Health literacy interventions
Health literacy is the degree to which people have the capacity to obtain, process, and understand basic health information and services required to make appropriate health decisions1. Low levels of health literacy are associated with limited health-related knowledge, poor health outcomes, and behaviors such as limited use of preventive care2, 3, as well as higher health care costs and expenditures4. Elderly individuals, those with low levels of income and education, and racial and ethnic minority groups are at higher risk of having low health literacy4, 5. Approaches to addressing limited health literacy include improving patient-provider communication, simplifying health information in educational materials, eHealth interventions (i.e., PCs and tablets with videos & interactive self-help tools), and efforts to improve underlying health literacy skills, such as the ability to read. These approaches can be delivered by various health care providers, clinic staff, and public health professionals2, 6, 7.
What could this strategy improve?
Expected Benefits
Our evidence rating is based on the likelihood of achieving these outcomes:
Improved health-related knowledge
Improved adherence to treatment
Potential Benefits
Our evidence rating is not based on these outcomes, but these benefits may also be possible:
Improved patient-provider communication
Improved mental health
Increased patient satisfaction
What does the research say about effectiveness?
There is some evidence that interventions designed to address limited health literacy increase health-related knowledge6, 7, 8, 9, 10, 11, 12, 13 and comprehension14, and improve adherence to treatment9, 15. Additional evidence is needed to confirm effects and determine which interventions are most effective.
Health literacy interventions that use written, print-based materials which are easy to read and understand have been shown to increase health-related knowledge among children and adults more than traditional materials7, 13. Primary care-based group education programs designed to be sensitive to health literacy limitations also appear to increase health-related knowledge among adults16. Health literacy programs for older adults offered in community settings can build capacity to retain and apply relevant health information12. Similarly, broader health intervention programs tailored for older adults and designed to be sensitive to health literacy limitations, like education and income17, can increase participants’ knowledge and capacity to find relevant health information10. Complex diagnoses, such as cancer, can create barriers in health literacy for patients as they navigate the decisions and experiences required for their treatment; tailored health literacy interventions may help overcome these barriers18, 19. More intense interventions appear to increase the likelihood of improvement20, particularly when they use individual focus21.
Health literacy interventions that combine multiple approaches (e.g., written and visual materials that are easy to read and understand, video tutorials, health literacy training for physicians, and in-person patient assessments) appear to increase patients’ comprehension and appropriate use of health care14. Interventions that use multi-media approaches, focus on interpersonal interactions22, or face-to-face communication appear to promote improved communication between patients and providers15. Health literacy interventions that use technology or the internet (i.e., eHealth interventions) can increase knowledge of HIV6, 9, colorectal cancer6, and mental health conditions such as post-traumatic stress disorder (PTSD)11. Web-based interventions can reduce symptoms of depression and anxiety11.
Health literacy interventions can improve adherence to medical treatment, particularly for patients following non-medication regimens or with cardiovascular disease15. Interventions that include in-person counseling with interactive or technology-assisted education can also increase treatment adherence for those taking HIV medications9.
Health literacy interventions that include skill-building in communication and self-management techniques can increase patient satisfaction and improve chronic disease management for older adults10. Health literacy driven diabetes self-management interventions may reduce HbA1C levels and improve diabetes related self-management outcomes23, particularly for patients with low health literacy levels24. One study found that promoting health literacy in primary schools can support good health literacy development in children, which could lead to improved health literacy in adulthood25.
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 the ability to find, evaluate, and use online health information26.
Experts suggest that health care providers may have difficulty accurately identifying patients’ health literacy limitations27, 28 and recommend that health professions curriculums train medical students, residents28, 29, and pharmacy students30 to assess health literacy for all patients.
How could this strategy advance health equity? This strategy is rated potential to decrease disparities: suggested by intervention design.
Health literacy interventions have the potential to decrease disparities in health-related knowledge, if they are designed and tailored for specific populations41 like migrants42 and refugees43 or caregivers and parents44. Disparities in health literacy disproportionately impact older women, individuals with lower educational attainment, and individuals experiencing barriers caused by socio-economic status and race17, 45. Health literacy interventions can improve adherence to medical treatment with benefits appearing greater for minorities and individuals with low incomes than for non-Hispanic whites and those with higher incomes15, 46.
Tailoring interventions to minorities, those with low levels of education, or limited experience with computers can promote patient engagement6.
