Improving Health Literacy in America

Improving Health Literacy in America

To make healthy decisions, patients must be able to understand and react to the health information they receive. But the National Assessment of Adult Literacy (NAAL), the only large-scale survey of health literacy in the country, revealed that 88 percent of American adults do not have proficient health literacy. Greater health literacy awareness is critical for healthcare providers, who must help patients manage their health and prevent disease.

What Is Health Literacy?

The definition of health literacy has evolved through the years, according to Orthopaedic Nursing.

  • Initial Definition: Health literacy is an individual’s ability to read health information.
  • Healthy People 2010 Initiative: Health literacy is “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.”
  • NAAL: Health literacy is “the ability of US adults to use printed and written health-related information to function in society, to achieve one’s goals, and to develop one’s knowledge and potential.”

Health literacy requires basic literacy skills and knowledge of health topics. Also, health literacy depends on individual patients and the healthcare system, the Department of Health and Human Services says.

Patients without proficient health literacy may have trouble with self-care and disease management, filling out complex forms and locating providers, and sharing personal information like health history with providers. Additionally, they may struggle with math skills, which can make it difficult to measure medications, compare health insurance plans or prescription drug coverage, or calculate cholesterol or blood sugar levels.

People with strong literacy skills can still struggle with health literacy. For instance, a serious illness can cause confusion, complex conditions might require complicated self-care, certain medical terms may be unfamiliar and, overall, the rapid progression of medical science can result in misunderstandings.

Health Literacy in America

Survey Results

The NAAL survey used four different health literacy levels to reflect the skills and knowledge of participants.

  • Proficient: 12 percent would be able to use a table for calculating an employee’s share of health insurance costs for a year.
  • Intermediate: 53 percent would be able to read instructions on a prescription label to determine when to take medication.
  • Basic: 21 percent would be able to read a pamphlet and provide two reasons why someone with no symptoms should be tested for a disease.
  • Below basic: 14 percent would be able to read a short set of instructions and identify what is permissible to drink before a medical test.
Health Literacy Scale

More than one-third of the population, or 77 million people in United States as of 2003, had basic or below basic health literacy skills. This level of health literacy means that they would have trouble with common tasks such as understanding a prescription drug label or a childhood immunization schedule.

Survey results show the relationship between health literacy and certain demographic factors. Health literacy scores range from 0 to 500.

  • Gender: Women scored six points higher than men, on average.
  • Race: White and Asian/Pacific Islander adults had higher average health literacy than black, Hispanic, American Indian/Alaska Native and multiracial adults.
  • Language: Adults who only spoke English prior to beginning school had higher health literacy than those who spoke one language other than English.
  • Age: Adults ages 25 to 39 had the highest average health literacy, while adults 65 and over had the lowest average health literacy.
  • Education: Health literacy level generally increased as educational level increased.
  • Poverty: Those living below the poverty level had an average health literacy score of 205. The average health literacy score increased as income level increased.
  • Health assessment: The average health literacy score increased in relation to self-reported health level. For instance, adults who reported excellent health had an average health literacy score of 262, adults reporting good health had a score of 234, and adults reporting poor health had a score of 196.
  • Health insurance: The average health literacy score varied depending on type of health insurance — 259 for employer, 248 for military, 243 for private purchase, 216 for Medicare, 212 for Medicaid and 220 for no insurance.


Limited health literacy is associated with poor health, according to research compiled by the Department of Health and Human Services. People with limited health literacy:

  • Are more likely to skip important preventative measures such as flu shots and mammograms
  • Are more likely to have chronic health conditions and are less able to manage them effectively
  • Have a higher rate of hospitalization and use of emergency services
  • Use more services designed to treat complications of disease than services designed to prevent complications, resulting in higher healthcare costs
  • Experience negative psychological effects, such as a sense of shame about their skill level, and may hide their reading or vocabulary difficulties

Health literacy plays a powerful role in the health of patients. Poor health literacy is “a stronger predictor of a person’s health than age, income, employment status, education level, and race,” according to the American Medical Association.

Strategies to Improve Health Literacy in America

Achieving a higher level of health literacy is the goal of the National Action Plan to Improve Health Literacy. It focuses on a vision of society that:

  • Provides everyone with access to accurate and actionable health information
  • Delivers person-centered health information and services
  • Supports lifelong learning and skills to promote good health

The report includes seven goals to improve health literacy, as well as strategies for achieving them.

  • Develop and disseminate health and safety information that is accurate, accessible and actionable.
  • Promote changes in the healthcare system that improve health information, communication, informed decision-making and access to health services.
  • Incorporate accurate, standards-based and developmentally appropriate health and science information and curricula in childcare and education through the university level.
  • Support and expand local efforts to provide adult education, English language instruction and culturally and linguistically appropriate health information services in the community.
  • Build partnerships, develop guidance and change policies.
  • Increase basic research and the development, implementation and evaluation of practices and interventions to improve health literacy.
  • Increase the dissemination and use of evidence-based health literacy practices and interventions.

Responsibility for improving health literacy lies with healthcare professionals and the healthcare system. Take specific steps to overcome issues presented by limited health literacy by ensuring that information given to patients is accurate, accessible and actionable. Provide supplemental information, including visuals and simple written instructions. Finally, be aware of cultural differences and other barriers to communication.

Enhancing Communication

Aurora University’s online BS in Healthcare Administration degree helps nurses communicate with patients of all literacy levels. Graduates are equipped with the skills and knowledge to pursue advanced career opportunities. The program takes place in an online learning environment that allows students to complete their degree while maintaining their work and personal schedule.