Disease Prevention and Health Promotion
Health Communication Activities
Ths Guide contains:
A basic overview of key health literacy concepts
Techniques for improving health literacy through communication, navigation, knowledge-building, and advocacy
Examples of health literacy best practices
Suggestions for addressing health literacy in your organization
These tools can be applied to healthcare delivery, policy, administration, communication, and education activities aimed at the public. They also can be incorporated into mission, planning, and evaluation at the organizational level.
If you are new to health literacy, the toolkit will give you the information you need to become an effective advocate for improved health literacy. If you are already familiar with the topic, you will find user-friendly, action-oriented materials that can be easily referenced, reproduced, and shared with colleagues.
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The guide is designed to be a quick and easy reference, filled with facts, definitions, helpful tips, checklists, and resources you can use on the job. You can print out the materials and keep them at your desk, share them with colleagues, or bookmark this Web page on your computer.
The Quick Guide is divided into the following three sections:
The first section contains a series of fact sheets on health literacy, including a basic overview of key concepts and definitions and information on health literacy and health outcomes.
- Improve the usability of health information
- Improve the usability of health services
- Build knowledge to improve decisionmaking
- Advocate for health literacy in your organization
The final section contains a list of resources, including Web sites, research studies, and additional publications on health literacy.
|Health Literacy Basics|
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.1
Health literacy is dependent on individual and systemic factors:
Health literacy affects people's ability to:
Health literacy includes numeracy skills. For example, calculating cholesterol and blood sugar levels, measuring medications, and understanding nutrition labels all require math skills. Choosing between health plans or comparing prescription drug coverage requires calculating premiums, copays, and deductibles.
In addition to basic literacy skills, health literacy requires knowledge of health topics. People with limited health literacy often lack knowledge or have misinformation about the body as well as the nature and causes of disease. Without this knowledge, they may not understand the relationship between lifestyle factors such as diet and exercise and various health outcomes.
Health information can overwhelm even persons with advanced literacy skills. Medical science progresses rapidly. What people may have learned about health or biology during their school years often becomes outdated or forgotten, or it is incomplete. Moreover, health information provided in a stressful or unfamiliar situation is unlikely to be retained.
What is literacy?
Literacy can be defined as a person's ability to read, write, speak, and compute and solve problems at levels necessary to:
The term “illiteracy” means being unable to read or write. A person who has limited or low literacy skills is not illiterate.
What is plain language?
Plain language is a strategy for making written and oral information easier to understand. It is one important tool for improving health literacy.
Plain language is communication that users can understand the first time they read or hear it. With reasonable time and effort, a plain language document is one in which people can find what they need, understand what they find, and act appropriately on that understanding.3
Key elements of plain language include:
Language that is plain to one set of readers may not be plain to others.3 It is critical to know your audience and have them test your materials before, during, and after they are developed.
Speaking plainly is just as important as writing plainly. Many plain language techniques apply to verbal messages, such as avoiding jargon and explaining technical or medical terms.
What is cultural and linguistic competency?
Culture affects how people communicate, understand, and respond to health information. Cultural and linguistic competency of health professionals can contribute to health literacy. Cultural competence is the ability of health organizations and practitioners to recognize the cultural beliefs, values, attitudes, traditions, language preferences, and health practices of diverse populations, and to apply that knowledge to produce a positive health outcome.4 Competency includes communicating in a manner that is linguistically and culturally appropriate.5
Healthcare professionals have their own culture and language. Many adopt the “culture of medicine” and the language of their specialty as a result of their training and work environment. This can affect how health professionals communicate with the public.
For many individuals with limited English proficiency (LEP), the inability to communicate in English is the primary barrier to accessing health information and services. Health information for people with LEP needs to be communicated plainly in their primary language, using words and examples that make the information understandable.
Why is health literacy important?
Only 12 percent of adults have Proficient health literacy, according to the National Assessment of Adult Literacy. In other words, nearly nine out of ten adults may lack the skills needed to manage their health and prevent disease. Fourteen percent of adults (30 million people) have Below Basic health literacy. These adults were more likely to report their health as poor (42 percent) and are more likely to lack health insurance (28 percent) than adults with Proficient health literacy.6
Low literacy has been linked to poor health outcomes such as higher rates of hospitalization and less frequent use of preventive services (see Fact Sheet: Health Literacy and Health Outcomes). Both of these outcomes are associated with higher healthcare costs.
Who is at risk?
Populations most likely to experience low health literacy are older adults, racial and ethnic minorities, people with less than a high school degree or GED certificate, people with low income levels, non-native speakers of English, and people with compromised health status.7 Education, language, culture, access to resources, and age are all factors that affect a person's health literacy skills.
Who is responsible for improving health literacy?
The primary responsibility for improving health literacy lies with public health professionals and the healthcare and public health systems. We must work together to ensure that health information and services can be understood and used by all Americans. We must engage in skill building with healthcare consumers and health professionals. Adult educators can be productive partners in reaching adults with limited literacy skills.
