Health literacy is how well individuals can access, understand and apply health information, so they can make good decisions about their health.
Evidence shows that poor health literacy is associated with poor health outcomes. It is also associated with high healthcare costs, high rates of hospital presentations and admissions, and a higher mortality rate among older people.1
To better engage people in their own healthcare, we need to improve their health literacy. Health literacy gives people the knowledge, attitude, skills and motivation to:
- maintain their health
- manage minor illnesses
- find and use healthcare services
- navigate the healthcare system
- communicate with health professionals
- improve their environment and conditions.
Measuring health literacy
Measuring health literacy can help you identify what interventions are needed for individuals and populations, and see whether they are effective. It can also help with problem-solving for people with complex conditions.
There are a number of basic measures that can be used to measure someone’s health literacy, including:
- the three-item scanner tool, used in waiting rooms
- the Newest Vital Sign tool, used during face-to-face consultations
- CHAT, a conversational tool that provides a series of topics to discuss.2 3 4
These tools don’t always detect low health literacy, but their simplicity means they are suitable for use in routine practice. For a more comprehensive screening tool, try the Health Literacy Questionnaire or the European Health Literacy Survey Questionnaire.5 6
These tools are self-administered and can help you understand the health literacy needs and strengths of individuals and communities. The Health Literacy Questionnaire is particularly useful, as it is used in the Australian Bureau of Statistics National Health Survey to provide a benchmark for health literacy in Australia.
Improving health literacy
Most health literacy programs focus on improving health communication between health professionals and consumers. To address a range of health literacy levels, it is recommended that multiple strategies are used. They may include:
- improving the design and readability of written materials
- providing education to help people understand their health condition
- training staff in techniques such as teach-back, where the clinician asks the person what they have understood
- encouraging people to have a support person with them in the consultation
- developing strategies to improve communication, such as getting people to write down questions before their consultation
- modifying health service environments and developing policies or frameworks to improve health literacy.
There are a number of factors that can affect health literacy, including cognitive and intellectual disabilities, low general literacy, language barriers and cultural differences. Individual definitions of health (such as social and spiritual aspects) and health preferences can also play a role in health literacy.
As such, health professionals and services need a high level of cultural competence to understand the needs of the individuals, families and communities they work with, find common ground and identify the best way to work together.
The role of health organisations
While strategies to improve health literacy are often focused on the individual, changes are required at an organisational level for them to be successful.
Health organisations have an important role to play in supporting health literacy, by:
- understanding health literacy and its impact on healthcare
- helping individuals and communities develop health literacy skills
- keeping health routines and communication simple
- regularly assessing comprehension using techniques like teach-back
- improving cultural competence among staff
- making sure written materials are in Plain English, with no jargon
- using photos and images to convey information where appropriate
- making access, signage, websites and phone systems easy to use
- embedding health literacy in policy and practice.7 8
Organisations outside the health system (such as education, media, consumer and social welfare organisations) can also help improve health literacy.8
- Berkman ND, Sheridan SL, Donahue KE, et al. Low health literacy and health outcomes: an updated systematic review. Annals of internal medicine. 2011;155(2):97.
- Chew LD, Griffin JM, Partin MR, et al. Validation of Screening Questions for Limited Health Literacy in a Large VA Outpatient Population. Journal of General Internal Medicine. 2008;23(5):561-6.
- Weiss BD, Mays MZ, Martz W, et al. Quick assessment of literacy in primary care: the newest vital sign. Annals of Family Medicine. 2005;3(6):514-22.
- Adams RJ, Appleton SL, Hill CL, et al. Risks associated with low functional health literacy in an Australian population. The Medical Journal of Australia. 2009;191(10):530.
- Osborne RH, Batterham RW, Elsworth GR, et al. The grounded psychometric development and initial validation of the Health Literacy Questionnaire (HLQ). BMC public health. 2013;13(1):658.
