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Health Literacy

Health care requires the active involvement of patients, particularly those with chronic conditions. Patients have questions every step of the way, such as: What should I do about my illness? How do I talk to my doctor? What do I do with this medicine? Answering these questions requires understanding medical terms, being able to navigate a complex health care system, and navigating life with a chronic condition. Health literacy is an essential part of active involvement in health care.

By taking charge of their own health decisions, consumers can better communicate with health professionals, navigate the health system, and more effectively self-manage existing health conditions. The Agency for Healthcare Research and Quality (AHRQ) has launched an initiative to help consumers take control of their health: Toma las riendas. See the video below for more information or visit the Toma las riendas website.


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 decisions1. It includes knowing how and when to take medications, being able to have useful discussions with medical providers, and knowing which of the numerous decisions we make throughout the day impact our health. In short, health literacy opens up dialogue between providers and patients. Limited health literacy in turn limits communication about health and worsens health outcomes.


According to the American Medical Association Foundation, “Health literacy skills are a stronger predictor of an individual’s health status than age, income, employment status, education level or racial/ethnic group.”

People with low health literacy are more likely to:
  • Smoke
  • Have diets high in salt, cholesterol, and fat
  • Take medications incorrectly
  • Suffer from preventable illnesses
  • Visit the emergency room
  • Have poor health
People with low health literacy are less likely to:
  • Exercise
  • Be able to read a thermometer
  • Use an asthma inhaler properly
  • Have good control of their diabetes
  • Know early symptoms of stroke or heart attack


According to the 2003 National Assessment of Adult Literacy, only 12% of adults have the health literacy necessary to proficiently navigate their own health care3. This translates to over 89 million adults in the US with limited health literacy skills.

Achieving proficient health literacy is a significant challenge for many adults in the United States. In 2010, the United States Department of Health and Human Services released the National Action Plan to Improve Health Literacy, a blueprint to guide health care providers, consumer advocates and all health sectors to improve the nation’s health literacy.


  • People with less than a high school degree or GED
  • People with at or below poverty level
  • Racial and ethnic minorities
  • Immigrants and refugees
  • Older adults (65+)



Older adults not only are more likely to seek health services for chronic conditions, they are also less likely to have low health literacy. According to the National Library of Medicine:

  • 71% of older adults report difficulty using print materials provided by their medical provider
  • 80% have difficulty using forms and charts posted in the clinic or doctor’s office
  • 68% have difficulty calculating the amount of medication prescribed to them
  • 29% have a below basic health literacy level
  • 41% of Latino adults lack basic health literacy
  • Only 4% have the proficient health literacy necessary to make
    appropriate health decisions
  • Non-native English speakers are more likely to have low health literacy
  • Immigrants are more likely to have difficulty navigating the US health care system
  • Linguistic and cultural barriers further compound the


Improving health literacy is a public health imperative. By improving the ability of individuals to make appropriate health decisions, we can decrease the cost of healthcare, increase quality of care, and improve health outcomes. Doing so requires health professionals to become more culturally and linguistically competent, as indicated by the Affordable Care Act. This includes creating materials with straightforward messages and and communicating more effectively with patients and their families. Simultaneously, health educators and other community health workers must work to improve the health literacy of at-risk populations, many of whom are in frequent contact with the health care system because of chronic diseases.


The National Culturally and Linguistically Appropriate Services (CLAS) Standards in Health and Health Care were created to eliminate health disparities by improving communication, engagement and providing standards for communication and service for health care providers. These standards are intended to “provide effective, equitable, understandable and respectful quality care and services that are responsive to diverse cultural health beliefs and practices, preferred languages, health literacy and other communication needs.”

CLAS standards require health care providers to:

  • Provide free language assistance to individuals who are not proficient in English
  • Notify individuals in their preferred language, verbally and in writing, of the availability of language assistance
  • Establish competence of individuals who provide language assistance rather than using untrained interpreters minors
  • Provide easy-to-read handouts and posters in common languages other than English


In the Hispanic community, the promotor de salud (lay health worker) model is a widely successful educational approach that delivers simple bilingual content with pictures through interactive learning, community presentations and other events in English-limited, low-literacy Latino communities. Promotores (community health workers) bridge the Hispanic community and the health care system through their knowledge and understanding of the language, culture, and health behaviors common in Hispanic populations.

Promotor–based programs are ideal avenues for improving health literacy in underserved Hispanic communities. Not only do they actively engage hard-to-reach populations, the flexibility of the promotor model allows promotores to continually evolve to meet the needs of the community while also disseminating information more rapidly than traditional health education means.



NHCOA seeks to improve the lives of Hispanic older adults and their families through various health education and promotion programs that involve community-based promotores as partners to bring these programs to underserved Latino communities. As part of this mission, NHCOA has launched a pilot project to train and deploy promotores in community-based settings to improve the health literacy of older Hispanic adults with chronic diseases, as well as their caregivers and families.

Through this project, NHCOA seeks to address the critical issue of low health literacy among Hispanics, focusing primarily on older adults afflicted with chronic diseases.This project includes the development of an e-learning platform, Portal E Comunidad, to provide educational opportunities not often accessible to promotores. During the pilot phase, Portal E Comunidad will be restricted to the community-based organizations and their promotores/as, who  will collaborate in the development of the system. Once the pilot phase is complete, NHCOA plans to expand Portal E Comunidad for free to promotoras/es nationwide.


Through NHCOA’s signature leadership development program, Empowerment and Civic Engagement Training, we have trained more than 1,000 community and grassroots leaders in community advocacy rooted in positive leadership. Over the past year, we have integrated a health literacy component to the training as these local leaders often are one of the main, if not the sole source of information for isolated Hispanic older adults. In 2015, we hope to reach XX community and grassroots leaders, providing them with the tools to assist Latino seniors in learning how to navigate the U.S. healthcare system, how to make best use of their health insurance, and how to know when they are eligible and how to apply for public health benefits.

NHCOA is hosting its next Empowerment and Civic Engagement training as part of the 2015 Promoting Communities of Success Regional Meeting in Miami from June 2-3. The health literacy outreach component of NHCOA’s ECET is funded in part by the Anthem Foundation and Meadows Foundation.



There is a lot of alarming news and reports about Ebola, but there is no need for panic or fear. Dr. Henry Pacheco, NHCOA Director of Medicine and Public Health, offers information and recommendations here.


Low levels of health literacy is one of several barriers Hispanic older adults face when it comes to understanding their Medicare coverage and the system itself. This makes them more likely to fall prey to scammers and con artists who commit fraud, waste, and abuse against the Medicare system.  Through the National Hispanic SMP, NHCOA helps Latino seniors understand Medicare concepts, how to use their benefits, and most importantly, how to detect, protect themselves, and report potencial Medicare fraud.


7th Annual Health Literacy Research Conference

November 2-3, 2015 Bethesda

Maryland, Hyatt Regency Bethesda

Abstract Submission Portal Opens: May 4, 2015

Abstract Submission Deadline: July 2, 2015

The Health Literacy Annual Research Conference is an interdisciplinary meeting for investigators dedicated to health literacy research. It is an opportunity to advance the field of health literacy, a method to raise the quality of our research, and a venue for professional development.

The aim is to attract a full range of investigators engaged in health literacy research including those involved in a broad array of public health, health services, epidemiology, translational, and interventional research activities.

For more information, visit: