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); health knowledge, skills, and self-efficacy allow patients to leverage information to support their health (Miller 2016, Brainard 2016, Brijnath 2016, , Taggart 2012). Low levels of health literacy are associated with poor health outcomes and limited use of preventive care (AHRQ-Berkman 2011, Taggart 2012), along with higher health care costs and expenditures. 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 can be delivered by various providers and include simplifying health education materials in various formats, improving patient-provider communication, eHealth interventions (i.e., PCs and tablets with videos & interactive self-help tools), and efforts to improve overall literacy ().

Expected Beneficial Outcomes (Rated)

  • Improved health-related knowledge

  • Improved adherence to treatment

Other Potential Beneficial Outcomes

  • Improved patient-provider communication

  • Improved mental health

  • Increased patient satisfaction

Evidence of Effectiveness

There is some evidence that interventions to improve health literacy increase health-related knowledge (Perazzo 2017, Brainard 2016, Brijnath 2016, , , Taggart 2012, Bush 2010, DeWalt 2009, Pignone 2005) and comprehension (Sheridan 2011), and improve adherence to treatment (Perazzo 2017, Miller 2016). Additional evidence is needed to confirm effects and determine which interventions are most effective.

Health literacy interventions that use enhanced written and print-based materials have been shown to increase health-related knowledge among children and adults (DeWalt 2009, Bush 2010, Pignone 2005, ). Group-based education programs in primary care settings also appear to increase knowledge among adults (Taggart 2012). Programs that serve older adults can increase participants’ knowledge and capacity to find relevant health information (Brainard 2016, ).

Health literacy 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). Interventions that use multi-media approaches, focus on interpersonal interactions (Bush 2010, ), or face-to-face communication appear to promote improved communication between patients and providers (Miller 2016). Interventions that use technology or the internet (i.e., eHealth interventions) can increase knowledge of HIV (Perazzo 2017, ), colorectal cancer (), and mental health conditions such as post-traumatic stress disorder (PTSD) (Brijnath 2016). Web-based interventions can reduce symptoms of depression and anxiety (Brijnath 2016).

Health literacy interventions can improve adherence to medical treatment, particularly for patients following non-medication regimens or with cardiovascular disease. The benefits appear greater for minorities and individuals with low incomes than for peers with higher incomes (Miller 2016). Interventions can also increase treatment adherence for those taking HIV medications (Perazzo 2017).

Health literacy interventions can increase patient satisfaction and improve chronic disease management for older adults (Brainard 2016). Health literacy-sensitive diabetes self-management interventions may reduce HbA1C levels, particularly for patients with low health literacy ().

Tailoring interventions to minorities, those with low levels of education, or limited experience with computers can promote patient engagement (). Classes that teach participants how to access health information on the internet may increase self-efficacy in health information seeking and health information comprehension, improving online 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, the National Academies of Medicine, the American Medical Association, and the National Institutes of Health promote health literacy as a research priority (CDC-NCHS 2012). Federal initiatives including the Affordable Care Act, the National Action Plan to Improve Health Literacy, the Plain Writing Act (), and Healthy People 2020 also emphasize health literacy (CDC-Healthy People 2020 HL).  

There are a number of statewide programs that aim to improve health literacy. Examples include the North Carolina Program on Health Literacy (NCPHL), the Colorado Health Literacy Coalition (Colorado-HL), and Engage for Health, a Pennsylvanian program that utilizes the Agency for Healthcare Research and Quality’s (AHRQ’s) “Questions are the Answer” patient engagement tools and resources (AHRQ-Tools).

Universities such as the University of Michigan and Duke University Medical Center provide information and training materials for patients, providers, and educators on strategies to improve health literacy (UM-HL resources, Duke-HL).

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). 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.

AHRQ-Teach-Back - Agency for Healthcare Research and Quality (AHRQ). Teach-Back intervention: Patient and family engagement in primary care.

UM-HL resources - University of Michigan (UM), Taubman Health Sciences Library (THSL). Improving health literacy (HL): Training resources.

Duke-HL - Duke University Medical Center Library and Archives. Health literacy (HL): initiatives, research, and tools for patients, clinicians, multi-lingual patients, and educators.

Citations - Evidence

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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.

Perazzo 2017 - Perazzo J, Reyes D, Webel A. A systematic review of health literacy interventions for people living with HIV. AIDS and Behavior. 2017;21(3):812-821.

Kim 2016b* - Kim SH, Lee A. Health-literacy-sensitive diabetes self-management interventions: A systematic review and meta-analysis. Worldviews on Evidence-Based Nursing. 2016;13(4):324-333.

Brainard 2016 - Brainard J, Loke Y, Salter C, et al. Healthy ageing in Europe: Prioritizing interventions to improve health literacy. BMC Research Notes. 2016;9(1):270.

Jacobs 2014a* - Jacobs RJ, Lou JQ, Ownby RL, Caballero J. A systematic review of eHealth interventions to improve health literacy. Health Informatics Journal. 2016;22(2):81-98.

Miller 2016 - Miller TA. Health literacy and adherence to medical treatment in chronic and acute illness: A meta-analysis. Patient Education and Counseling. 2016;99(7):1079-1086.

Brijnath 2016 - Brijnath B, Protheroe J, Mahtani KR, Antoniades J. Do web-based mental health literacy interventions improve the mental health literacy of adult consumers? Results from a systematic review. Journal of Medical Internet Research. 2016;18(6):e165.

Citations - Implementation Examples

* Journal subscription may be required for access.

CDC-NCHS 2012 - Centers for Disease Control and Prevention (CDC). Healthy People 2010 final review. National Center for Health Statistics (NCHS). 2012.

NCPHL - NC Program on Health Literacy (NCPHL). 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.

AHRQ-Tools - Agency for Healthcare Research and Quality (AHRQ). AHRQ tools help consumers across Pennsylvania take an active role in their health care.

UM-HL resources - University of Michigan (UM), Taubman Health Sciences Library (THSL). Improving health literacy (HL): Training resources.

Duke-HL - Duke University Medical Center Library and Archives. Health literacy (HL): initiatives, research, and tools for patients, clinicians, multi-lingual patients, and educators.

CDC-Healthy People 2020 HL - Centers for Disease Control and Prevention (CDC). Healthy People 2020. Health communication and health information technology objectives: Improve the health literacy (HL) of the population.

Colorado-HL - Colorado Health Literacy Coalition. Assist the Colorado community with health navigation, promote wellness, and achieve quality outcomes.

Date Last Updated

Feb 23, 2018