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Health literacy refers to an individual’s ability to understand and interpret information about their health status or their interactions with healthcare services. It therefore impacts the extent to which individuals can effectively access and engage with health services.  Health literacy is also closely correlated with health inequalities. Research has found that children born in communities with significant reading challenges have particularly low life expectancy rates. In order to achieve equitable access to quality healthcare, we must address the issue of health literacy gaps.  This guide explores what is meant by health literacy, the benefits of applying health literacy interventions, recommendations for trust board members, and case studies from five trusts that have effectively embedded interventions.

Digital health has the potential to improve healthcare delivery and population health outcomes. To ensure equitable benefits, its development and implementation must address potential health inequities arising from biased technologies and systemic factors. This scoping review used a sociotechnical lens to examine how equity is considered in digital health regulation, implementation and evaluation within the WHO European Region. Equity is increasingly acknowledged in digital health, but its integration into practice remains inconsistent. Regulatory frameworks primarily emphasise safety, privacy and performance, with limited focus on inclusion of underserved populations or adaptability to low resource settings. Implementation strategies often overlook structural barriers. Standardised equity metrics and robust bias auditing for artificial intelligence-driven technologies are lacking. The review highlighted the need for an equity-by-design approach to embed equity throughout the digital health life cycle. Advancing equity requires inclusive governance, participatory design and cross-sectoral collaboration. Recommendations include establishing a shared understanding of equitable digital health, integrating equity metrics into maturity models, and reinforcing regulation, governance and sustainable financing.

The World Patients Alliance (WPA), Elsevier and the Elsevier Foundation are collaborating on an inspiring initiative to raise awareness about patient safety through a series of children’s books. This innovative project aims to instill fundamental patient safety principles in children aged six to twelve, fostering a culture of safer care for the future. The launch of this series marks a significant milestone in our collective mission to improve health literacy among younger generations. By presenting critical patient safety information in a child-friendly format, we aim to empower children, families, and educators to engage in meaningful conversations about health and safety. These books serve as valuable educational tools that can be used both at home and in schools.

Health literacy, defined as an individual's ability to access, understand, and use health information to make informed decisions about their health and healthcare, plays a critical role in determining health outcomes. Wider determinants of health, on the other hand, refer to a range of social, economic, and environmental factors that influence an individual's health status. This article aims to explore the relationship between health literacy and the wider determinants of health, and how understanding this connection can contribute to more effective population health management and health equity.

This Healthcare Safety Investigation Branch (HSIB) investigation focuses on the systems used by healthcare providers to book patient appointments for clinical investigations, such as diagnostic tests and scans. ‘Clinical investigation booking systems’ are used throughout the NHS to support the delivery of patient care. Healthcare services use paper-based or fully electronic systems, or a combination of the two (hybrid systems), to communicate to patients the time, date and location of their appointment. These systems also produce information for patients about actions they need to take to prepare for their appointment. Written patient communication is a key output of clinical investigation booking systems. This investigation examines the safety implications of patient communications, produced by booking systems, that do not account for the needs of the patient. In addition, it looks at why patients are ‘lost to follow-up’ after an appointment is cancelled, rescheduled or not attended. Lost to follow-up is the term used to describe a patient who does not return for planned appointments (whether for continued care or evaluations) or is no longer being tracked in the healthcare system when they should be. The reference event for this investigation was a child of Romanian ethnicity who was referred for an MRI scan, which required a general anaesthetic. The scan was booked, and a letter was sent to the child’s parents including the appointment details and pre-appointment instructions. The Trust’s booking system was only able to produce appointment letters in English, and there were no Trust processes or policies to routinely translate written appointment information. The family recognised key details in the written information, including the time, date and location of the scan. However, they were not able to understand the instructions about the child not eating or drinking (fasting) for a certain amount of time before the scan. When the family attended the appointment for the scan, the child had eaten. This meant the MRI scan could not be completed and it was therefore cancelled. When the scan was finally carried out cancer was diagnosed. The child received treatment, but sadly the disease progressed and they were placed on a palliative care pathway and died. Findings Written communications to patients about radiology appointments are routinely sent in English only. Healthcare staff expect that written appointment information will be translated by a patient’s friend or family member. NHS England standards do not require written appointment information to begiven in any non-English language, other than for people with a disability. Confusion about the requirements for appointments can result in delayed care and additional costs if appointments need to be rebooked. The language needs of patients are not always clearly understood. There is differing national guidance as to whether written communication needs should be recorded. The national NHS system that holds patient information and populates it into many trust systems (the Personal Demographics Service) can store information on patients’ preferred written communication methods. However, this information is often not entered into the system. Administrative staff are not routinely involved in assessing and testing electronic booking systems before they are implemented. Recommendations HSIB recommends that NHS England develops and implements a standard for healthcare providers on supplying written appointment information in languages other than English. Safety observations It may be beneficial for NHS care providers to explore options for the translation of written appointment communications, including pre-attendance guidance, for patients whose preferred written language is not English. Safety actions It may be beneficial if the ‘preferred written communication method’ field of the Personal Demographics Service system is completed for patients who require written communications in a language other than English. It may be beneficial if NHS trusts identify mechanisms to appreciate the language needs of their patient demographic and adjust the written communications accordingly. It may be beneficial to clarify the roles and functions of national organisations in supporting the health inequalities landscape. It may be beneficial for NHS healthcare providers to incorporate the NHS Service Standard into agreements with third-party developers of electronic clinical investigation booking systems.

