Introduction

Health literacy is much more than being able to read. Health literacy is defined by the CDC as “the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.” In other words, it’s the ability of people to read health-related information, understand it, and act on it.

Low health literacy is very common among adults in the US. According to the first ever national assessment of adult literacy, only 12% of adults have adequate health literacy skills. This means only 12% of adults in the US can navigate our complex health system, engage in medical discussions, and fully participate in managing their health.

Key statistics:

• More than 80% of health information provided in a doctor’s office is forgotten before patients or parents get home.
• More than 50% of the recalled information is remembered incorrectly.

This is a problem that affects the entire population, but certain groups are more heavily impacted:

• People living below the poverty level.
• Black, Hispanic, American Indian/Alaska Native, Hispanic, and multiracial people.
• People without a high school education.
• Non-native English speakers.
• Adults over the age of 65.

Poor health literacy results in negative health outcomes.  Low health literacy is associated with high rates of hospitalization, poorer self-reported health, and higher healthcare costs.

How to Promote Health Literacy in Written Materials

1. Maximize white space. Difficulties with reading are often more to do with the look and layout of the text versus the content itself. Short, clearly separated chunks of text that maximize the amount of white space on a page are best.
2. Consider line spacing. Spacing between lines also impacts readability of text. If lines are too close, readers may drop lines. If too far apart, how the lines relate to each other may be unclear. Line spacing (otherwise known as leading) of 2 pt is recommended for a normal 12-point type size.
3. Use upper- and lowercase letters. A combination of upper and lowercase is easier to read than upper case only. To show the importance of text, it’s better to use bold type rather than overuse upper case.
4. Break up long text with illustrations. Illustrations break up the density of text and should, if possible, come at the end of paragraphs or sentences, rather than in the middle of them.
5. Add headings and section titles at the top of each page. The look of the layout of pages is also important. It’s recommended that headings and new sections are located at the top of pages. Sentences and paragraphs should not run into the next column or page.
6. Use thicker paper and avoid dark backgrounds. Paper should be thick enough to avoid shadowing from the text over the page. Darker colors are difficult backgrounds for reading.
7. Write in short sentences. It is best to write sentences with one main point per sentence. Use full stops rather than semi-colons.
8. Try to write at a sixth grade reading level. According to the American Medical Association (AMA) and the National Institutes of Health (NIH) recommendations, readability of patient education materials should not exceed a sixth grade reading level. The average reading skill of U.S. adults is at the eighth-grade level.

 

Simplify Medical Language

At Jumo Health, without compromising the medical accuracy of the information delivered, we avoid unnecessary medical jargon, using easy-to-understand words with fewer syllables.

For example, instead of:

• Hypertension: high blood pressure
• Investigations: tests
• Cardiovascular: heart
• Pulmonary: lung
• Administer: give
• Approximate: about

Avoiding polysyllabic words, in addition to keeping sentences as short as possible, significantly lowers the readability scores of written materials.

 

Combine Text and Illustrations

Our products use a combined visual and verbal format to enhance comprehension of the educational content. This helps to ensure that those with lower readability scores can still learn from the illustrated content.

For example:

• Explaining tests that may take place during a clinical trial (adults):

• Explaining tests that may take place during a clinical trial (children):

• Explaining complex conditions and how they impact the body:

Conclusion

Efforts to improve health literacy have a number of benefits. They lead to improved health knowledge and self management of long-term medical conditions, positive lifestyle changes, and a reduction of burden on healthcare services. In addition, health literacy is a significant mediator of social determinants of health, and health literacy interventions have the capacity to reduce health inequalities.

 

References:

1. Centers for Disease Control and Prevention. What is Health Literacy [webpage]? Available at https://www.cdc.gov/healthliteracy/learn/index.html. Accessed on May 9, 2022.
2. Kutner M, Greenberg E, Jin Y, Paulsen C. The Health Literacy of America’s Adults: Results from the 2003 National Assessment of Adult Literacy (NCES 2006-483). Washington, DC: U.S. Department of Education, National Center for Education Statistics; 2006.
3. Aaby A, Friis K, Christensen B, Rowlands G, Maindal HT. Health literacy is associated with health behaviour and self-reported health: a large population-based study in individuals with cardiovascular disease. Eur J Prev Cardiol 2017;24(17):1880–1888.
4. Bass, PF. Three steps to boost health literacy. Contemporary Pediatrics. Jan 2018. http://www.contemporarypediatrics.com/modern-medicine-feature-articles/3-steps-boost-health-literacy