About Health Literacy and Plain Language

Health Literacy in the National Limelight

Health literacy is currently in the national limelight and on the national health agenda. This results, in part, from key reports issued in 2004 by the Institute of Medicine and the Agency for Healthcare Research and Quality. The impact of these complementary reports, that documented the nature and scope of the problem and the research evidence, was enhanced by the 2010 release of the National Action Plan to Improve Health Literacy. Many provisions of the Affordable Care Act require and support attention to health literacy and effective communication.


The Challenge of Health Literacy

While researchers continue to debate the exact definition of health literacy, most agree that the term reflects patient/consumer literacy skills as well as the demands of our complex health system. Only 12% of American adults have Proficient health literacy skills–reading, writing, understanding, computing, communicating and using health information well.

Many factors contribute to health literacy being a challenge for most American adults, including:

the need to access and use health-related information across multiple media, topics, and environments;

the unfamiliarity of the vocabulary and concepts in health and medicine;

the complexity of our healthcare system;

the increasing demands on consumers to prevent and manage health conditions.

Adults are expected to gather and use health information from media sources as diverse as food and medicine labels to computer print-outs; to understand topics ranging from fat grams to medication instructions; to use high-level reading and analysis skills in locations ranging from the grocery store to the hospital. These are not easy demands to meet.

For the 93 million adults across the country with limited literacy skills, health literacy is an even larger challenge. And many of these adults will be eligible to sign up for health insurance for the first time in 2014. Research in the past decade has provided evidence that adults with limited literacy skills have:

less knowledge about and poorer adherence to medication and self-care regimens for certain chronic conditions;

less knowledge and less likelihood of getting specific preventive tests and exams, even with equal access to care;

poorer self-reported health and poorer health outcomes;

increased hospitalizations and costs.

Research studies have also documented that elders (adults 65 and older) and are at particular risk of low health literacy. Literacy abilities decline progressively with age, posing a large and growing healthcare risk as our entire population ages and diversifies.


Plain Language: One Response to the Challenge

While research doesn’t provide any easy “solutions” to the challenge of health literacy, national reports do state the need for clear language (IOM report) and “well-conceived interventions” (AHRQ). Plain language, as defined by well-established criteria, IS clear language and certainly is part of a well-conceived intervention. While not a magic bullet, it can help all adults better understand health information and make wise health-related choices.

Plain Language: What It Is and Is Not

Some hear the term plain language and think “short words/short sentences” or “dumbed down ideas” or “low reading level.” This description is simply not accurate. In fact, plain language uses evidence-based recommendations about how to structure, write and design information to facilitate reading ease and audience understanding. In patient teaching, it includes ways of verbally structuring and offering information to help assure patient understanding.

Plain language is essential in technology-based communication as well. Reading on screen is more difficult and adults tend to skim and scan. We have only seconds to present major points.

Vibrant plain language is far from plain. It’s lively, engaging, and results in effective communication.

Learning Plain Language Skills

Writing effective plain language information — brochures, letters, handbooks, self-care instructions, consent forms, web text, etc. — requires more than good intentions and goodwill. It requires skills. The Institute taught those skilll for 22 years.