Health literacy interventions

Health literacy is the degree to which people obtain, process, and understand basic health information and services in order to make appropriate health decisions (IOM-Nielsen-Bohlman 2004). Low levels of health literacy are associated with poor health outcomes and limited use of preventive care (AHRQ-Berkman 2011, Taggart 2012). Patients with low health literacy also appear to have higher health care costs and health care expenditures. Up to one-half of the US population has limited health literacy; elderly and low income individuals are most likely to have low health literacy (Eichler 2009). Health insurance literacy is also low, particularly among those with low incomes (, Urban-Long 2014), the uninsured, and racial and ethnic minorities (Urban-Long 2014). Approaches to improving health literacy include simplifying health education materials (written, video, audio, and computer formats), improving patient-provider communication, and improving overall literacy.

Expected Beneficial Outcomes (Rated)

  • Improved health-related knowledge

Other Potential Beneficial Outcomes

  • Improved patient-provider communication

Evidence of Effectiveness

There is some evidence that interventions to improve health literacy increase health-related knowledge (Taggart 2012, APHCRI-Bush 2010, DeWalt 2009, Pignone 2005) and comprehension (Sheridan 2011). Additional evidence is needed to confirm effects and determine which interventions are most effective.

Interventions that use enhanced written and print-based materials have been shown to increase health-related knowledge among children and adults (DeWalt 2009, APHCRI-Bush 2010, Pignone 2005, ). Programs that serve older adults may increase participants’ knowledge and capacity to find relevant health information (). Group-based education programs in primary care settings also appear to increase knowledge among adults (Taggart 2012). Classes that teach participants how to access health information on the internet may improve online health literacy by increasing self-efficacy in health information seeking and health information comprehension ().

Interventions that combine various approaches (e.g., enhancing written materials and conducting an in-person interview) appear to increase patients’ comprehension and appropriate health care use (Sheridan 2011). Health literacy interventions that use multi-media approaches or focus on interpersonal interactions appear to promote improved communication between patients and providers (APHCRI-Bush 2010, ).

Various types of health care professionals can deliver interventions that improve health literacy; more intense interventions appear to increase the likelihood of improvement (Dennis 2012).

Impact on Disparities

Likely to decrease disparities

Implementation Examples

The US Department of Health and Human Services (HHS), the Institute of Medicine, the American Medical Association, and the National Institutes of Health have promoted health literacy as a research priority (CDC-Healthy People 2010). Recent federal initiatives including the Affordable Care Act, the National Action Plan to Improve Health Literacy, and the Plain Writing Act also emphasize health literacy (). As a result, there are a number of statewide programs that aim to improve health literacy. Examples include Health Literacy Iowa and the North Carolina Program on Health Literacy (IHS-HLI, NCPHL).

Implementation Resources

CDC-Health literacy - Centers for Disease Control and Prevention (CDC). Health literacy: Accurate, accessible and actionable health information for all.

AHRQ-Health literacy toolkit - DeWalt DA, Callahan LF, Hawk VH, et al. Health literacy universal precautions toolkit. Rockville: Agency for Healthcare Research and Quality (AHRQ); 2010.

HRSA-Health literacy - Health Resources and Services Administration (HRSA). About health literacy.

NNLM-Health literacy - National Network of Libraries of Medicine (NN/LM). Health literacy.

CDC-Cross-cultural tools - Centers for Disease Control and Prevention (CDC). Tools for Cross-Cultural Communication and Language Access Can Help Organizations Address Health Literacy and Improve Communication Effectiveness.

Citations - Evidence

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APHCRI-Bush 2010 - Bush R, Boyle F, Ostini R, et al. Advancing health literacy through primary health care systems. Canberra, AU: Australian Primary Health Care Research Institute (APHCRI); 2010.

DeWalt 2009 - DeWalt DA, Hink A. Health literacy and child health outcomes: A systematic review of the literature. Pediatrics. 2009;124(Suppl 3):S265-74.

Pignone 2005 - Pignone M, DeWalt DA, Sheridan S, Berkman N, Lohr KN. Interventions to improve health outcomes for patients with low literacy: A systematic review. Journal of General Internal Medicine. 2005;20(2):185-92.

Sheridan 2011 - Sheridan SL, Halpern DJ, Viera AJ, et al. Interventions for individuals with low health literacy: A systematic review. Journal of Health Communication. 2011;16(Suppl 3):30-54.

Taggart 2012 - Taggart J, Williams A, Dennis S, et al. A systematic review of interventions in primary care to improve health literacy for chronic disease behavioral risk factors. BMC Family Practice. 2012;13(1):49.

Wilson 2012a* - Wilson EA, Makoul G, Bojarski EA, et al. Comparative analysis of print and multimedia health materials: A review of the literature. Patient Education and Counseling. 2012;89(1):7-14.

Manafo 2012* - Manafo E, Wong S. Health literacy programs for older adults: A systematic literature review. Health Education Research. 2012;27(6):947–60.

Cochrane-Car 2011* - Car J, Lang B, Colledge A, Ung C, Majeed A. Interventions for enhancing consumers’ online health literacy. Cochrane Database of Systematic Reviews. 2011;(6):CD007092.

Dennis 2012 - Dennis S, Williams A, Taggart J, et al. Which providers can bridge the health literacy gap in lifestyle risk factor modification education: A systematic review and narrative synthesis. BMC Family Practice. 2012;13(1):44.

Citations - Implementation Examples

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CDC-Healthy People 2010 - Centers for Disease Control and Prevention (CDC). Healthy People 2010 final review.

IHS-HLI - Iowa Health System (IHS). Health literacy Iowa.

NCPHL - NC Program on Health Literacy. North Carolina program on health literacy.

Koh 2012* - Koh HK, Berwick DM, Clancy CM, et al. New federal policy initiatives to boost health literacy can help the nation move beyond the cycle of costly “crisis care.” Health Affairs. 2012;31(2):434-43.

Date Last Updated

Aug 7, 2014