Building a Health-Literate Society [Communication Strategies]

    Health literacy is important for improving people’s long-term health and quality of life. In an ideal society, health literacy would be high and people would regularly take preventative measures to protect their health, manage chronic conditions, and have better health outcomes.

    It is important to build a health-literate society

    What is health literacy?

    Health literacy is more complicated than just being able to read. It is a measurement of a person’s understanding of health-related topics, which allows them to make informed decisions to improve and maintain their health. Health literacy is defined by the Institute of Medicine as “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions”

    Health literacy is the ability to find health information, understand that information, and act on it.

    Most adults in the US are less than proficient in health literacy

    About 1 in 3 adults in the US couldn’t do a task requiring intermediate health literacy, such as determining what time to take a prescription medication based on information on the label that relates the timing of medication to eating.

    Elderly man confused about how to take his medicines.

    About 9 in 10 adults couldn’t complete a proficient health literacy task like calculating an employee’s share of health insurance costs for a year using a table that shows how the employee’s monthly cost varies depending on income and family size.

    These findings are from the first national assessment of health literacy, the 2003 National Assessment of Adult Literacy (NAAL), a survey of over 19,000 English-speaking adults conducted by the National Center for Education Statistics. The survey categorized health proficiency in 4 performance levels: proficient (12%), intermediate (52%), basic (22%), and below basic (14%).

    The problem has continued. In 2012, the Program for the International Assessment of Adult Competencies (PIAAC) was conducted in 24 countries. In the US, only 12% of adults scored in the highest level in literacy skills and only 9% scored in the highest level in numeracy.

    This is a population-level problem, but the NAAL established that some groups are more likely to experience lower health literacy than others, including

    • People living below the poverty level
    • Black, Hispanic, American Indian/Alaska Native, Hispanic, and multiracial people
    • People without a high school education
    • Non-native English speakers
    • Adults over the age of 65

    Improving health communication is a priority for better health outcomes

    Low health literacy is associated with high rates of hospitalization, poorer self-reported health, and higher healthcare costs. People may hide their low health literacy out of embarrassment.

    While it is important to improve people’s ability to understand health information, that’s not the only change needed.

    In 2010, the US Department of Health and Human Services (HHS) released the National Action Plan to Improve Health Literacy. It outlines goals to close the knowledge gap between healthcare professionals and patients. The HHS identified improving the way we communicate health information to people as part of “the best opportunity to achieve a health literate society.”

    Health communicators can lead the way in improving the way we communicate health information by implementing some simple strategies.

    Strategies for creating healthcare information that moves us toward health literacy

    Strategy 1: Partner with your audience

    People sitting on chairs in a circle, talking.

    Understanding your audience is critical to creating successful healthcare information. Partner with your audience or community stakeholders to develop your content – and to make sure it makes sense to the people who need to understand and use it! Here are some steps to take.

    • Identify your audience. Who are they?
    • Research your audience. What do they already know, and what do they need to know?
    • Include members of your audience in early planning. What questions do they have, what are their top concerns, and what is the best way for them to get this information?
    • Have a goal. Be able to clearly state what you want your audience to be able to do after they have read your content.
    • Conduct usability testing with your audience to make sure you achieve your goal.

    Strategy 2: Determine how to best present your information

    A brochure or handout may be the best way to give your audience the information they need, but it also may not be the best way. Consider other ways to present the information, keeping in mind the needs of your audience and what you’ve learned about how they get information. These are just a few alternate ideas.

    • Infographic
    • Video
    • Podcast
    • Web-based learning
    • Checklist for a patient educator to walk through with a patient

    Strategy 3: Use plain language and scannable design

    For written content, use scannable design and plain language to create content that is easy to understand and has a clear action. Your audience needs to be able to find, understand, and use the information. Here are some simple ways to use plain language in your healthcare information.

    • Start with the most important information.
    • Use clear, useful headlines to break content into chunks. Headlines that are questions or statements help readers who are scanning for specific information.
    • Keep it simple with simple words, simple sentences, and varied sentence length. Wordiness and medical jargon can bog down and confuse readers, making it harder for them to understand the information and act on it.
    • Use lists and bullets. This can help readers identify order of importance or steps in a process, scan for information, or clearly understand separate items
    • Address the reader. Using “you” helps the reader understand what they need to do and what is their responsibility rather than someone else’s responsibility (like a doctor or nurse)
    • Make it actionable.

    Strategy 4: Incorporate accessible design techniques

    Consider how your audience will access your information and what limitations they may have. These are just a few examples of accessibility concerns.

    • If the information is online, will many people view it using smartphones or tablets?
    • Consider blind and vision-impaired people. For online content, they may be using screen readers, and for videos they would be unable to see written text or images.
    • Be mindful of people who are color blind. In addition to using color to make statements or data stand out, incorporate light and dark shades, patterns, and symbols.

    What’s next?

    When you’re communicating health information, remember that people need to be able to find, understand, and act on it. Know your audience, keep them in mind, and apply principles of plain language to improve health literacy!

    Health literacy is a critical issue for medical communicators. This topic will be discussed at the 2019 Medical Writing & Communication Conference.


    July 8, 2019 at 1:30 PM

    Callie Leuck

    Callie Leuck is a medical writer in Indianapolis, Indiana, focusing on promotional medical education and medical storytelling. She holds a master's degree in science-medical writing from Johns Hopkins University. You can find Callie on LinkedIn at