- Sørensen K, van den Broucke S, Pelikan JM, et al. Measuring health literacy in populations: illuminating the design and development process of the European Health Literacy Survey Questionnaire (HLS-EU-Q). BMC Public Health. 2013;13(1):948.
- Brach C, Keller D, Hernandez LM, et al. Ten Attributes of Health Literate Health Care Organizations. [Discussion Paper]. Washington (DC): Institute of Medicine; 2012 [updated 2012 Jun; cited 2018 Jan 15].
- Australian Commission on Safety and Quality in Health Care. National Statement on Health Literacy: Taking action to improve safety and quality. Sydney: ACSQHC; 2014 [updated 2014 Aug 25; cited 2018 Jan 15].
Easy read resources
- The Information Access GroupOrganisationThe Information Access GroupDescriptionInformation about what 'easy read' means and examples of easy read resources.Licensing/Cost--
- The mandate for health literacyOrganisationWorld Health Organization, Regional office for EuropeDescriptionFrom the 9th Global Conference on Health Promotion, Shanghai 2016Licensing/Cost--
- Health Literacy. The solid factsOrganisationWorld Health OrganizationDescriptionProduced with evidence from the European Health Literacy Survey, this resource identifies practical and effective ways public health and other sector authorities and advocates can strengthen health literacy in a variety of settings, including educational settings, workplaces, marketplaces, health systems, new and traditional media and political arenas.Licensing/Cost--
- The Impact of the Chronic Disease Self-Management Program on Health Literacy: A Pre-Post Study Using a Multi-Dimensional Health Literacy InstrumentOrganisationInternational Journal of Environmental Research and Public HealthDescriptionJournal articleLicensing/Cost--
Improving health literacy
- Clinical Excellence Commission - Health LiteracyOrganisationClinical Excellence CommissionDescriptionThe NSW Health Literacy Framework outlines four health literacy priorities that aim to create a sustainable system level change, and improve safety and quality of care.Licensing/Cost--
- Australian Commission on Safety and Quality in Health CareOrganisationAustralian Commission on Safety and Quality in Health CareDescriptionAccess to the National Statement on health literacy and resources for improving health literacy for clinicians, consumers and managers.Licensing/Cost--
- GoShare HealthcareOrganisationHealthilyDescriptionGoShare is a customisable content distribution platform, which enables the efficient and measurable sharing of health resources, tailored to patients’ information needs to help increase their health literacy.Licensing/Cost--
- GoShare case studyOrganisationCentre for Healthcare Knowledge and InformationDescriptionCase study of how Feros Care used GoShare in its Staying Healthy Living Well program to improve their clients' health literacy, self-management abilities and quality of life.Licensing/Cost--
- A Universal Precautions approachOrganisationU.S. Department of Health and Human Services, Office of Disease Prevention and Health PromotionDescriptionDefinition of 'Universal Precautions Approach'Licensing/Cost--
- AHRQ Health Literacy Universal Precautions ToolkitOrganisationAgency for Healthcare Research and Quality (USA)DescriptionToolkit to help primary care practices reduce the complexity of health care, increase patient understanding of health information, and enhance support for patients of all health literacy levels. Developed for the USA but many of the tools will be useful in the Australian context.URLLicensing/Cost--
- NHS Health Literacy ToolkitOrganisationNHS Health Education EnglandDescriptionToolkit for raising awareness and upskilling staff. Developed for the UK but many of the tools will be useful in the Australian context.Licensing/Cost--
- The Health Literacy PlaceOrganisationNHS Education for ScotlandDescriptionHealth literacy tools, training, evidence and resources.Licensing/Cost--
Local health literacy resources
- Western Sydney Health Literacy HubOrganisationWestern Sydney Local Health DistrictDescriptionThe Hub provides access to resources on health literacy and practical tools to aid communication with patients and the public.Licensing/Cost--
