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].
- 6 Dimensions of a health literate organisationOrganisationNew Zealand Department of HealthDescriptionDimensions and questions to think about in relation to each one.URLLicensing/Cost--
- AHRQ Health Literacy Universal Precautions ToolkitOrganisationAgency for Healthcare Research and Quality (USA)DescriptionImplementation toolkit. USA resource, many of the tools will be useful in the Australian context.URLLicensing/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--
- Clinical Excellence CommissionOrganisationClinical Excellence CommissionDescriptionAccess to the CEC Health Literacy Guide that provides resources and practical strategies to assess and address health literacy barriers for patients and includes LHD example resources.URLLicensing/Cost--
- European Health Literacy Survey Questionnaire (HLS-EU-Q)OrganisationThe HLS-EU ConsortiumDescriptionA tool for measuring health literacy in European populations, original, extended and short versions are available.Licensing/CostNo license or cost.
- 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--
- Health Literacy QuestionnaireOrganisationDeakin UniversityDescriptionInformation about the Health Literacy Questionnaire (HLQ) and the Information and Support for Health Actions Questionnaire (ISHA-Q) identify health literacy strengths and limitations of individuals and communitiesLicensing/CostLicence required and licence processing fee applies
- Health Literacy Tool ShedOrganisationBoston UniversityDescriptionThe Health Literacy Tool Shed is an 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/CostSome tools may required a fee, license or author permission.
- 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/CostBook available for purchase or free PDF download
- HelloTasOrganisationTasmanian Council of Social ServiceDescriptionA toolkit for health literacy learning organisations in the community sector and smaller community health organisations.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--
- NCPHN Health Literacy FrameworkOrganisationNorthern NSW Local Health District and North Coast Primary Health NetworkDescriptionFramework for improving health literacy among consumers, health professionals and throughout health services.URLLicensing/Cost--
- NHS Health Literacy ToolkitOrganisationNHS Health Education EnglandDescriptionToolkit for raising awareness and upskilling staff. UK resource, many of the tools will be useful in the Australian context.URLLicensing/Cost--
- Northern NSW Health Literacy ProjectOrganisationNorthern NSW Local Health District and North Coast Primary Health NetworkDescriptionAccess to health literacy information, tools and resources.Licensing/CostParts of the website are only accessible to health professionals and you need to register to request access.
- Ophelia ToolkitOrganisationDeakin UniversityDescriptionA step-by-step guide for identifying and responding to health literacy needs within local communities.URLLicensing/Cost--
- Seminar: Breaking Down the BarriersOrganisationBlue Shadow GroupDescriptionVideo seminar presentations on health literacy, communication and health services. Sponsored by the , Clinical Excellence Commission, Australian Commission on Safety and Quality in Health Care, University of Sydney and NSW Health Care Complaints Commission.Licensing/Cost--
- SWSLHD Consumer & Community Participation FrameworkOrganisationSouth Western Sydney Local Health DistrictDescriptionChapter 15 - health literacyLicensing/Cost--
- Teach backOrganisationSouth Eastern Sydney Local Health District and Deakin University Health Systems Improvement UnitDescriptionFree online learning module and other teach back resourcesLicensing/Cost--
- Ten attributes of a health literate healthcare organisationOrganisationTasmanian Department of Health and Human ServicesDescriptionAttributes and examples of actions that can be taken to achieve them.URLLicensing/Cost--
- The Health Literacy PlaceOrganisationNHS Education for ScotlandDescriptionHealth literacy tools, training, evidence and resources.Licensing/Cost--
- The Newest Vital Sign (NVS)OrganisationPfizer Inc.DescriptionThe Newest Vital Sign (NVS) is a 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/CostNo license or cost.
- The teach-back methodOrganisationSA HealthDescriptionSimple information sheet and good practice example.URLLicensing/Cost--
- Using the teach-back techniqueOrganisationCentre for culture, ethnicity & healthDescriptionSimple information sheet and good practice example.Licensing/Cost--
- Video - Teach back - a technique for clear communicationOrganisationNorth Western Melbourne Primary Health NetworkDescriptionShort training video for cliniciansLicensing/Cost--
- Video - Three simple steps to better healthOrganisationCentral and Eastern Sydney Primary Health NetworkDescriptionShort video for consumersLicensing/Cost--
- Video - What is Teach-Back?OrganisationInstitute for Healthcare ImprovementDescriptionShort training video for cliniciansURLLicensing/Cost--