The Diabetes Record Information Standard defines the information needed to support a person’s diabetes management. It includes information that could be recorded by health and care professionals or the person themselves that is relevant to the diabetes care of the person and should be shared between different care providers. It was commissioned by NHS England and developed in partnership with the Professional Record Standards Body (PRSB). The Diabetes Self-Management Information Standard defines the information that could be recorded by the person themselves (or their carer) at home (either using digital apps or medical technology, for example, continuous glucose monitors or insulin pumps) and shared with health and care professionals.

Structuring and presenting healthcare information that aligns with a patient’s level of understanding can help patients achieve optimal outcomes. Verbal communication strategies such as “teach back” and “Ask Me 3®” programmes and written strategies address opportunities identified in the event reports and may help improve patient understanding and engagement in their care. The Patient Safety Authority have collated guidance, resources and education tools on health literacy.

Risks and statistics are an essential part of patient information. What is a person’s risk of developing a particular condition in their lifetime, or of having a certain symptom if they have that condition? What are the risk factors for a disease, and can people change these? What is the chance of a treatment or procedure working? And what is the risk of getting the different side-effects and complications that can come with it? Many patients are unable to comprehend basic statistics, never mind navigate their way through the reams of data that may come with health information to compare treatment options. As information producers, our job is to make sure we can guide patients through the minefield of data and figures to help them feel confident in making their own decisions. This guide from the Patient Information Forum highlights a range of approaches and tools for unbiased communication.  This resource covers the following topics: illustrating risk, perceptions of risk, know your numbers, explaining uncertainty, useful resources and references. Communicating risk checklist Numbers not words Interpretation of words like ‘rare’ and ‘common’ varies enormously. Always use a statistic such as 1 in 100 people alongside words like rare or common. Use natural frequencies rather than percentages, for example 10 in 100, rather than 10%. When giving people two frequencies to compare, make sure they are both expressed as ‘out of’ the same number. For example, 1 in 100 compared with 2 in 100, NOT 1 in 100 compared with 1 in 50. Use absolute risk rather than relative risk The absolute risk of an event increases from 1 in 100 to 2 in 100, but the relative risk of the event doubles. Using relative risk in isolation can be misleading. Illustrating risk A great way to improve users’ understanding of risk and statistics is to use visual aids. Using a mix of numerical and pictorial formats to communicate risk is helpful. Visual displays may be most helpful for giving people an overall pattern, whereas actual numbers can be better for communicating detail. Perceptions of risk Consider using both positive and negative framing, i.e. ‘3 out of 100 people experienced this side effect, but 97 out of 100 did not’. Consider adding some context to your statistics. What would make a useful comparison to give people a sense of the likelihood, or to help them make their decision? Explaining uncertainty Communicate the uncertainty of data or if evidence is of low quality. Pre-empt misunderstandings If something is easily misunderstood, or there is a common myth, it is better to address it head-on.

