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Healthy Literacy

Friday, October 5, 2018

By Ashley Petersen. 

Oh, no!  You don’t understand what the doctor is saying. You don’t know what questions to ask or don’t remember what you were going to ask at your appointment. What can you do?

There are steps you can take to make your doctor’s appointments more productive.  Before any appointment, write down any questions you may have. Take those questions with you when you go to the appointment. And then ASK those questions!  Often, we forget that we are the customer in the doctor/patient relationship—you are paying (with your time and your money) to sit in the room with your doctor.  He or she is more than willing to answer your questions.  Also, depending on the appointment, take someone with you to help listen and understand information. Take notes and write information down from the provider. “…Medical information can be an overload. About 40-80% of medical information is forgotten right away” (Kessels, 2003).

October is Health Literacy Month and the theme for this month is "Be a Health Literacy Hero."  Health Literacy Month is a time for organizations and individuals to promote the importance of understandable health information, and a chance for you to tell the world what you're doing, too!

Healthy 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. Health Literacy is a person’s ability to talk with their doctor, take their medicine, eat right, and live a healthier life. It includes the ability to speak, listen, read, write, and do math. “Almost half of information is remembered wrong” (Anderson et al, 1979), and this can have negative, even deadly, effects on your life.

Healthy Literacy allows the public and personnel working in all health-related fields to find, understand, evaluate, communicate and use information. Most adults have trouble making sense of health information at one time or another.  Health Literacy includes the collection of skills that health care and public health providers need to clearly inform the public about health-related choices.  These skills are a key part of making the healthy choice the easy choice. “The more information given, the more information forgotten” (McGuire, 1996). Watch the following video on Health Literacy and patient safety.  It’s called, “Help Patients Understand”

When creating information for the public, know your audience.  Use the tools such as Health Literacy Advisor software, Quick Checklist for Plain Language, Patient Education Material Assessment Tool (PEMAT), Centers for Disease Control Clear Communication Index, Teach Back, and other tools to help your audience understand the message.

Health Literacy Advisor is the nation's first interactive health literacy software tool. This tool assesses and improves the readability of your documents using plain language principles. The HLA works entirely within Microsoft Word, offers a full array of readability formulas, and has an easy-to-use interactive "readability-checker." Watch a 15-minute demonstration of this tool at

Another tool is the Quick Checklist for Plain Language, which can be found at This will help you check over your materials. The more check boxes on this list, the more likely your audience can understand and use the material. When material is run through the Health Literacy Advisor software to check for readability, if the grade level score is high, it means the material is too difficult for most readers. However, it’s also important to realize that a low score does not mean the material will be easy for readers to understand and use, either. That’s because short words and sentences are only one of many things that help readers understand the material. Use field testing before releasing the information, when possible.  A golden rule is to have nine people review your document prior to releasing it to the public. Field testing is the best and most direct way to tell if your materials are easy to understand and use. Feedback from people who represent the readers lets you know where improvements need to be made in the material. If it doesn’t look easy to read, it’s probably not going to be picked up.

Another tool is the Teach-back Method. Using this method, a provider would also incorporate the “Ask Me 3” from the National Patient Safety Foundation (NPSF).  If you are a patient, you can also use this method when talking to your provider, as well. 

o   PATIENT:  What is my main problem? ...  PROVIDER:  Your main Problem is…

o   PATIENT:  What do I need to do? ...  PROVIDER:  You need to…

o   PATIENT:  Why is this important? …  PROVIDER:  This is important because…


When teaching back, sit down and slow down, give the most important information first, and focus on two or three concepts. You want to limit new information given. Ask the patients to demonstrate their understanding of the information given by having them share in their own words what they need to know or do. If you are the patient, take the time to repeat what you understand the doctor has said in your own words.  Repeat the teach-back process until the patient truly understands the situation and what they need to do. The teach-back is a test of how well you explained a concept, not of the patient’s knowledge or understanding. It’s a chance to check for understanding and re-teach the information if necessary.  Visit for a Teach-back toolkit.

Use the simplest, most straightforward language to express an idea. Avoid jargon, abbreviations, and acronyms; make sure to use common, everyday language. When medical terms are difficult but unavoidable, make sure they are defined. For example, you might say, “Hypertension is also called high blood pressure.” Choose which term you want to use at that point, using only one or the other throughout the material or information you are sharing.

With written materials, you can use visual cues to draw attention to key points. Make material look easy to read, and make sure to provide a summary of the material. When creating material, take into consideration the layout; make good use of “white space” and the design and formatting such as the bullets and fonts. Don’t use too many different types of fonts and use Italics and bold sparingly. When using visual or pictures, make sure they relay the message you are trying to get across to your readers. An example of this might be a bike safety brochure. You include the equipment in a list to be a safe biker, but your visual is a picture of a person without a helmet. You are sending two different messages to your reader. Use a visual of a person with a helmet as you stated in the context of the brochure to make sure you are getting the correct message across to your readers. Pictures should be correct, safe, and show proper image information.

Hopefully, you have a better understanding from a provider’s view and a patient’s view about the importance of health literacy. As a patient, when you come home from your doctor’s visit and have a chance to review the information again after hearing it, you may think of more questions or of the forgotten questions you wanted to ask. Again, write the questions down and call your doctor back to talk him or her, or take the questions with you to the next appointment. As a patient, do not hesitate to ask or feel ashamed to admit you don’t understand—you are the customer and you have the right to know what is being discussed regarding your health. Ask any questions and as many times as needed to fully understand the information correctly.  As a provider, be patient, slow down, and make sure your patient has a full understanding of what are telling them about their health.  Their lives may depend on it!

Additional Resources:












Pictures: CDC Public Health Image Library (Free Pictures)

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Elkhorn Logan Valley
Public Health Department
2104 21st Circle / PO Box 779, Wisner, NE 68791
Phone: 402.529.2233  - or -  877.379.4400
Fax: 402.529.2211
After Hours: 402.841.8110