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Health literacy interventions

Health Factors: Access to Care Quality of Care
Decision Makers: Grantmakers Healthcare Professionals & Advocates Nonprofit Leaders Public Health Professionals & Advocates
Evidence Rating: Some Evidence
Population Reach: 20-49% of WI's population
Impact on Disparities: Likely to decrease disparities

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Health literacy is the degree to which people obtain, process, and understand basic health information and services in order to make appropriate health decisions (IOM-Nielsen-Bohlman 2004). Low levels of health literacy are associated with poor health outcomes and limited use of preventive care (AHRQ-Berkman 2011, Taggart 2012). Patients with low health literacy also appear to have higher health care costs and health care expenditures. Up to one-half of the US population has limited health literacy; elderly and low income individuals are most likely to have low health literacy (Eichler 2009). Health insurance literacy is also low, particularly among those with low incomes (Barcellos 2014, Urban-Long 2014), the uninsured, and racial and ethnic minorities (Urban-Long 2014). Approaches to improving health literacy include simplifying health education materials (written, video, audio, and computer formats), improving patient-provider communication, and improving overall literacy.

Expected Beneficial Outcomes

Improved health-related knowledge
Improved patient-provider communication

Evidence of Effectiveness

There is some evidence that interventions to improve health literacy increase health-related knowledge (Taggart 2012, APHCRI-Bush 2010, DeWalt 2009, Pignone 2005) and comprehension (Sheridan 2011). Additional evidence is needed to confirm effects and determine which interventions are most effective.

Interventions that use enhanced written and print-based materials have been shown to increase health-related knowledge among children and adults (DeWalt 2009, APHCRI-Bush 2010, Pignone 2005, Wilson 2012a). Programs that serve older adults may increase participants’ knowledge and capacity to find relevant health information (Manafo 2012). Group-based education programs in primary care settings also appear to increase knowledge among adults (Taggart 2012). Classes that teach participants how to access health information on the internet may improve online health literacy by increasing self-efficacy in health information seeking and health information comprehension (Cochrane-Car 2011).

Interventions that combine various approaches (e.g., enhancing written materials and conducting an in-person interview) appear to increase patients’ comprehension and appropriate health care use (Sheridan 2011). Health literacy interventions that use multi-media approaches or focus on interpersonal interactions appear to promote improved communication between patients and providers (APHCRI-Bush 2010, Wilson 2012a).

Various types of health care professionals can deliver interventions that improve health literacy; more intense interventions appear to increase the likelihood of improvement (Dennis 2012).


United States

The US Department of Health and Human Services (HHS), the Institute of Medicine, the American Medical Association, and the National Institutes of Health have promoted health literacy as a research priority (CDC-Healthy People 2010). Recent federal initiatives including the Affordable Care Act, the National Action Plan to Improve Health Literacy, and the Plain Writing Act also emphasize health literacy (Koh 2012). As a result, there are a number of statewide programs that aim to improve health literacy. Examples include Health Literacy Iowa and the North Carolina Program on Health Literacy (IHS-HLI, NCPHL).


There are a number of efforts underway in Wisconsin to improve health literacy. HLW is part of Wisconsin Literacy, a nonprofit coalition of adult, family, and workplace literacy providers in Wisconsin. These organizations aim to raise awareness and foster two-way communication between health care consumers and health care providers.

Implementation Resources

AHRQ-Health literacy toolkit - DeWalt DA, Callahan LF, Hawk VH, et al. Health literacy universal precautions toolkit. Rockville: Agency for Healthcare Research and Quality (AHRQ); 2010. Accessed on December 1, 2015
CDC-Cross-cultural tools - Centers for Disease Control and Prevention (CDC). Tools for Cross-Cultural Communication and Language Access Can Help Organizations Address Health Literacy and Improve Communication Effectiveness. Accessed on September 27, 2016
CDC-Health literacy - Centers for Disease Control and Prevention (CDC). Health literacy: Accurate, accessible and actionable health information for all. Accessed on November 27, 2015
HRSA-Health literacy - Health Resources and Services Administration (HRSA). About health literacy. Accessed on February 10, 2016
NNLM-Health literacy - National Network of Libraries of Medicine (NN/LM). Health literacy. Accessed on March 14, 2016

