Organizations Have an Opportunity to Enhance Health Literacy

Health and Well-Being Matter is the monthly blog of the Director of the Office of Disease Prevention and Health Promotion. This month RDML Paul Reed, ODPHP Director is pleased to welcome a co-author, Cindy Brach, MPP, a Senior Healthcare Researcher at the Agency for Healthcare Research and Quality and the Co-Chair of the HHS Health Literacy Workgroup.

There’s widespread agreement that health care is not the principal driver of health. Rather, the conditions in the places where people live, work, and play — what many refer to as social determinants of health — have the greatest influence on our health. Organizational health literacy — the degree to which organizations equitably enable individuals to find, understand, and use information and services to inform health-related decisions and actions for themselves and others — is one of those key social determinants. Organizations that produce health information that is complex and full of jargon, or make it challenging to obtain resources and services, create unnecessary barriers to good health. On the other hand, organizations that follow health literacy principles — making information easy to understand and act on and ensuring systems are easy to navigate — equip people to make healthy lifestyle choices and seek health care when they need it.

While everyone benefits from information and services that are easy to find and understand, it’s especially important for people whose ability to find, understand, and use information and services are not strong — that is, people with limited personal health literacy. People may have limited personal health literacy because they have trouble reading or interpreting numbers, struggle with communication or analytic skills, or face circumstances that interfere with their ability to process information at a given point in time — such as when they’re sick, tired, or frightened. It’s equally important to understand a person’s health literacy in the environmental and social context of their lives. For instance, how effectively can one apply their personal health literacy skills if they don’t have access to high-speed internet?

As health professionals, making health literacy strategies part of our daily routines can advance health equity, reduce health disparities, and improve health outcomes. There’s no doubt that increasing organizational health literacy comes with challenges, and it’ll take effort to systematically integrate its principles into existing practices. But over time, it will become the way of doing our work rather than additional work to do. The payoff — a more engaged and healthier population — is worth the upfront investment in integrating health literacy principles.

One of the challenges we face is replacing the language of health that we’ve adopted. As public health and health care professionals, we’ve been schooled in the use of technical terminology that forms the basis for communication within our disciplines. Though efficient for us, technical terminology — the shorthand of our areas of expertise — is mostly unrecognizable jargon to those outside the health sector. When we use such language, we risk many of the people we serve not comprehending critical health information.

Even for those who do understand health jargon, it requires more of their mental energy to interpret what we say, possibly distracting from the main point. Conversely, using plain language — common, everyday words in simple sentences — makes it more likely that people will understand and act on messages that benefit their health.

You may be wondering where to start your organizations’ efforts to improve health literacy, and we have a few suggestions. First, test materials and messages with your intended audience. One of our nation’s greatest public health crises was significantly exacerbated by a lack of clarity in our risk communications. During the early days of the COVID-19 pandemic, and even to date, guidance on what precautions to take and what to do if you got sick was often difficult to understand, conflicting, and impractical for many people. For example, telling people with COVID-19 to isolate in their own bedroom and not share a bathroom with others didn’t make sense to people living in crowded conditions. Disseminating information that doesn’t account for people’s life circumstances and cultural context can erode trust, especially for people who may be wary of unfamiliar sources of information. Such dynamics not only made it harder to manage the spread of coronavirus, but also provided openings for dangerous misinformation to compete with evidence-based health information.

Make sure you share information from trusted, health literate sources. However, it can be hard to know what your audience considers to be a trusted source. A proven best practice is to leverage recognized community advocates to share accurate information with their communities in a culturally sensitive way. In 2014 and 2015, such insights changed the trajectory of the Ebola crisis in West Africa. The wide range of cultures across the region required diverse messaging strategies and tactics tailored to many different perspectives. Leaders with a deep cultural understanding of their communities ultimately shared critical information in ways that people in those communities could hear, understand, and act on — leading to the behavioral changes necessary to stop the spread of the virus.

Second, confirm understanding by using the teach-back method. We all think we’re using plain language and being clear, but the only way to know for sure is to ask people to state what they heard in their own words. The teach-back method is also valuable in cross-cultural communication, as it may help identify language barriers and false cultural assumptions, such as presuming people are familiar with Western medicine or common medical concepts. 

Third, gather colleagues to map out a joint health literacy plan — and commit to implementing it. Health literacy is a team sport and requires consistently applied systems-level approaches to address it. For example, improving health literacy requires communication training for staff, routinely assessing and revising written materials, reviewing facilities and systems to see if they’re easy to navigate, and developing supports for people with limited health literacy that don’t stigmatize them. Fortunately, you can address health literacy incrementally, starting with low-hanging-fruit strategies and working up to comprehensive initiatives until you’ve made health literacy part of your organization’s culture.

Use a variety of available resources to make the job easier. For example, there are many health literacy tools from the Agency for Healthcare Research and Quality (AHRQ) and the Centers for Disease Control and Prevention (CDC). You can also consult the National Action Plan to Improve Health Literacy for ideas. And don’t forget to share what you learn throughout your organization to ensure broad understanding and application of these important concepts and resources.

Improving health literacy is everyone’s responsibility, and organizations have a leading role to play. By raising awareness of how important health literacy is to achieving health equity, integrating health literacy practices into our everyday operations, and adapting our strategies to the cultural context at hand, we can help advance health literacy, lessen disparities, and improve health and well-being for all.  

Yours in health,
Paul and Cindy

Paul Reed, MD
Rear Admiral, U.S. Public Health Service
Deputy Assistant Secretary for Health
Director, Office of Disease Prevention and Health Promotion
In Officio Salutis — In the Service of Health

Cindy Brach, MPP
Senior Healthcare Researcher, Agency for Healthcare Research and Quality
Co-Chair, HHS Health Literacy Workgroup