"Over half of the disease burden in England is deemed preventable", says this report, "with one in five deaths attributed to causes that could have been avoided". It notes however, that progress has stalled on reducing the number of people with preventable illness and that compared to other high-income countries, we are underperforming. The authors call for a paradigm shift in prevention policy, from interventions that "blame and punish" to those that "empathise and assist". Regressive taxes and bans have not, they say, delivered the transformation required. Key to any new prevention strategy is the online information environment. Over 60% of British adults use the internet to check symptoms or self-diagnose, with the NHS website considered to be the most trustworthy. There is also, however, a "pernicious prevalence of false information". Polling shows that less than half of the population believe obesity is linked to cancer (misinformation), while over a third either agree that vaccinations can cause autism, or say they don't know (disinformation). The report states that the COVID-19 crisis shows how rapidly disinformation spreads. A poll revealed that nearly half (48%) of all British people had either seen or been sent "fake news" about COVID-19, online since the outbreak began. In addition, almost two in five (17%) said they did not know whether they had come across fake news, suggesting that the ability to identify and report the spread of misinformation is less than perfect. In this context, health education, on its own, is insufficient. We need to build health literacy (people's ability to understand health information), and work towards the goal of patient activation (enabling people to exert control over the determinants of health). The report makes a series of recommendations, including the introduction of a permanent "disinformation unit" to correct false information and help shape public health narratives. The authors conclude that "New technologies have created opportunities to reach wider audiences, but ... It is also clear that the NHS and health sector more broadly need to take a more proactive approach. As an extremely trusted source of health information, it is imperative the NHS stays ahead of the curve".

The health literacy field has evolved over several decades. Its initial focus was on individuals who had poor literacy skills. Now there is a broad recognition that everyone—not just those with limited literacy—face challenges in understanding health information and navigating the healthcare system. Acknowledging that the healthcare system is overly complex, healthcare organisations have started to take responsibility to ensure that everyone, especially the vulnerable, is able to find, understand, and use health information and services. The Agency for Healthcare Research Quality (AHRQ) provides national health literacy leadership. AHRQ’s health literacy work spans from developing improvement tools, to designing professional training and education, to funding and synthesising health literacy research. You can find health literacy improvement tools, educational and training, and publications on the AHRQ Health Literacy website.

Quality improvement measures can help health care organisations make health information easy to understand and health systems easy to navigate. The Agency for Healthcare Research and Quality (AHRQ) obtained consensus from experts on the usefulness, meaningfulness, feasibility, and face validity of 22 measures that can help organisations seeking to become more health literate.

This site provides pharmacists with recently released health literacy tools and other resources from the Agency for Healthcare Research and Quality (AHRQ). Pharmacy health literacy is the degree to which individuals are able to obtain, process, and understand basic health and medication information and pharmacy services needed to make appropriate health decisions. Only 12% of adults have proficient health literacy (e.g., can interpret the prescription label correctly). Medication errors are likely higher with patients with limited health literacy, as they are more likely to misinterpret the prescription label information and auxiliary labels. Studies document an association between low literacy and poor health outcomes. The tools include: Seven health literacy tools for pharmacy: Pharmacy Health Literacy Assessment Tool & User's Guide. Training Program for Pharmacy Staff on Communication. Guide on How To Create a Pill Card. Telephone Reminder Tool To Help Refill Medicines On Time. Explicit and Standardized Prescription Medicine Instructions. How to Conduct a Postdischarge Followup Phone Call Health literacy tools to improve communication for providers of medication therapy management Curricular modules for pharmacy faculty. Resources for pharmacists interested in understanding more about health literacy. Health literacy tools to improve communication for providers of medication therapy management.

The AHRQ Health Literacy Universal Precautions Toolkit, 2nd edition, can help primary care practices reduce the complexity of health care, increase patient understanding of health information, and enhance support for patients of all health literacy levels. Health literacy universal precautions are the steps that practices take when they assume that all patients may have difficulty comprehending health information and accessing health services. Health literacy universal precautions are aimed at: Simplifying communication with and confirming comprehension for all patients, so that the risk of miscommunication is minimized. Making the office environment and health care system easier to navigate. Supporting patients' efforts to improve their health. This AHRQ toolkit provides evidence-based guidance to adult and paediatric practices to ensure that systems are in place to promote better understanding by all patients, not just those you think need extra assistance. The toolkit is divided into manageable chunks so that its implementation can fit into the busy day of a practice. It contains: - 21 tools (3-5 pages each) that address improving: spoken communication. written communication. self-management and empowerment. supportive systems. - Appendices (over 25 resources such as sample forms, PowerPoint presentations, and worksheets). - Quick start guide.

