Are you health literate?

The US has an overall literacy rate of 97%. I used to take that to mean that almost all adults could read reasonably well. Then I started working with a patient-centered medical home for an adult Medicaid population. Essentially, a third of the nation can't read these words.


Health literacy numbers are worse. Here is how the US Department of Health and Human Services defines health literacy:

Health literacy is the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.


Health literacy is dependent on individual and systemic factors:

  • Communication skills of lay persons and professionals

  • Lay and professional knowledge of health topics

  • Culture

  • Demands of the healthcare and public health systems

  • Demands of the situation/context

Health literacy affects people's ability to:

  • Navigate the healthcare system, including filling out complex forms and locating providers and services

  • Share personal information, such as health history, with providers

  • Engage in self-care and chronic-disease management

  • Understand mathematical concepts such as probability and risk

Health literacy may be a more difficult challenge than overall literacy. Even if you avoid the vast sea of jargon and acronyms, understanding health requires some knowledge of basic biology. Where do we start?

If money were no object, health systems would hire more health educators to spend time with patients. But hiring more patient-facing staff is expensive. Maybe software can help. Touchscreen devices with text-to-speech capabilities are now widely available. For <$300, health systems can extend their staff with a device that can deliver interactive health information covering virtually all conditions. These devices aren't so much staff replacements as they are personnel extenders. 

Patients need assistance that adapts to both their health literacy level and their overall literacy level. Providers need to know where to target human intervention. Software is ideally suited for both.


This is one of the important problems that Axial is working on. Here are some of the metrics we seek to improve:


Just 22% of patients discharged from the ER understand their diagnosis.

Annals of Emergency Medicine, 2005


Just 37% of patients can state the purpose of their medications at inpatient discharge.

Mayo Clinic Proceedings, 2005


The average time spent with patients reviewing discharge instructions is just 8 minutes.

Boston University Medical Center, Project RED


Bottom Line

The national emphasis on patient engagement will bring health literacy issues to the surface for many health systems. Poor health literacy can limit a patient's ability to get involved in his or her health. Effective solutions will accommodate a patient's overall literacy and allow patients to build health literacy over time. This progress will be shared with providers so that live encounters are focused on helping patients where they are struggling. Health systems and ACOs that include health literacy in their patient engagement strategy could thrive in pay-for-performance programs.