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Clear Communication: A NIH Health Literacy Initiative

Health Literacy

What is health literacy?

Health literacy is:

“The degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions.” — Source: Healthy People 2010

Individuals must possess the skills to understand information and services and use them to make appropriate decisions about health. Similar to our traditional understanding of literacy, health literacy incorporates a range of abilities: to read, comprehend, and analyze information; decode instructions, symbols, charts, and diagrams; weigh risks and benefits; and, ultimately, make decisions and take action. The concept of health literacy extends to the materials, environments, and challenges specifically associated with disease prevention and health promotion.

According to Healthy People 2010, an individual is considered to be "health literate" when he or she possesses the skills to understand information and services and use them to make appropriate decisions about health.

Areas commonly associated with health literacy include:

  • Patient-physician communication
  • Drug labeling Medical instructions and medical compliance
  • Health information publications and other resources
  • Informed consent
  • Responding to medical and insurance forms
  • Giving patient history
  • Public health training
  • Assessments for allied professional programs, such as social work and speech-language pathology

Alarmingly, these skills and strategies are absent in more than half of the U.S. population. This fact is more disturbing when one considers that these are the very skills and strategies that often lead to longer life, improved quality of life, reduction of both chronic disease and health disparities, as well as cost savings. Health literacy is estimated to cost $106-$236 billion annually [Source: Pfizer]. In addition:

  • The 2000 census counted 20 million people who speak poor English, 10 million who speak none. The White House Office of Management and Budget, in a 2002 report estimated the number of patient encounters across language barriers each year at 66 million.
  • Less than 60 percent of the population has English as a first language.
  • According to the 1993 National Adult Literacy Survey, 10 to 22 percent of Americans are at the bottommost level of literacy. Many of these Americans are unable to read a medicine bottle or poison warning.
  • A 1992 study at the University of Arizona, Tucson, found that healthcare costs for patients enrolled in Medicare who were identified with low health-literacy skills were more than four times as high as costs for patients with high literacy, roughly $13,000 per year compared to $3,000 per year.

Questions and Answers

Why is health literacy an issue for health communication professionals?

Health communication professionals must consider literacy and all its facets when developing health materials and communication strategies for a range of diverse audiences—each with differing abilities, experiences, levels of knowledge, cultural beliefs and practices, and communication expectations. Analyzing these differences can ultimately improve health and prevent disease. In fact, helpful materials are available on many aspects of health communication, including strategies and tactics, understanding audiences, and evaluation and planning. One example is this guide available from the National Cancer Institute: Making Health Communication Programs Work: A Planner's Guide.

What is the health literacy objective in Healthy People 2010?

Progress can be made on objectives that have baseline, measurable data. In order to improve health literacy, health professionals will use the Healthy People 2010 strategy to track improvements over a decade. Health literacy is one of the Health Communication objectives in Healthy People 2010. It reads:

"Objective 11-2. (Developmental) Improve the health literacy of persons with inadequate or marginal literacy skills. Potential data source: National Adult Literacy Survey, 2002, U.S. Department of Education."

Healthy People 2010 outlines key points for achieving this objective, stating that the issue of health literacy is fundamental to efforts to reduce health disparities. Two key areas are emphasized as crucial to attaining measurable improvement:

  • Develop appropriate written materials for audiences with limited literacy.
  • Health communicators should use existing resources to create plain language health communications targeted to this population.
  • Professional publications and Federal documents already provide the necessary criteria.
  • Improve the reading skills of persons with limited literacy.
  • Health literacy programs can be tailored to target skill improvement.
  • These programs could be offered through a variety of organizations, such as libraries, schools, and community groups.

Can better communication strategies improve health?

In recent publications, Dean Schillinger, M.D., University of California, San Francisco, an associate professor of medicine at San Francisco General Hospital, identified health improvements based on improved literacy. His work focused on diabetes compliance as it relates to doctor-patient-doctor interaction and on strategies for verifying that individuals with literacy challenges understand health information. These principles may prove useful in confronting challenges in other health settings. Dr. Schillinger's publications include the following:

Where can I learn more about health literacy?

What research is being done?

The NIH recognizes the need to apply research advances in such a way as to ensure improved health for all Americans. Recently NIH issued a number of trans-NIH program announcements (PARs) supporting research on health literacy. The goal of NIH-funded research is to improve scientific understanding of the nature of health literacy and its relationship to:

  • healthy behaviors,
  • illness prevention and treatment,
  • chronic disease management,
  • health disparities,
  • risk assessment of environmental factors, and
  • health outcomes, including mental and oral health.

Research results will also serve to inform the development of materials for the public. A list of selected NIH-funded projects is available online at http://www.nih.gov/icd/od/ocpl/resources/healthliteracyresearch.htm.

Publications

Contact us: NIH Clear Communication Info

Other Resources

Training from the CDC
for public health professionals

Training from HRSA
for professionals in clinical settings

Health Literacy Online
Office of Disease Prevention & Health Promotion

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This page last reviewed on March 5, 2012

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