Health literacy: Using words to empower patients

At Sprout, we specialise in producing materials that are accessible and engaging for both patients and healthcare professionals. Health literacy is central in the development of these materials.

For many patients, low health literacy is a major barrier to managing health. Clear, person-centered communication has been shown to improve adherence to medical recommendations, overall health outcomes and patient satisfaction¹ and is an important consideration in the development of any patient-facing materials.

Health Literacy

Health literacy is defined by the World Health Organization as “the achievement of a level of knowledge, personal skills and confidence to take action to improve personal and community health by changing personal lifestyles and living conditions.”² Poor health literacy can affect people’s health directly by limiting their personal, social and cultural development. ²

To fully address health literacy, we must go beyond simply ensuring people can read medical pamphlets. We must first start by making sure they have access to health information and have the ability to use it effectively. By improving people’s access to health information, and their capacity to use it effectively, health literacy becomes critical to empowerment. It is then that we can start to address behaviour change and long-term adherence.

Empowering patients

Poor health literacy is common – more than one in three US adults are considered to have low health literacy. ³ Older adults, minority and low-income populations tend to be at greatest risk. Evidence shows low health literacy can have a major impact on overall health, including medication adherence. Those with low health literacy are more likely to have difficulties following medical instructions¹ and to take medicines incorrectly.⁴   In addition, those with low health literacy have problems managing long-term conditions. For example, people with type 2 diabetes who have low health literacy have been found to have poorer control over their blood glucose levels, while those with asthma and inadequate health literacy don’t use their inhalers as well. ⁵

Reasons for poor health literacy can include:

• lack of opportunity in education – in addition, evidence shows reading abilities usually fall three to five grade levels below the last year of school an individual completed
• learning and reading disabilities
• cognitive decline in older age
• lack of proficiency in the language used in communications

Readability and why it matters

Readability is a vital component of health literacy and is particularly relevant in health content, from web articles to entire patient support programs. It means making material clear and simple, so it’s easy to understand. Centering content around readability improves the chances of the audience reading and engaging with it. ⁶

When developing patient-facing materials, here are a few points to consider:

1. Average reading age is probably far lower than you expect

The average American adult is considered to have a reading age of around 12. Many patient education materials in the US have been found to be written at levels higher than the average adult is capable of understanding. ⁷ And in the UK, an audit of National Health Service (NHS) content aimed at patients found the average reading age of the materials was 16. Almost eight in 10 UK adults are unable to read at this level. ⁸  

2. Keeping reading age low is good practice

In the US, it’s recommended that medical information is written at a reading age of 12⁷ and, in the UK, government recommendations are that medical information should be around a reading age of 9. The rationale is that at this age, children have been found to stop reading common words, instead recognising their shape and skipping over them so they can read faster. Simplifying words and sentences to this level makes content quicker and easier to read at all ages and abilities. ⁹  

3. Plain English is more engaging and efficient for all readers

Clear, simple language is good practice for all audiences and there’s evidence that those with more sophisticated reading levels also prefer to read shorter, clearer words and sentences. ⁹ Plain English is simply faster and more efficient to write and read. ¹⁰   

Audiences tend to have greatest resistance to long words and sentences on a screen. So readability is an especially important consideration in digital content.

Charlotte Haigh is a freelance health writer and editor. She develops content for charities and healthcare brands, translating medical language into clear and engaging copy for websites, leaflets, emails, SMS banks, call guides and video scripts. To learn more about Charlotte and her work click here: https://www.linkedin.com/in/charlotte-haigh-00a48832/

Laura Meade is a Senior Scientist at Sprout. She develops content for patient support programs and other patient-facing materials, across many different conditions and for populations including children and adolescents through to older adults. To learn more about Laura and her work click here: https://www.linkedin.com/in/laura-b-meade/

References:

1. Wynia MK and Osborn CY. Health literacy and communication quality in health care organizations. J Health Commun. 2010; 15(Suppl 2): 102–115

2. World Health Organization. Health Promotion Glossary. Found at: https://www.who.int/publications/i/item/WHO-HPR-HEP-98.1

3. Kountz DS. Strategies for improving low health literacy. Postgrad Med. 2009 Sep;121(5):171-7

4. National Library of Medicine. Health literacy. Found at: https://nnlm.gov/initiatives/topics/health-literacy

5. Safeer RS and Keenan J. Health literacy: the gap between physicians and patients. Am Fam Physician.2005 Aug 1;72(3):463-468.

6. Center for Plain Language. 2017. What is readability and why should content editors care about it? Found at: https://centerforplainlanguage.org/what-is-readability/

7. Stossel LM et al. Readabillity of patient education materials available at the point of care. J Gen Intern Med.2012 Sep; 27(9): 1165–1170.

8. NHS Digital. 2019. Creating better content for users with low health literacy. https://digital.nhs.uk/blog/transformation-blog/2019/creating-better-content-for-users-with-low-health-literacy

9. Center for Plain Language. 2017. What is readability and why should content editors care about it? Found at: https://centerforplainlanguage.org/what-is-readability/

10. Plain English Campaign. How to write in plain English. Found at: https://www.plainenglish.co.uk/files/howto.pdf