Richard Carmona, MD said, “Health literacy can save lives, save money, and improve the health of millions.” On a more personal level, you will more fully understand your treatment plan and its purpose, be in a better position to carry out and maintain recommended health instructions, and have less possible or actual negative health effects or complications. The main payoff however, is that you will feel better and improve your overall state of health!

So, here’s a question: What can you do now to improve your health literacy? Please leave a comment. Also please consider subscribing to my blog and feel free to follow me on Twitter, “like” my Facebook page, or connect on LinkedIn. Thanks!


US Department of Health and Human Services: Quick Guide to Health Literacy http://www.health.gov/communication/literacy/quickguide/Quickguide.pdf

  • Marcie Timmerman

    Paying attention to the teach-back is good for health literacy at any level. Providers are typically dealing with people who are sick – physically, mentally, even all of the above. Even when a patient presents as intelligent and educated, illness can sometimes mess with a person’s logic and learning. Plus, in today’s world of general inattentiveness, just making sure someone heard you correctly is important.

  • Marcie, I agree absolutely. But it’s a little disheartening how few providers even know about the ‘teach-back’ technique, let alone use it on a regular basis. I’ve seen how effective it is in clearing up inaccuracies in understanding of health information. Plus it’s so simple and easy to use. We need to keep getting the word out about this useful process. Thanks for your comment.

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