Citations - Description

AHRQ-Berkman 2011 - Berkman ND, Sheridan SL, Donahue KE, et al. Health literacy interventions and outcomes: An updated systematic review. Rockville: Agency of Healthcare Research and Quality (AHRQ); 2011. Accessed on December 12, 2015
Barcellos 2014* - Barcellos SH, Wuppermann AC, Carman KG, et al. Preparedness of Americans for the Affordable Care Act. Proceedings of the National Academy of Sciences of the United States of America. 2014;111(15):5497–502. Accessed on February 1, 2016
Eichler 2009 - Eichler K, Wieser S, Brugger U. The costs of limited health literacy: A systematic review. International Journal of Public Health. 2009;54(5):313-24. Accessed on December 28, 2015
IOM-Nielsen-Bohlman 2004 - Nielsen-Bohlman L, Panzer AM, Kindig DA. Health literacy: A prescription to end confusion. Washington, DC: Institute of Medicine (IOM), National Academies Press; 2004 Accessed on February 24, 2016
Taggart 2012 - Taggart J, Williams A, Dennis S, et al. A systematic review of interventions in primary care to improve health literacy for chronic disease behavioral risk factors. BMC Family Practice. 2012;13(1):49. Accessed on November 9, 2015
Urban-Long 2014 - Long SK, Goin D. Large racial and ethnic differences in health insurance literacy signal need for targeted education and outreach. Washington, DC: Urban Institute; 2014. Accessed on February 2, 2016

Citations - Evidence

APHCRI-Bush 2010 - Bush R, Boyle F, Ostini R, et al. Advancing health literacy through primary health care systems. Canberra, AU: Australian Primary Health Care Research Institute (APHCRI); 2010. Accessed on November 23, 2015
Cochrane-Car 2011* - Car J, Lang B, Colledge A, Ung C, Majeed A. Interventions for enhancing consumers’ online health literacy. Cochrane Database of Systematic Reviews. 2011;(6):CD007092. Accessed on February 1, 2016
Dennis 2012 - Dennis S, Williams A, Taggart J, et al. Which providers can bridge the health literacy gap in lifestyle risk factor modification education: A systematic review and narrative synthesis. BMC Family Practice. 2012;13(1):44. Accessed on January 27, 2016
DeWalt 2009 - DeWalt DA, Hink A. Health literacy and child health outcomes: A systematic review of the literature. Pediatrics. 2009;124(Suppl 3):S265-74. Accessed on January 11, 2016
Manafo 2012* - Manafo E, Wong S. Health literacy programs for older adults: A systematic literature review. Health Education Research. 2012;27(6):947–60. Accessed on January 28, 2016
Pignone 2005 - Pignone M, DeWalt DA, Sheridan S, Berkman N, Lohr KN. Interventions to improve health outcomes for patients with low literacy: A systematic review. Journal of General Internal Medicine. 2005;20(2):185-92. Accessed on March 3, 2016
Sheridan 2011 - Sheridan SL, Halpern DJ, Viera AJ, et al. Interventions for individuals with low health literacy: A systematic review. Journal of Health Communication. 2011;16(Suppl 3):30-54. Accessed on May 20, 2016
Taggart 2012 - Taggart J, Williams A, Dennis S, et al. A systematic review of interventions in primary care to improve health literacy for chronic disease behavioral risk factors. BMC Family Practice. 2012;13(1):49. Accessed on November 9, 2015
Wilson 2012a* - Wilson EA, Makoul G, Bojarski EA, et al. Comparative analysis of print and multimedia health materials: A review of the literature. Patient Education and Counseling. 2012;89(1):7-14. Accessed on November 23, 2015

Citations - Implementation

CDC-Healthy People 2010 - Centers for Disease Control and Prevention (CDC). Healthy People 2010 final review. Accessed on November 30, 2015
HLW - Health Literacy Wisconsin (HLW). About Health Literacy Wisconsin. Accessed on February 24, 2016
IHS-HLI - Iowa Health System (IHS). Health literacy Iowa. Accessed on December 16, 2015
Koh 2012* - Koh HK, Berwick DM, Clancy CM, et al. New federal policy initiatives to boost health literacy can help the nation move beyond the cycle of costly “crisis care.” Health Affairs. 2012;31(2):434-43. Accessed on February 4, 2016
NCPHL - NC Program on Health Literacy. North Carolina program on health literacy. Accessed on March 1, 2016
Wisconsin Literacy - Wisconsin Literacy. Strengthening Wisconsin’s workforce, families and communities through literacy. Accessed on November 24, 2015

Page Last Updated

August 7, 2014

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