Health Literacy, An Underused but Valuable Tool in a Doctor's Tool Belt

You’ve just gotten back from the pharmacy, happy to have finally gotten medicine for your headaches. You open the brown baggie and take out the pill bottle. Just before opening the bottle, you read the label: “Take two pills daily.” But wait. Does this mean one pill in the morning and one in the afternoon? Two pills in the morning? Two pills in the afternoon? You decide not to take any because you don’t want to hurt yourself by not following instructions. This is how navigating health care can feel for many. 

According to the National Assessment of Adult Literacy, nearly 9 out of 10 adults in the US struggle with health literacy, meaning they lack the skills to fully understand medical terminology and instructions. This can lead to miscommunication and unintended harm. Katie Leath, director of the UAMS Center for Health Literacy, emphasizes the importance of health care providers adopting health literacy best practices to communicate clearly, ensuring patients understand their care instructions before walking out the door.

What is Health Literacy?

There are two sides to health literacy: the personal side and the organizational side. The UAMS Center for Health Literacy has adopted Healthy People 2030’s definitions of health literacy. Ultimately, however, the Center considers health literacy to be a problem that health organizations and health providers have a responsibility to address.

“On the personal side, health literacy is an individual’s ability to find, understand, and use health information to make appropriate decisions for themselves and the people they’re caring for,” Katie says. “The organizational health literacy definition is very similar to personal health literacy but with a focus on what organizations do to equitably enable individuals to find, understand, and use health information to make appropriate decisions for themselves and the people they care for.”

Organizational health literacy focuses more on enabling people to find, use, and act upon information regardless of their level of education, race, ethnicity, native language, reading level, or technical savvy.

The Benefit of Health Literacy

At the most basic level, if our patients don’t understand health information, they will not be able to follow instructions properly, leading to poor health outcomes. In today’s value-based care models, poor doctor-patient communication leads to poor reimbursement rates and lower patient satisfaction ratings on CMS-required CAHPS surveys, which commonly ask our patients to rate how well their doctor or nurse communicated.

“A big motivator for those going into the medical field is their desire to help people. You’re not helping anyone if you’re not communicating clearly and getting the outcomes you want your patients to have,” Katie adds.

On a deeper level, paying attention to health literacy protects you and your care team from safety and liability issues. Numerous studies reveal the connection between poor health literacy and a higher risk for medical and safety errors. For example, a patient who struggles to understand health information may lack an understanding of certain symptoms and when to seek care. This can result in a delay of needed treatment due to confusion and lead to more severe health outcomes and the need for more costly health care services (such as a visit to the emergency room when initial symptoms could have been treated by a primary care provider).

“When we’re talking about the time it takes to implement plain language strategies into your practice, there is a misconception that explaining something more clearly and using techniques like teach-back take too much time. Initially, it may take some time, but as you continue to practice, you get faster and could actually save time if patients do not call back with questions,” Katie says.

The bottom line is clear: good communication enhances patient safety and satisfaction and reduces the time spent on follow-ups and callbacks.

The Role Providers and Professionals Play

While doctors, nurses, and health care professionals are not necessarily experts in health literacy, we do play an important role in upholding health literacy best practices when communicating with patients and colleagues.

“I think it is really hard sometimes for all of us to remember that not everybody had the benefit of an education in a health-related field,” Katie says. “Even when talking with another doctor, you can never assume they know the same terminology you do because you might be talking to a cancer specialist about kidney disease.”

You can also advocate for clear communication, understand your own limitations, and reach out to health literacy specialists or plain language experts for assistance. There are also a variety of resources available to help you and your patients improve their health literacy.

The UAMS Center for Health Literacy

The UAMS Center for Health Literacy is one of the best health literacy resources available for providers and health care organizations in Arkansas. “While we don’t do a lot of work directly with patients, we do develop materials for dissemination to patients and other community members,” Katie says. “Samples of these materials are available on our website along with facilitator guides to help with delivery.”

The UAMS Center for Health Literacy most recently developed materials about health insurance, one of the most complex health care topics for patients to understand. The Center also manages educational materials and patient training on a variety of important health care topics.

