Health Literacy Tools
At times all of us have trouble understanding health information. When we are worried or under stress, we may not listen or read as well as we normally would. We may be afraid or embarrassed to ask the doctor questions. All of us are responsible to speak up and make sure we understand health information.
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But health literacy goes beyond our individual ability to access and understand health information. The Institute of Medicine offers a broader definition:
Health literacy is a shared function of social and individual factors. Individuals’ health literacy skills and capacities are mediated by their education, culture, and language. Equally important are the communication and assessment skills of the people with whom individuals interact regarding health, as well as the ability of the media, the marketplace, and government agencies to provide health information in a manner appropriate to the audience. (Health Literacy: A Prescription to End Confusion, The Institute of Medicine, 2004)
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This definition calls out the responsibility of health care providers and public health agencies to provide information in a way that everyone can access, understand, and act upon.
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Health literacy is a central focus of Healthy People 2030 and includes six objectives:
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Increase the proportion of adults whose health care provider checked their understanding.
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Decrease the proportion of adults who report poor communication with their health care provider.
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Increase the proportion of people who say their online medical record is easy to understand.
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Service providers can directly influence four of these six goals. Doctors, nurses, and other health care professionals have the responsibility to ensure everyone can access, understand, and act on health information. Techniques such as the chunk and check method, the teach back method, and using plain language help ensure all of us can understand important health information.
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Often the health behaviors we recommend to people actually include complex text, multiple tools, and demanding activities that must be mastered first. Literacy and Health in America (2004) offers a process for deconstructing health behaviors in order to identify sub-tasks, tools, and knowledge that need to be mastered before the behavior can be achieved.
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Additional tools to help public health departments and their partners implement health literacy-friendly practices include:
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Self-assessment tools:
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Additional resources for providers:
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Health Literacy: Universal Precautions Toolkit, AHRQ
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Health Literacy: Pharmacy Health Literacy Center, AHRQ
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Health Literacy: Guidelines for Creating Materials, Harvard T.H. Chan School of Public Health
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Health Literacy: Guidelines for Rewriting Materials, Harvard T.H. Chan School of Public Health
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Diabetes: Learning About Diabetes (low literacy handouts in multiple languages), Learning About Diabetes
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Eye Health: Health Literacy, Patient Awareness & Opthalmology (provider guidance), Kresge Eye Institute
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Oral Health: Oral Health Literacy in Practice (provider toolkit), CA Dept of Public Health
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Oral Health: Cavity Free Kids (childcare center curriculum and parent resources), Arcora
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National resources:
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Health literacy training:
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Using plain language
Plain language means using simple words to clearly communicate. For example, instead of saying "hypertension," say "high blood pressure."
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Plain language also includes using action words that tell people what they can or should do. Instead of saying "a diet low in saturated fat helps to reduce the risk of heart disease," say "help your heart by eating healthier foods."
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Using visual aids also helps.
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Using chunk and check
The chunk and check method encourages providers to break down complex information into digestible pieces.
Start by asking the client what they already know about the topic. Ask what questions they have. Identify and highlight three new pieces of information you can share based on their knowledge and questions. Use the chunk and check method to explain each key point and then check for understanding.
Using the teach back method
The teach back method encourages providers to ask open ended questions to clients after providing instruction to gauge understanding. Instead of asking "Do you understand?" ask "Would you explain to me in your own words what we covered today so I can make sure I was clear?"
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Practice with your co-workers to learn the technique and then use it every time you interact with people throughout the day, even through telemedicine.