Health Literacy in Medicines Use and Pharmacy: A Definitive Guide highlights issues related to medication literacy from the context of the pharmacist and other healthcare professionals. The book provides a clear explanation of medication literacy, presents different tools to assess health and medication literacy, readability, and comprehensibility of written medicine information (WMI), and elaborates on different approaches to develop customized and patient-friendly WMI. The book also covers health and medication literacy in special populations, including geriatrics, paediatrics, and pregnant/lactating patients. Written by experts in health communication, this book will help pharmacists, other health professionals, educators, students, and regulators, who need to develop customised educational materials that can be understood by a broad range of patients, especially those with low health literacy.

For people living with type 2 diabetes, achieving the best health outcomes requires good self-management and sticking to agreed treatment. While some studies suggest an association between poor medication adherence and lower levels of health literacy, the evidence for this association remains inconclusive. This systematic review aimed to examine the evidence on the association between health literacy and medication adherence among adults from ethnic minority backgrounds living with type 2 diabetes.

Adults in the UK are struggling to find health information they can trust and there are clear inequalities in access to information. Knowledge is Power offers new insights into information access, trusted sources, communication with healthcare professionals and the impact of misinformation. The Patient Information Forum (PIF) and Ipsos have published new research into health information access across the UK. Knowledge is Power offers new insights on information access, trusted sources, communication with healthcare professionals and the impact of misinformation.  Key findings Half of adults in the UK are struggling to access trusted health information. 1 in 10 adults in the UK have been affected by misinformation, rising to 1 in 5 for ethnic minorities. 8 in 10 adults in the UK agree access to trusted health information would help them manage their health. 1 in 6 adults in the UK say their views are not taken seriously by their health professional. This rises to 1 in 4 for ethnic minorities. Only 1 in 10 adults with long term conditions in the UK are signposted to patient organisations, yet these are highly trusted by their users. 2 in 3 adults in the UK state independent verification of health information would increase trust. Recommendations Knowledge is Power makes five recommendations on the right to health information, aligned with the three shifts proposed in the NHS 10-year plan. In summary they are: A right to health information – Health information is provided as a core part of patient care. Tackle misinformation – Through robust content standards and effective signposting of credible health information via health professionals and the NHS Apps. Tackle inequality – Health information must be accessible and appropriate for all. Lived experience as a metric – Embedding patient experience as a measure of NHS performance using the NHS Apps and single patient record. 5. Dedicated leadership – A mandate for the effective delivery of health information with a named lead in all NHS organisations.

Poor health literacy can inhibit patient or caregiver understanding of care instructions and threaten patient safety. This cross-sectional study from Selzer et al. of medically complex children treated at one academic hospital in Austria reveals that despite high levels of satisfaction with care, many caregivers do not understand medication management instructions at discharge. Misunderstandings were more likely to occur with higher numbers and/or new prescriptions, poor medication-related communication, and language or literacy barriers.

Healthcare decision making should be a collaboration between patients and their providers. This eBook produced by Pfizer is for patients, caregivers and care team members. It aims to help empower individuals on their healthcare journey so they can be engaged patients who understand the health information they receive in order to act upon it.

The Schools for Health in Europe network foundation (SHE) aims to improve the health of children and young people in Europe, including reducing health inequalities, through a specific setting focus on schools. This factsheet by SHE provides an overview of current evidence on health literacy with a specific focus on schools, pupils, and educational staff. It contains information and data on: Health literacy among school-aged children The interplay between health literacy, health and education Health literacy in schools in the WHO European Region A future avenue for health literacy in schools

Health literacy is about people having enough knowledge, understanding, skills and confidence to use health information, be active partners in their care and navigate health and social care systems. Health literacy levels in the UK are low, with 43% of 16 to 65-year-olds in England struggling with text-based health information and 61% unable to understand health information that includes both text and numbers. This e-learning resource by Health Education England and NHS Scotland aims to help people working in health and social care understand and promote health literacy. This e-learning session takes about 30 minutes to complete and covers: why health literacy is important how to use some simple techniques to improve communication, including TeachBack, chunk and check and using pictures and simple language. Learning objectives List the benefits of health literacy to individuals and services List health literacy tools and techniques Explain how to use health literacy tools and techniques Describe the impact of health literacy on people’s health choices Create a personal action plan to be health literacy friendly