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Launching a Health Literacy Initiative: Implementation Strategies

Added on 05 Feb 2016
Last updated on 05 Feb 2016

Authors: By Monica Jumpp; Reviewed by Thomas K. Bauer, MBA, RT(R)

Many studies have shown that the skills required to effectively understand and use health care-related forms of communication are far beyond the abilities of the average person—in fact, only 12 percent of English-speaking individuals have proficient health literacy skills.1 Health literacy encompasses the educational, social, and cultural factors that influence an individual’s expectations and preferences surrounding their health care, but also the ways in which these factors interact with the demands of the health care system.

Several factors have caused the issue of health literacy to bubble to the surface in recent years—the aging and evolving racial and ethnic composition of the US population, the passage of the Affordable Care Act which has launched some Americans into the health care system for the first time, and the well-documented effects of low health literacy levels on patient safety. This influx of patients with possible low health literacy levels requires a call to action for addressing this issue both on a practice and policy-based level.

This Expert Panel aimed to highlight health literacy programs and implementation strategies in a range of settings.

Key Points:

  • Promoting health literacy initiatives is vital for health professionals and patients to share a common goal of mutual understanding.
    • “The health literacy of a society can be improved both by developing the skills of individuals and by lowering the barriers created by health service personnel and systems.”2
  • Reading comprehension must be taken into consideration when determining what patients are able to understand about their diagnosis and aftercare.
    • Health literacy must be comprehensible and user-friendly.
    • The average American’s reading comprehension is at an 8th grade level.
    • Applying “University Precautions” to health literacy is extremely helpful in addressing health literacy in clinical settings.
      • Communication materials should be presented in plain language and in the patient’s preferred language.
      • This cultivates dignity, respect, and enhances effective communication.
    • Reading comprehension is varied and the construction of language used in determining comprehension is based on vocabulary length. It is important to note that a patient’s literacy cannot truly be measure by the literacy skills of individuals unless we simultaneously measure the literacy demand.
  • There are several challenges to achieving efficient health literacy program implementation.
    • Some health care professionals are dismissive of the effectiveness of their communication.
    • Patients often feel shameful of discussing issues or concerns they may have, especially around the language of diagnoses. Asking the patient, “Are there any more questions?” with no response does not negate the gap in proper patient care. Providers should observe nonverbal cues and body language to help determine a patient’s understand of the information received.
    • Failing to apply effective methods such as “teach-back” due to time constraints leads to patient safety concerns. Proper communication between patient providers is crucial to diagnosing, treating, and avoiding readmission.
    • Health literacy is a two way street—providing resources for both health care providers and patients will help eliminate health literacy challenges. Volunteering with adult literacy programs or partnering with these agencies can also raise awareness.
  • Developing an organizational health literacy culture is important to improving health literacy.
    • Support from senior leadership will integrate effective communication skills between health care professionals and patients.
    • A strong organizational foundation promoting health literacy issues can be achieved through assessments, raising awareness, and providing education to all staff and employees.
    • A “teacher’s approach”—listening to the population being served while acknowledging cultural and social determinants, and adjusting how information will be received—may be used to improve communication.
  • Health communication methods are helpful in supporting health literacy initiatives.
    • The effectiveness of various health communication methods can provide physicians with a better understanding of patients’ comprehension. (Ask Me 3/Tell Me 3, Teach-Back)
    • Providers should present patients with possible strategies and options, even those that may benefit, harm, or risk helping patients. This can allow patients to make decisions that align with their values.
    • Engagement and activation are important tools when implementing patient education strategies that will be deployed through listening, reading, or visual devices.

Health Literacy Initiatives:

  • Novant Health is researching methods to expand their health care professional’s communication tools to meet the needs of all of their patients through technology and experience.
  • Project RED (Re-Engineered Discharge) was developed by a research group at Boston University Medical School and has shown a significant impact on reducing readmissions. Download the Project RED toolkit.
  • Teach with Stories is an empowerment-based approach that focuses on participant outcomes from an evaluation standpoint.
  • Health Literacy Outcomes is a site aimed at improving Australian health literacy rates by providing education and support to both practitioners and patients.
  • HealthCare Information for All (HIFA) is an organization determined to provide access to health care information for every patient and health care worker.

Key Resources:


  1. Parnell TA, McCulloch EC, Edwards F, Mieres JH. Health Literacy as an Essential Component to Achieving Excellent Patient Outcomes: Institute of Medicine; 2014.
  2. Coleman C, Kurtz-Rossi S, McKinney J, Pleasant A, Rootman I, Shohet L. The Calgary Charter on Health Literacy: Rationale and Core Principles for the Development of Health Literacy Curricula. The Centre for Literacy of Quebec. 2010. Available at:

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