The Importance of Health Literacy in Rural and Critical Access Hospitals

How well do your patients understand doctor’s orders, prescription labels and disease pamphlets? While various definitions exist, health literacy is widely considered to be the “degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions.” Landmark research published in 2006 found that health literacy is a big problem in America.

• 36% of Americans have basic or below basic health literacy.

• 59% of Americans age 65+ have basic or below basic health literacy.

• 60% of Medicaid beneficiaries have basic or below basic health literacy.

• 44% of Americans whose highest level of education was graduating high school have basic or below basic health literacy; for those who did not finish high school, the percentage jumps to 76%.

The study found that only one in 10 American adults is proficient in understanding health information. But just like education, poverty and age can impact their proficiency, so can a stressful situation, explains Paul Smith, MD, a professor in the Department of Family Medicine and Community Health at the University of Wisconsin-Madison, to

“Even for the folks who do have proficiency, all you have to do is to give them a cancer diagnosis, make them sleep deprived, experiencing severe pain, any of those things that happen all the time in a hospital or an emergency room,” he said.  “Anybody, anybody with those things happening is going to have trouble processing, remembering, or making decisions related to healthcare information.”

Not only has low health literacy been linked to improved population health, there’s also a cost connection—to the tune of more than $100 billion. Because the populations served by rural and critical access hospitals tend to be older, poorer and less educated, boosting health literacy becomes even more vital to the health of these communities. Here are three ways to address health literacy in your hospital.

Focus on Plain Language: Your language choices will make or break your connection with your readers. Use language that is clear and direct to get your message across. So, what does plain language mean? Keep sentences short. Keep sentences simple. And no jargon. Also, use second person pronouns to connect with your audience. Everyday Words for Public Health Communication from the Centers for Disease Control and Prevention recommends words to use—and avoid—in order to boost health literacy. 

Get to Know Your Audience: There’s no such thing as the general public. Take the time to understand the members of your community and the challenges they face related to health literacy. The National Institutes of Health also recommends testing your communications with a small section of your target audience. Ask them to read the piece and give you feedback. Find out whether they understood your main ideas—ask questions to check. And ask if they have any unanswered questions about the topic.

Use the Teach-Back Method: According to the Agency for Healthcare Research and Quality, between 40-80% of the medical information patients are told during office visits is forgotten immediately, and nearly half of the information retained is incorrect. That’s where the teach-back method comes in. It’s a simple but valuable tool that can help improve patient understanding and adherence, and decrease call backs and cancelled appointments. Making the teach-back method a part of everyday patient interaction can help you determine how well you explained your concept. And that’s the thing about health literacy. While the definition may focus on the patient’s understanding. The solution shouldn’t be focused there. Instead, recommends, “shift the focus to making that health information easier to understand—and to receive.”