- Sydney North Health Literacy ProgramOrganisationSydney North Health NetworkDescriptionHealth literacy information and resources.Licensing/Cost--
- HNECC Health Literacy GuideOrganisationHunter New England and Central Coast Primary Health NetworkDescriptionGuide to help service providers produce health information that is appropriate for all consumers, including those with low health literacy.Licensing/Cost--
- Northern NSW Health LiteracyOrganisationNorthern NSW Local Health District and North Coast Primary Health NetworkDescriptionComprehensive website of health literacy information, tools and resources.Licensing/Cost--
- SWSLHD Consumer & Community Participation FrameworkOrganisationSouth Western Sydney Local Health DistrictDescriptionSee chapter 15 - Health literacyLicensing/Cost--
- Video - Three simple steps to better healthOrganisationCentral and Eastern Sydney Primary Health NetworkDescriptionShort video for consumers.Licensing/Cost--
Measuring health literacy
- Health Literacy MesaurementOrganisationSwinburne University of TechnologyDescriptionEmbracing diversity in a strengths-based approach to promote health and equity, and avoid epistemic injustice.Licensing/Cost--
- Health Literacy QuestionnaireOrganisationSwinburne University of TechnologyDescriptionInformation about the Health Literacy Questionnaire (HLQ) and related tools.Licensing/Cost--
- Newest Vital Sign (NVS)OrganisationPfizer Inc.DescriptionA valid and reliable screening tool available in English and Spanish that identifies patients at risk for low health literacy. It is based on a nutrition label from an ice cream container and takes approximatley three minutes to administer.Licensing/Cost--
- Health Literacy Tool ShedOrganisationBoston UniversityDescriptionAn online database of health literacy measures. The site contains information about measures, including their psychometric properties, based on a review of the peer-reviewed literature.Licensing/Cost--
- Validation of an Australian parenting health literacy skills instrument: The parenting plus skills indexOrganisationPatient Education and CounselingDescriptionJournal articleURLLicensing/Cost--
Organisational health literacy
- Ten attributes of a health literate healthcare organisationOrganisationTasmanian Government, Department of HealthDescription10 attributes and examples of actions that can be taken to achieve them.URLLicensing/Cost--
- 6 Dimensions of a health literate organisationOrganisationNew Zealand Ministry of Health – Manat? HauoraDescription6 dimensions and questions to think about in relation to each one.URLLicensing/Cost--
- HelloTas! A toolkit for Health Literacy Learning OrganisationsOrganisationTasmanian Council of Social ServiceDescriptionA toolkit for health literacy learning organisations in the community sector and smaller community health organisations.Licensing/Cost--
Plain language writing resources
- Plain Language Summaries (PLS) of Publications ToolkitOrganisationEnvision Pharma GroupDescriptionToolkit for producing plain language summaries of publications, which improves transparency and accessibility and facilitates improved health literacy and shared decision making.Licensing/Cost--
- Writing in plain languageOrganisationAustralian Clinical Trials AllianceDescriptionTips and tools for writing in plain language.URLLicensing/Cost--
- Teach-backOrganisationSouth Eastern Sydney Local Health District and Deakin University Health Systems Improvement UnitDescriptionFree online learning module and other teach-back resources.Licensing/Cost--
- Video - What is Teach-Back?OrganisationInstitute for Healthcare ImprovementDescriptionShort training video for cliniciansURLLicensing/Cost--
- Video - Teach back - a technique for clear communicationOrganisationNorth Western Melbourne Primary Health NetworkDescriptionShort training video for cliniciansLicensing/Cost--
- Using the teach-back techniqueOrganisationCentre for culture, ethnicity & health (Vic)DescriptionSimple information sheet and good practice example.Licensing/Cost--
- The teach-back methodOrganisationSA HealthDescriptionSimple information sheet and good practice example.URLLicensing/Cost--
- Increase the use of and confidence with teach-backOrganisationHealthy North CoastDescriptionQuality improvement activityLicensing/Cost--