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Health Literacy: Do Patients Really Understand What We Are Communicating?

The definitions of literacy range from the Merriam Webster definition of the “ability to read and write” to the National Literacy Act of 1991 definition of “an individual’s ability to read, write and speak English and compute and solve problems at levels of proficiency necessary to function on the job and in society, to achieve one’s goals, and to develop one’s knowledge and potential.” Functional health literacy can be distinguished from literacy as the “ability to read and comprehend prescription bottles, appointment slips, and the other essential health-related materials required to successfully function as a patient.”3

Poor health literacy affects people of all ages, races, incomes and education levels and affects 36% of U.S. adults.4 According to Doak et al, the average American reads at an 8th or 9th grade level; however, most health care materials are written on a 10th grade level.5 Poor health literacy is of great concern within a public health context as demonstrated by the inclusion of “increasing health literacy skills” as one of the objectives in the Healthy People 2020 goals.

Basic health literacy is fundamental to the success of each interaction between health care professionals and patients. Low health literacy may result in poor self-care management, increased disability and morbidity, and adverse health outcomes such as ED visits and hospitalizations.4

Health care professionals working in hospice are often educating not only the patient but the caregivers and other support systems for the patient. Being aware of available tools can aid in supporting patients and families. Health communication materials which may be helpful include:

1. SIMPLY PUT: A guide for creating easy-to-understand materials. This is a publication developed by the Centers for Disease Control and Prevention which highlights many best practices regarding assessing and creating written information for the public on almost any scientific subject. [http://www.cdc.gov/healthliteracy/pdf/Simply_Put.pdf]

2. ASK ME 3: This is an educational program designed by the National Patient Safety Foundation to improve communication between patients and health care providers and encourage patients and caregivers to become active members of their health care team. [https://npsf.siteym.com/?page=askme3]

3. SCRIPT YOUR FUTURE: This is a campaign designed to help patients become adherent with taking their prescribed medication regimens. Some of the tools included allow the health care provider and patient to personalize health literacy interventions regarding medication adherence and education. [http://www.scriptyourfuture.org/]

Communicating with patients is a large component of clinical practice. Being well versed in cultural competence, understanding socioeconomic factors, a patients/caregivers education level, and patient’s priorities or motivations can be powerful tools in the promotion of health literacy and clear communication.


1. Merriam Webster: An Encyclopedia Britannica Company. Available at: http://www.merriam-webster.com/dictionary/literate. Accessed December 15, 2014.

2. National Literacy Act of 1991. Available at: https://www.govtrack.us/congress/bills/102/hr751. Accessed December 15, 2014.

3. Ad Hoc Committee on Health Literacy for the Council on Scientific Affairs, American Medical Association. Health Literacy: Report of the Council on Scientific Affairs. JAMA. 1999; 281(6):552-557.

4. U.S. Department of Health and Human Services. Office of Disease Prevention and Health Promotion. Healthy People 2020. Washington, DC. Available at http://www.healthypeople.gov/2020/topicsobjectives2020/default.aspx. Accessed December 15, 2014.. 5. Doak CC, Doak LG, Root JH. The literacy problem in teaching patients with low literacy skills. 2nd ed. Philadelphia, PA: JB Lippincott Co; 1996.

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