For migrant women, specifically women of Afghan and Mexican backgrounds, gender roles may affect their health decisions42. Available evidence suggests that culturally tailored health literacy interventions can reduce these barriers and create a more comfortable environment that is culturally appropriate for patients42. In Spanish-speaking communities, Hispanic community health workers and communication strategies that are linguistically and culturally tailored and appropriate may help inform decisions regarding health47.
Both in-person and digital community-based health literacy interventions have the potential to enhance parental health literacy44. However, challenges to accessing digital health literacy resources should be considered, such as lack of broadband access and reduced availability of computers and smartphones48.
Health literacy interventions may help improve health outcomes for individuals with neurodevelopmental and chronic conditions when the interventions are targeted to caregivers and parents49.
What is the relevant historical background?
The phrase ‘health literacy’ was first published in 1974 in an article that discussed whether health education was a policy issue that impacted health care systems, education systems, and mass communication50. Since then, the field has expanded in scope and breadth to explore the role health literacy plays in patient’s decision-making and its impact on health and healthcare. Experts have investigated reading skills, information accessibility, and many other factors to understand methods to improve health literacy for patients.
More recently, findings from the National Assessment of Adult Literacy Survey has found that 36% of U.S. adults had basic or below-basic health literacy and non-white Americans are more likely to have limited health literacy51. To improve health literacy in the United States, public health experts have advocated for mass communication campaigns that are accessible and use plain language52.
Equity Considerations
- Does your community have health literacy interventions? If not, what organizations, health clinics, and/or health systems can you partner with to develop a health literacy program?
- Are there individuals or groups in your community that are more likely to have low health literacy? Are there health literacy interventions in your community that could be tailored for them?
- What resources are available to fund health literacy programs? What partnerships could help develop or expand health literacy programs in your community?
Implementation Examples
Federal initiatives including the Affordable Care Act (ACA), the National Action Plan to Improve Health Literacy, and the Plain Writing Act emphasize health literacy31.
There are a number of statewide programs that aim to improve health literacy; at least 25 states maintain health literacy coalitions or working groups, including Kentucky, Ohio, and Texas32. Specific examples include the North Carolina Health Literacy: Health Literacy Basics guide, the Colorado Health Literacy Coalition33, and Engage for Health, a Pennsylvania-based program that uses the Agency for Healthcare Research and Quality’s (AHRQ’s) “Questions are the Answer” patient engagement tools and resources34.
The National Institutes of Health has established the Clear Communication initiative that focuses on reaching all Americans with health information they can understand and use35. Many states are collaborating with local partners and non-profit groups to improve health literacy in their communities to meet the goals outlined in the National Action Plan to Improve Health Literacy36, 37.
Research organizations such as Duke University Medical Center, the Harvard T.H. Chan School of Public Health, and the University of Maryland provide information and training materials for patients, providers, and educators on strategies to improve health literacy38, 39, 40.
Implementation Resources
‡ Resources with a focus on equity.
Lopez 2022 - Lopez, C., Kim, B., & Sacks, K. (2022). Health literacy in the United States: Enhancing assessments and reducing disparities. SSRN Electronic Journal.
CDC-Health literacy action plan - Centers for Disease Control and Prevention (CDC). (2024, October 16). National action plan to improve health literacy. Accessed September 10, 2025.
CDC-Importance of health literacy - Centers for Disease Control and Prevention (CDC). (2024, October 16). Importance of health literacy. Accessed September 10, 2025.
CDC-Develop & test materials - Centers for Disease Control and Prevention (CDC). (2024, October 16). Develop & test materials. Accessed September 10, 2025.
CDC-Health literacy - Centers for Disease Control and Prevention (CDC). Health literacy: Accurate, accessible and actionable health information for all.
NNLM-Health literacy - National Network of Libraries of Medicine (NN/LM). Health literacy.
AHRQ-Health literacy toolkit - Brega AG, Barnard J, Mabachi NM, et al. AHRQ Health literacy universal precautions toolkit, 2nd edition. Rockville: Agency for Healthcare Research and Quality (AHRQ); 2015.
CDC-Cross-cultural tools - Centers for Disease Control and Prevention (CDC). (2024, October 16). Culture and Language: 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.
Harvard-Health literacy - Harvard T.H. Chan School of Public Health, Department of Social and Behavioral Sciences. Health literacy studies.
AHRQ-Shoemaker 2014 - Shoemaker S, Wolf M, Brach C. The patient education materials assessment tool (PEMAT) and user’s guide: An instrument to assess the understandability and actionability of print and audiovisual patient education materials. Rockville: Agency for Healthcare Research and Quality (AHRQ); 2014.
PLAIN - The Plain Language Action and Information Network (PLAIN). Plain language in healthcare. An official website of the U.S. government.
