In Plain English, Please? Health Literacy’s Rising Prominence | Healthcare Informatics Magazine | Health IT | Information Technology Skip to content Skip to navigation

In Plain English, Please? Health Literacy’s Rising Prominence

February 1, 2012
by Gabriel Perna
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From a government plan of action to software solutions, low health literacy is suddenly becoming a focal point for providers everywhere

More often than not, if you aren’t in the medical field, going to the doctor can be like seeing a foreign language film without the English subtitles. Plain and simple, not everyone knows medical speak.

For this reason, health literacy has become an emerging issue in the healthcare industry. Health literacy is simply the ability to read and understand health information, whether it’s doctor’s instructions, a package, or any information that consumers have to read involving their health. Studies from the National Assessment of Adult Literacy say 77 million American adults have basic or below-literate health literacy skills due to their below eighth-grade reading level.

That’s why the U.S. Department of Health and Human Services (HHS) created the National Action Plan to Improve Health Literacy. Health literacy is a part of HHS’ Healthy People 2020 plan, a series of objectives to be achieved by the end of the decade. It also has been linked to the health IT objectives that are supported by the American Recovery and Reinvestment Act/Health Information Technology for Economic and Clinical Health (ARRA-HITECH). Cynthia Baur, chief author of the National Action Plan to Improve Health Literacy and the health literacy lead for the Centers for Disease Control and Prevention (CDC), says varying circumstances led to the federal government to realize this was a pressing issue.

“At the same time the health literacy data [from the National Assessment of Adult Literacy] came out, the Surgeon General’s office did a scientific review and their conclusion is that limited health literacy is a major issue and needs greater attention,” Baur says. “All of those things coming together, having the objective, the data, the Surgeon General’s review, led us to conclude that we needed a national action plan that not only looked at the government’s role, but the private sector’s role as well.”

Baur says this is what the National Action Plan does, using stakeholders from both the private and public sector to make progress on the issue. It consists of goals and strategies, while dishing out specific responsibilities to particular sectors. For instance, it has specific instructions, strategies and resources for non-profit organizations that are looking to improve health literacy to underserved populations. The plan itself is nearly 70 pages long and includes strategies for people from all walks of life, in healthcare or not, from early childhood administrators to members of the media.  

Simplifying with Software

The Lehigh Valley Health Network, which operates two full-service hospitals and numerous community health centers in Pennsylvania’s Lehigh Valley, is one of the many providers looking to take on this issue directly. Paula Robinson, the network’s manager of patient, family and consumer education, says in order to reduce readmissions in its acute care setting, the organization developed an integrated approach with physicians and other practitioners seeing if patients were really getting the essence of the information they were being told and had been given to read.

By figuring out where the learning gaps in communication were, Lehigh was able to develop ways to close them. Additionally, on the technological front, there have been advancements aimed at solving the health literacy issue through software programs. Programs like the Health Literacy Advisor from the Bethesda, Md.-based Health Literacy Innovations are meant to take complex medical documents and turn them into easier reading material for patients. Health Literacy Innovations claims it can read the material, figure out the difficult words and phrases and determine plain English alternatives.

“We looked at our education material,” says Robinson. “Some things were written at a very high reading level and so we started incorporating more software into the review of our educational material. We realized just because someone might be able to read something, doesn’t mean they’ll be able to understand it.”

Health Literacy for the Insured

Using this kind of software was a strategy adopted by the Chicago-based health insurer, Health Care Service Corporation (HCSC), which is an independent licensee of Blue Cross Blue Shield. Jo Poorman, who is the insurer’s senior director of print and digital media, says the organization wanted to improve health literacy because doing reduces the number of doctor visits and improves treatment compliance. She also says better health literacy can help HCSC’s members make better use of their health plans.

Jo Poorman

Poorman says HCSC started using the Health Literacy Advisor software in 2009, back when it was the only solution in the industry. Along with some “common-sense guidelines,” HCSC leveraged it to improve communication to its members. Poorman says the program has become like a “second editor, highlighting words that could be simplified.” For an healthcare organization looking to solve the issue of health literacy, she notes there will be different solutions necessary. The software, she stresses, is not a be-all, end-all. “There are certain things the software will pick up on regardless, and it’s very rare to get a clean read,” she says.

There will always be a “gray area,” Poorman says. She adds figuring out the right health literacy strategy will depend an organization’s audiences and the requirements of their business partners. In the same light, Robinson says the road to success in health literacy is empowering patients, and families of patients.

“If they [patients] don’t understand, they need to realize that we’re here to help them better,” Robinson says. “I put a lot of responsibility on healthcare professionals because we should know better, but at the same token there needs to be some kind of responsibility on patients and families as well. Patients need to know they are empowered to speak up. It starts with us and changing the culture and the way we currently do things and letting individuals know what they say matters.”


According to the CDC’s Baur, the incentives for providers to adopt a health literacy strategy are clear as day. She says there is a link between health literacy and several of the objectives in both HITECH and the Affordable Care Act, specifically in the areas of access, quality improvement, and cost of care.

“There are these goals articulated in more traditional areas of health policy, and if we look at how these goals depend on not just patients, but their families, caregivers, and clinicians all effectively using health information, then health literacy becomes absolutely essential to achieving these other health goals,” Baur says.

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