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Clear Communication: an NIH Health Literacy Initiative

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What is health literacy?

Similar to our traditional understanding of literacy, health literacy incorporates a range of abilities: to read, comprehend, and analyze information; decode instructions, symbols, charts, and diagrams; weigh risks and benefits; and, ultimately, make decisions and take action. However, the concept of health literacy extends to the materials, environments, and challenges specifically associated with disease prevention and health promotion.

Areas commonly associated with health literacy include

Patient-physician communication
Drug labeling Medical instructions and medical compliance
Health information publications and other resources
Informed consent
Responding to medical and insurance forms
Giving patient history
Public health training
Assessments for allied professional programs, such as social work and speech-language pathology

According to Healthy People 2010, an individual is considered to be "health literate" when he or she possesses the skills to understand information and services and use them to make appropriate decisions about health. Alarmingly, these skills and strategies are absent in more than half of the U.S. population. This fact is more disturbing when one considers that these are the very skills and strategies that often lead to longer life, improved quality of life, reduction of both chronic disease and health disparities, as well as cost savings.

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Why is health literacy an issue for health communication professionals?

Health communication professionals must consider literacy and all its facets when developing health materials and communication strategies for a range of diverse audiences—each with differing abilities, experiences, levels of knowledge, cultural beliefs and practices, and communication expectations. Analyzing these differences can ultimately improve health and prevent disease. In fact, helpful materials are available on many aspects of health communication, including strategies and tactics, understanding audiences, and evaluation and planning. One example is this guide available from the National Cancer Institute: Making Health Communication Programs Work: A Planner's Guide.

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What is the health literacy objective in Healthy People 2010?

Progress can be made on objectives that have baseline, measurable data. In order to improve health literacy, health professionals will use the Healthy People 2010 strategy to track improvements over a decade. Health literacy is one of the Health Communication objectives in Healthy People 2010. It reads:

"Objective 11-2. (Developmental) Improve the health literacy of persons with inadequate or marginal literacy skills. Potential data source: National Adult Literacy Survey, 2002, U.S. Department of Education."

Healthy People 2010 outlines key points for achieving this objective, stating that the issue of health literacy is fundamental to efforts to reduce health disparities. Two key areas are emphasized as crucial to attaining measurable improvement:

Develop appropriate written materials for audiences with limited literacy.

Health communicators should use existing resources to create plain language health communications targeted to this population.
Professional publications and Federal documents already provide the necessary criteria.

Improve the reading skills of persons with limited literacy.

Health literacy programs can be tailored to target skill improvement.
These programs could be offered through a variety of organizations, such as libraries, schools, and community groups.

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Can better communication strategies improve health?

In recent publications, Dean Schillinger, M.D., University of California, San Francisco, an associate professor of medicine at San Francisco General Hospital, identified health improvements based on improved literacy. His work focused on diabetes compliance as it relates to doctor-patient-doctor interaction and on strategies for verifying that individuals with literacy challenges understand health information. These principles may prove useful in confronting challenges in other health settings. Dr. Schillinger's publications include the following:

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