Georgetown-Patient education - Georgetown University, School of Nursing and Health Studies. Nursing @ Georgetown. Back to school: Patient education.
Footnotes
* Journal subscription may be required for access.
1 Ratzan 2000 - Ratzan SC, Parker RM. Introduction. In: National Library of Medicine current bibliographies in medicine: Health literacy. Selden CR, Zorn M, Ratzan SC, Parker RM, Editors. Bethesda: National Institutes of Health; 2000:v-vi.
2 AHRQ-Berkman 2011 - Berkman ND, Sheridan SL, Donahue KE, et al. Health literacy interventions and outcomes: An updated systematic review. Rockville: Agency of Healthcare Research and Quality (AHRQ); 2011.
3 AHRQ-Berkman 2004 - Berkman ND, Dewalt DA, Pignone MP, et al. Literacy and health outcomes: Summary. Rockville: Agency of Healthcare Research and Quality (AHRQ); 2004.
4 Eichler 2009 - Eichler K, Wieser S, Brugger U. The costs of limited health literacy: A systematic review. International Journal of Public Health. 2009;54(5):313-24.
5 NCES-Kutner 2006 - Kutner M, Greenberg E, Jin Y, Paulsen C, White S. The health literacy of America’s adults: Results from the 2003 National Assessment of Adult Literacy (NCES 2006–483). Washington, D.C.: U.S. Department of Education (U.S. ED), National Center for Education Statistics (NCES); 2006.
6 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.
7 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.
8 Dong 2023 - Dong, Q., Liu, T., Liu, R., Yang, H., & Liu, C. (2023). Effectiveness of digital health literacy interventions in older adults: Single-arm meta-analysis. Journal of Medical Internet Research, 25, e48166.
9 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.
10 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.
11 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.
12 Manafo 2012 - Manafo E, Wong S. Health literacy programs for older adults: A systematic literature review. Health Education Research. 2012;27(6):947–60.
13 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.
14 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.
15 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.
16 Brega 2013 - Brega AG, Pratte KA, Jiang L, et al. Impact of targeted health promotion on cardiovascular knowledge among American Indians and Alaska Natives. Health Education Research. 2013;28:437-449.
17 Fleary 2019 - Fleary, S. A., & Ettienne, R. (2019). Social disparities in health literacy in the United States. HLRP: Health Literacy Research and Practice, 3(1).
18 Holden 2021 - Holden, C. E., Wheelwright, S., Harle, A., & Wagland, R. (2021). The role of health literacy in cancer care: A mixed studies systematic review. PLOS ONE, 16(11), e0259815.
19 Housten 2021 - Housten, A. J., Gunn, C. M., Paasche-Orlow, M. K., & Basen-Engquist, K. M. (2021). Health literacy interventions in cancer: A systematic review. Journal of Cancer Education, 36(2), 240–252.
20 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.
21 Marshall 2025 - Marshall, N., Butler, M., Lambert, V., Timon, C. M., Joyce, D., & Warters, A. (2025). Health literacy interventions and health literacy-related outcomes for older adults: A systematic review. BMC Health Services Research, 25(1), 319.
22 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.
23 Butayeva 2023 - Butayeva, J., Ratan, Z. A., Downie, S., & Hosseinzadeh, H. (2023). The impact of health literacy interventions on glycemic control and self‐management outcomes among type 2 diabetes mellitus: A systematic review. Journal of Diabetes, 15(9), 724–735.
24 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.
25 Otten 2022 - Otten, C., Kemp, N., Spencer, M., & Nash, R. (2022). Supporting children’s health literacy development: A systematised review of the literature. International Journal of Educational Research, 115, 102046.
26 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.
27 Kelly 2007 - Kelly PA, Haidet P. Physician overestimation of patient literacy: A potential source of health care disparities. Patient Education and Counseling. 2007;66(1):119-122.
28 Rogers 2006 - Rogers ES, Wallace LS, Weiss BD. Misperceptions of medical understanding in low-literacy patients: Implications for cancer prevention. Cancer Control. 2006;13(3):225-229.
29 Hildenbrand 2020 - Hildenbrand, G. M., Perrault, E. K., & Keller, P. E. (2020). Evaluating a health literacy communication training for medical students: Using plain language. Journal of Health Communication, 25(8), 624–631.
30 Murphy 2022 - Murphy, P. Z., & Jester, A. P. (2022). Pharmacists’ knowledge and perceptions of health literacy. Journal of Pharmacy Practice, 36(3), 620–627.
