Closing the Gap on Health Literacy


By Carol Howe



It’s October – health literacy awareness month.  As a fellow health care provider, I ask that we take time to consider health literacy – what this means for the patients we see and what this means in terms of our health-literate practice.


Statistics on Health Literacy

According to the National Assessment of Adult Literacy, 36% of adults in American have basic or below basic health literacy.  We can expect that they will struggle to understand and use health information to make decisions about their health.

Even people with higher education may find health information difficult to understand. Although lower health literacy was associated with lower education attainment, 10% of college graduates were assessed with basic or below basic health literacy.


The Gap

As health care providers, we teach our patients how to take care of themselves; to test their blood sugar, to live a healthy lifestyle, to take their medications.

If you are a diabetes educator or see many patients with diabetes like myself, we teach this all day, every day. 

But did you know that most patients forget the information we tell them and many recall the information we provide incorrectly? In a survey study of patients at discharge from the hospital, less than half of patients could state their diagnosis or the names of their medications (Makaryus & Friedman, 2005).

We live in our medical world that has its own culture and language.  We give lengthy explanations of pathophysiology and pharmacokinetics, peppered with medical terminology, to communicate about disease and treatment. This medical world is so alienating for our patients. But they try; they try so hard to enter this world that they need to navigate to take care of their health.

For example, anyone who works with patients with diabetes have heard someone say “keystones” instead of “ketones.”  This can be a source of humor for health care providers when patients mix up words, but I see patient’s misuse of medical terms as their attempt to meet us in our world.  It is evidence to me that we are not meeting them at least halfway.

Our jargon ends up being an obstacle.  Several studies have really shown that health care providers do not communicate well with their patients.

  • Patients with low health literacy compared to those with adequate health literacy were six times more likely to report that their doctor used words that they did not understand (Schillinger et al., 2004).
  • Analysis of recordings of diabetes visits found that health care providers used, on average, four medical jargons at each visit and 60% of patients did not know what they meant.
  • See how our medical jargon confuses patients. Watch this compelling video from the American Medical Association. Could any of these people be your patient?


Mind the Gap

How can we make sure we are having productive, effective interactions with our patients?

The AHQR Universal Health Literacy Precautions Toolkit is packed full of ways for health care providers to reduce the complexity of health care and to increase patients’ understanding of health information. Tools #4 to #10 are focused on health care provider communication. They have everything you need to do a quality improvement project on improved patient provider communication:  lessons, power point presentations, discussion points, communication assessment tools.

Find an idea that you can implement today.


Close the Gap

Be a health literacy hero. Share the stats, share best practice in communicating with patients. Insist that it is our moral obligation to communicate in ways that our patients understand. If we all do our part to promote health literacy, we can increase equity in health care and health outcomes for all of our patients.

  • Use clear communication. Avoid medical jargon.
  • Make one to three important points at a time.
  • Use graphics, pictures and models to reinforce what you are teaching.
  • Demonstrate self-care; e.g., taking medicines, checking blood sugar.
  • Encourage questions.
  • Use teach-back and re-demonstration to ensure understanding.


Kutner, M., Greenburg, E., Jin, Y., & Paulsen, C. (2006). The Health Literacy of America’s Adults: Results from the 2003 National Assessment of Adult Literacy. NCES 2006-483. National Center for Education Statistics.

Makaryus, A. N., & Friedman, E. A. (2005). Patients’ understanding of their treatment plans and diagnosis at discharge. Mayo Clinic Proceedings, 80(8), 991-994.

Health Literacy Universal Precautions Toolkit, 2nd Edition. Content last reviewed February 2015. Agency for Healthcare Research and Quality, Rockville, MD.