“Most of what we do involves working with health care professionals and health organizations to improve the way they communicate with the people they serve,” Katie says. “We do this through our health literacy services.”

For health care providers, the Center provides plain language writing and editing, Spanish translation, and training modules on techniques to improve verbal or written communication so that you can better communicate with patients. The Center’s website includes community and patient engagement resources to help individuals to improve their health literacy skills.

The website also includes a list of reliable trustworthy online health websites. “The first place I tell people to go would be MedlinePlus. They have information on a variety of topics that are easy to understand, with links to outside resources that back up the info,” Katie says. “Medical information changes like the wind, so it’s important to know what is reliable and what is disinformation or misinformation.”

The Center has also recently begun assessing organizational health literacy, which is a great starting point for determining what strategies are working and what your staff can do to improve their interactions with patients.

You can reach out directly to the Center for Health Literacy at This email address is being protected from spambots. You need JavaScript enabled to view it.. “We can talk about the impact your communication strategies have on patients and the people you serve, or we can discuss any special projects or plans you have in mind,” Katie says.

Health Literacy is Hard to Master

“There is a lot of skill involved in being health literate or having proficiency in health literacy,” Katie adds. “So, addressing all of the complex elements of health literacy can be challenging. A great place to start is to lower the demands of every individual to understand what we’re saying all the time.”

Even if you are an expert in health literacy and speak or write in plain language, your audience will not fully understand you if they are stressed, overwhelmed, or have other things on their mind.

Katie provided an example of this in her own life:

“When my son was born, I was working at UAMS with a team involved in evaluating health insurance claims to inform policy decisions. I was well exposed to the issues surrounding health insurance and have had the benefit of having health insurance most of my life. However, when my son was born early, we spent 50 days in the NICU. My husband and I wondered how much a NICU stay would cost. And for the life of me, I could not figure it out from my health insurance information.

One of my coworkers printed out all the information she could find on the HR website and brought it to our room, and we all figured it out together. I was in two master’s programs at the time, and one would think I would have the ability to figure this out. But because I was scared and stressed about my child and what his outcomes were going to be, I was not able to decipher my health insurance information.”

Circumstances don’t need to be life or death in order to affect a person’s ability to process information. Just picture yourself in this scenario — someone cut you off in traffic, causing you to be late for work. Walking in, you spill coffee on your new shirt. You remember you have an urgent meeting with your boss to discuss a new policy or procedure. Your boss is using language and terms you’ve never heard of before, and all you can think about is the terrible luck you’ve had up to this point.

You aren’t paying attention to what your boss is saying. And it’s nearly impossible for you to understand or apply the information from the meeting because your brain is just not ready to focus on complex details after such a stressful morning.

Consider that same scenario for your patients, and you’ll likely see the benefit to using plain language in your everyday interactions.

Plain language helps everyone understand what is being said, regardless of how they’re feeling or what they just experienced. Granted, there are some who still may not understand what you tell them, but using plain language helps you be understood by the largest possible audience.

Plain Language Resources

In addition to the UAMS Center for Health Literacy website, there are several other reputable organizations you can use to help with plain language communication.

The Centers for Disease Control and Prevention created a health literacy website that houses information and tools on health literacy research, practice, and evaluation. You can learn about guidelines, laws, and standards, funded research initiatives, collaborative resources, and tips for creating your own health literacy action plan. The website also includes a list of health literacy activities by state, which may be a helpful resource when coordinating services with other professionals across state lines.

The U.S. Department of Health and Human Services (DHHS) promotes national health initiatives, including health literacy, on its website. The DHHS health literacy initiative includes the latest news and announcements, information about a health literacy workgroup, a care model, and other resources to help you adhere to health literacy best practices.

Final Thoughts

Health literacy is key to building a clinical environment where our patients feel informed, confident, and safe managing their health. By integrating plain language and health literacy best practices into our daily interactions with patients, we can bridge the gap of misunderstanding. Taking advantage of vital resources like the UAMS Center for Health Literacy will help ensure that no patient feels lost due to miscommunication. It’s important that, moving forward, we commit to making health information accessible and understandable, empowering our patients to make informed decisions about their health and well-being.