31 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.
32 CDC-Health literacy - Centers for Disease Control and Prevention (CDC). Health literacy: Accurate, accessible and actionable health information for all.
33 Colorado-HL - Colorado Health Literacy Coalition. Assist the Colorado community with health navigation, promote wellness, and achieve quality outcomes.
34 AHRQ-Tools - Agency for Healthcare Research and Quality (AHRQ). AHRQ tools help consumers across Pennsylvania take an active role in their health care.
35 NIH-Plain language at NIH - National Institutes of Health (NIH). (2025, February 21). Plain language at NIH. Accessed September 10, 2025.
36 CDC-Health literacy action plan - Centers for Disease Control and Prevention (CDC). (2024, October 16). National action plan to improve health literacy. Accessed September 10, 2025.
37 CDC-Health literacy activities by state - Centers for Disease Control and Prevention (CDC). (2024, October 16). Health literacy activities by state. Accessed September 10, 2025.
38 Duke-HL - Duke University Medical Center Library and Archives. Health literacy (HL): Initiatives, research, and tools for patients, clinicians, multi-lingual patients, and educators.
39 Harvard-Health literacy - Harvard T.H. Chan School of Public Health, Department of Social and Behavioral Sciences. Health literacy studies.
40 Maryland-Health literacy resources - University of Maryland, Health Sciences and Human Services Library. (n.d.). Health literacy resources: Plain language resources. Retrieved September 9, 2025.
41 Stormacq 2019 - Stormacq, C., Van Den Broucke, S., & Wosinski, J. (2019). Does health literacy mediate the relationship between socioeconomic status and health disparities? Integrative review. Health Promotion International, 34(5), e1–e17.
42 Aldin 2024 - Aldin, A., Baumeister, A., Chakraverty, D., Monsef, I., Noyes, J., Kalbe, E., Woopen, C., & Skoetz, N. (2024). Gender differences in the context of interventions for improving health literacy in migrants: A qualitative evidence synthesis. Cochrane Database of Systematic Reviews, 2025(1).
43 Bitterfeld 2025 - Bitterfeld, L., Ozkaynak, M., Denton, A. H., Normeshie, C. A., Valdez, R. S., Sharif, N., Caldwell, P. A., & Hauck, F. R. (2025). Interventions to improve health among refugees in the United States: A systematic review. Journal of Community Health, 50(1), 130–151.
44 Belfrage 2025 - Belfrage, S., Husted, M., Fraser, S., Patel, S., & Faulkner, J. (2025). A systematic review of the effectiveness of community-based interventions aimed at improving health literacy of parents/carers of children. Perspectives in Public Health, 145(1), 25–31.
45 Farid 2025 - Farid, G., Mahmood, K., Khalid, S., Khalid, F., & Iftikhar, S. (2025). Health information literacy of cardiac patients: A systematic literature review. Journal of Health Literacy, Online First.
46 Mantwill 2015 - Mantwill S, Monestel-Umana S, Schulz PJ. The relationship between health literacy and health disparities: A systematic review. PLoS ONE. 2015;10(12):e0145455.
47 Hernandez 2024 - Hernandez, J., Demiranda, L., Perisetla, P., Andrews, L., Zhang, K., Henderson, R., Mittal, A., Norton, H. F., & Hagen, M. G. (2024). A systematic review and narrative synthesis of health literacy interventions among Spanish speaking populations in the United States. BMC Public Health, 24(1), 1713.
48 Smith 2019b - Smith, B., & Magnani, J. W. (2019). New technologies, new disparities: The intersection of electronic health and digital health literacy. International Journal of Cardiology, 292, 280–282.
49 Nevill 2025 - Nevill, T., Keeley, J., Hunt, S., Skoss, R., Lindly, O., Downs, J., & Blackmore, A. M. (2025). Efficacy of health literacy interventions for caregivers of individuals with neurodevelopmental and chronic conditions: A rapid review. Children, 12(1), 9.
50 Pinheiro 2021 - Pinheiro, P. (2021). Conceptualizations of health literacy: Past developments, current trends, and possible ways forward toward social practice. HLRP: Health Literacy Research and Practice, 5(2).
51 Coughlin 2020 - Coughlin, S. S., Vernon, M., Hatzigeorgiou, C., & George, V. (2020). Health literacy, social determinants of health, and disease prevention and control. Journal of Environment and Health Sciences, 6(1), 3061.
52 CDC-Develop & test materials - Centers for Disease Control and Prevention (CDC). (2024, October 16). Develop & test materials. Accessed September 10, 2025.
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