Health Literacy

What health literacy means

Healthy People 2030, the US national health goals, defines two parts:

• Personal health literacy: how well a person can find, understand and use information and services to make health decisions for themselves and others.
• Organizational health literacy: how well organizations make it possible for people to do this, for example with plain-language materials and clear forms.

Health literacy is not the same as general reading ability or intelligence. Highly educated people can still struggle with unfamiliar medical terms, numbers, risks and insurance rules, especially when frightened or unwell.

Skills involved

• reading and understanding prescriptions, labels, consent forms and discharge instructions
• understanding numbers: doses, blood sugar readings, percentages and risks (numeracy)
• communicating symptoms and asking questions
• navigating appointments, referrals and insurance
• judging whether online health information is reliable
• applying advice to daily life, such as diet changes

Why health literacy matters

Studies link limited health literacy to:

• more medication errors and confusion about dosing
• lower use of screening and vaccines
• poorer control of chronic conditions like diabetes, high blood pressure and heart failure
• more emergency visits and hospital stays
• higher health care costs

Examples of common misunderstandings:

• "Take twice daily" interpreted as two tablets at once
• not knowing that a "negative" test result is often good news
• confusing teaspoons and tablespoons for liquid medicines
• stopping blood pressure medicine because you feel fine
• doubling doses of medicines with different brand names but the same active ingredient (for example, acetaminophen in cold remedies plus a pain reliever)

High-risk medicines, such as blood thinners, need particular care: see warfarin toxicity for how dosing mistakes and interactions cause harm.

Who is more likely to face barriers

Anyone can, but barriers are more common for:

• older adults
• people with limited English proficiency or different cultural expectations of care (cultural and language differences)
• people with lower income or less formal education
• people with vision, hearing or cognitive impairments
• people with complex conditions managing many medicines
• anyone who is ill, in pain, anxious or newly diagnosed

Signs that health literacy may be a barrier

• missing appointments or not following up on referrals
• forms left incomplete
• "I forgot my glasses, I'll read it at home"
• unable to name medicines or explain why they take them
• asking few questions
• relying heavily on family members to read or explain

How to understand your care better

Before an appointment

• Write down your top three concerns.
• Bring a list of all medicines and supplements, or bring the bottles.
• Bring a family member or friend to help listen and take notes.
• Ask for an interpreter if English is not your first language. In the US, health care providers receiving federal funding must provide language assistance at no cost.

During the appointment: Ask Me 3

1. What is my main problem?
2. What do I need to do?
3. Why is it important for me to do this?

Use teach-back

Repeat the instructions back in your own words: "So I take one tablet in the morning and one at night, with food, and call you if I get dizzy." This lets the clinician correct any misunderstanding.

Ask for

• plain language instead of jargon
• written or printed instructions, large print or translated versions
• pictures or diagrams
• a medicine schedule chart
• the patient portal and how to use it

With medicines

• Use one pharmacy so interactions can be checked.
• Ask the pharmacist to explain each new medicine.
• Use the measuring device that comes with liquid medicines, never kitchen spoons.
• Use a pill organizer and phone reminders.

Finding reliable information online

Look for information from government health agencies, academic medical centers and professional societies. Check that it is current, cites its sources and is not selling a product. Discuss anything you read with your clinician.

What health care organizations can do

The AHRQ Health Literacy Universal Precautions Toolkit encourages clinicians to assume everyone may have difficulty understanding, use plain language, limit information to a few key points, use teach-back routinely, and make forms and signs easy to understand.

Frequently asked questions

What is health literacy?

Health literacy is the ability to find, understand and use health information and services to make decisions about your health. It includes reading labels, understanding instructions and numbers, communicating with clinicians and finding your way through the health system.

Why is health literacy important?

People with limited health literacy are more likely to make medication errors, miss preventive care, have poorly controlled chronic diseases and need emergency care. Better understanding leads to safer, more effective care and better health outcomes.

What is the teach-back method?

Teach-back is when you explain instructions back to your doctor, nurse or pharmacist in your own words. It is not a test of you, but a check on how clearly they explained. It catches misunderstandings before you leave.

How can I improve my health literacy?

Prepare questions before appointments, bring a medicine list and a companion, ask for plain language, use the Ask Me 3 questions, repeat instructions back, request written materials or interpreters, and use trusted sources for online information.

Is low health literacy the same as not being able to read?

No. Many people who read well still find medical information confusing, especially with jargon, numbers and stress. Health literacy depends on the situation and on how clearly information is presented, not just on reading ability.