1U.S. Department of Health and Human Services. 2000. Healthy People 2010. Washington, DC: U.S. Government Printing Office. Originally developed for Ratzan SC, Parker RM. 2000. Introduction. In National Library of Medicine Current Bibliographies in Medicine: Health Literacy. Selden CR, Zorn M, Ratzan SC, Parker RM, Editors. NLM Pub. No. CBM 2000-1. Bethesda, MD: National Institutes of Health, U.S. Department of Health and Human Services.
3Plain Language Action and Information Network. What Is Plain Language? Available at www.plainlanguage.gov. Accessed on October 21, 2005.
6Kirsch IS, Jungeblut A, Jenkins L, Kolstad A. 1993. Adult Literacy in America: A First Look at the Results of the National Adult Literacy Survey (NALS). Washington, DC: National Center for Education Statistics, U.S. Department of Education.
|Health Literacy Basics|
Choosing a healthy lifestyle, knowing how to seek medical care, and taking advantage of preventive measures require that people understand and use health information. The ability to obtain, process, and understand health information needed to make informed health decisions is known as health literacy.
Given the complexity of the healthcare system, it is not surprising that limited health literacy is associated with poor health. This fact sheet summarizes key research study findings on the relationship between health literacy and health outcomes.
Use of preventive services
According to research studies, persons with limited health literacy skills are more likely to skip important preventive measures such as mammograms, Pap smears, and flu shots.1 When compared to those with adequate health literacy skills, studies have shown that patients with limited health literacy skills enter the healthcare system when they are sicker.2
Knowledge about medical conditions and treatment
Persons with limited health literacy skills are more likely to have chronic conditions and are less able to manage them effectively. Studies have found that patients with high blood pressure,3 diabetes,3-5 asthma,6 or HIV/AIDS7-9 who have limited health literacy skills have less knowledge of their illness and its management.
Rates of hospitalization
Limited health literacy skills are associated with an increase in preventable hospital visits and admissions.10-13 Studies have demonstrated a higher rate of hospitalization and use of emergency services among patients with limited literacy skills.12
Persons with limited health literacy skills make greater use of services designed to treat complications of disease and less use of services designed to prevent complications.1, 11-13 Studies demonstrate a higher rate of hospitalization and use of emergency services among patients with limited health literacy skills.10-13 This higher use is associated with higher healthcare costs.15 16,
Stigma and shame
Low health literacy may also have negative psychological effects. One study found that those with limited health literacy skills reported a sense of shame about their skill level.17 As a result, they may hide reading or vocabulary difficulties to maintain their dignity.18
2Bennet CL, Ferreira MR, Davis TC, Kaplan J, Weinberger M, Kuzel T, Seday MA, Sartor O. 1998. Relation between literacy, race, and stage of presentation among low-income patients with prostate cancer. Journal of Clinical Oncology. 16(9): 3101-3104.
3Williams MV, Baker DW, Parker RM, Nurss JR. 1998. Relationship of functional health literacy to patients' knowledge of their chronic disease. A study of patients with hypertension and diabetes. Archives of Internal Medicine. 158(2): 166-172.
4Schillinger D, Grumbach K, Piette J, Wang F, Osmond D, Daher C, Palacios J, Sullivan G, Bindman AB. 2002. Association of health literacy with diabetes outcomes. Journal of the American Medical Association. 288(4): 475-482.
5Schillinger D, Grumbach K, Wang F, Wilson C, Daher C, Leong-Grotz K, Castro C, Bindman AB. 2003. Closing the loop: Physician communication with diabetic patients who have low health literacy. Archives of Internal Medicine. 163(1): 83-90.
8Kalichman SC, Rompa D. 2000. Functional health literacy is associated with health status and health-related knowledge in people living with HIV-AIDS. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology. 25(4): 337-344.
9Kalichman SC, Benotsch E, Suarez T, Catz S, Miller J, Rompa D. 2000. Health literacy and health-related knowledge among persons living with HIV/AIDS. American Journal of Preventive Medicine. 18(4): 325-331.
10Baker DW, Parker RM, Williams MV, Clark WS. 1997. The relationship of patient reading ability to self-reported health and use of health services. American Journal of Public Health. 87(6): 1027-1030.
12Baker DW, Gazmararian JA, Williams MV, Scott T, Parker RM, Green D, Ren J, Peel J. 2002. Functional health literacy and the risk of hospital admission among Medicare managed care enrollees. American Journal of Public Health. 92(8): 1278-1283.
15Friedland R. 1998. New estimates of the high costs of inadequate health literacy. In: Proceedings of Pfizer Conference “Promoting Health Literacy: A Call to Action.” October 7-8, 1998, Washington, DC: Pfizer, Inc., 6-10.