Introduction to Health Literacy

Introduction to Health Literacy

Definition of Health Literacy

Let’s start by defining health literacy, using the definition from Healthy People 2030.

Personal health literacy is the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.”

“Organizational health literacy is the degree to which organizations equitably enable individuals to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.”

Source: U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. Healthy People 2030: Health Literacy in Healthy People.

Limited Health Literacy Is a Health Equity Issue

According to Healthy People 2030, health literacy is a key issue in the Health Care Access and  social determinant of health (SDOH). SDOH are factors in the environment that affect people’s health.

Source: U.S. Department of Health and Human Services. Healthy People 2030: Social Determinants of Health.

Like other SDOH, limited health literacy is not evenly distributed among groups. This inequity contributes to health disparities—differences in health outcomes across groups.

According to the NAAL assessment, people were more likely to have poor (Below Basic) health literacy skills if they:

  • Self-reported poor health.
  • Were age 65 or older.
  • Had health insurance from Medicare or Medicaid, or had no insurance.
  • Lived below the poverty level.
  • Were Hispanic or Black.

Source: National Center for Education Statistics. National Assessment of Adult Literacy (NAAL).

Limited Health Literacy Is Common

Limited health literacy is more common than you might think. According to the Centers for Disease Control and Prevention (CDC), “nine out of 10 adults struggle to understand and use health information when it is unfamiliar, complex, or jargon-filled.”

Source: Centers for Disease Control and Prevention. Talking Points About Health Literacy.


NAAL Health Literacy Findings

The most recent (2003) National Assessment of Adult Literacy (NAAL) assessed the health literacy of U.S. adults. The NAAL divides health literacy into 4 levels:

  1. Below Basic – no more than the most simple and concrete literacy skills
  2. Basic – skills needed to perform simple, everyday literacy activities
  3. Intermediate – skills needed to perform moderately challenging activities
  4. Proficient – skills needed for more complex and challenging literacy activities (such as navigating the healthcare system)

It found that:

  • 36% had Below Basic or Basic health literacy skills.
  • 53% had Intermediate health literacy skills.
  • Only 12% had Proficient health literacy skills.
  • Women’s average health literacy score was 6 points higher than men’s average health literacy score.

Source: National Center for Education Statistics. National Assessment of Adult Literacy (NAAL).

Limited Health Literacy Affects People’s Health

Limited health literacy has very real consequences for people’s health. Compared to adults with adequate health literacy, adults with limited health literacy have:

  • More serious medication errors.
  • Higher rates of emergency room visits, hospitalizations, and death.
  • Worse preventive care and health outcomes for their children.

Source: Brach C et al. [2012]. 10 Attributes of Health Literate Health Care Organizations


The NAAL assessment reported similar findings. Compared to people with adequate (Intermediate or Proficient) health literacy skills, people with limited (Below Basic or Basic) health literacy skills:

  • Report poorer overall health.
  • Have poorer ability to manage chronic diseases.
  • Have poorer outcomes.
  • Are less likely to understand their diagnosis.
  • Are less likely to have screening or preventive care.
  • Present in later stages of the disease.
  • Are more likely to be hospitalized and rehospitalized.

Source: National Center for Education Statistics. National Assessment of Adult Literacy (NAAL).

Limited Health Literacy Is Hard To Recognize

According to the Agency for Healthcare Research and Quality (AHRQ), it’s hard for healthcare providers to identify patients with limited health literacy. Indeed, even people who have good health literacy in general may have poor health literacy when they are under stress—such as when you give them a serious health diagnosis. Stress makes it harder for people to process information.

Source: Brega AG et al. (2015). AHRQ Health Literacy Universal Precautions Toolkit, Second Edition. AHRQ Publication No. 15-0023-EF. Rockville, MD. Agency for Healthcare Research and Quality.

Health Literacy Affects the Healthcare System

Low health literacy is very costly to the healthcare system, according to a 2007 study. Estimates range from $106 billion to $238 billion in unnecessary costs each year, which account for 7% to 17% of all personal healthcare spending in the United States.

Source: Vernon JA et al. (2007). Low Health Literacy: Implications for National Health Policy

Ways To Promote Health Literacy

Here are some ways you can promote health literacy:

  • Improve your cultural competence. This includes being aware of and sensitive to cultural diversity.
  • Use universal precautions. There are screening tools (such as the Newest Vital Sign, created by Barry D. Weiss, M.D. and colleagues with funding from Pfizer) for limited health literacy skills. However, most health literacy experts recommend using universal precautions instead. That is, promote health literacy equally among all
  • Use teach-back to confirm understanding. Just because something is clear to you, it doesn’t mean it’s clear to your listeners. Teach-back has 3 steps: 1) Explain the health information; 2) check for understanding; and 3) re-explain the health information if needed.
  • Use plain language for spoken and written communication. This includes using familiar words and short sentences, and providing simple, clear explanations for unfamiliar terms.
  • Ensure that written materials are easy for the intended audience to find, understand, and use. This includes making sure the materials are appropriate for the audience’s language, culture, and reading level.
  • Use an interpreter if needed. An interpreter converts a spoken or signed message from one language to another.
  • Build Health Literacy Awareness Through Action. October is Health Literacy Month, an observance to promote the importance of working collaboratively to integrate and expand the mission of health literacy. Visit for promotional resources, ideas and tools.

3 Ways To Learn More About Health Literacy

The Health Literacy Solutions Center has a wealth of health literacy resources. Here are 3 easy ways to learn more:

1. Watch the 60-minute Health Literacy 101 video, which features Michael Villaire, MSLM, IHA’s president/chief executive officer.

2. Explore the Learning Lab to find online trainings.
3. Review resources found in the Library to find tools for plain language and more.