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Understanding health literacy

Many times, when nurses hear about health literacy it is in the context of patient education or reading level. But is that all health literacy is about?

This story was published in the Fall 2022 issue of The Washington Nurse.

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Per the National Institutes of Health, “health literacy is 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.”

This means that while a patient’s ability to read is certainly important, the patient’s ability to comprehend the health information they have been given and use it to make informed decisions is paramount for health literacy. This is much more than just reading level!

It is important to acknowledge that health literacy (and a lack thereof) does not correlate with intelligence or education. Everyone, no matter their background, can be at the risk of misunderstanding health information, especially if the topic is complex or brand new, emotions are high, or the patient has had little interaction with healthcare systems.

So, what can you do to assess health literacy in your patients and ensure they receive information they can understand and apply?

  • As with any nursing assessment, understand the patient’s baseline. Keep in mind that our baseline knowledge as healthcare professionals is quite different than what the average layperson understands about health!
  • Patients who do not speak English as a first language can have additional barriers to health literacy. Hospitals are required to provide interpreter services for any patient who needs them. A video or in-person interpreter can supplement, but not entirely replace, patient education materials in their first language. (Note that qualified medical interpreters are required to be provided; friends, family, and bilingual staff do not meet this requirement!)
  • Minimize the use of jargon. Medical and healthcare terms can be a whole language all by themselves, and most of the time it is a language that patients do not know. Strive to use simple, clear, precise language, especially when explaining something for the first time.
  • Patients can be afraid or embarrassed to ask questions; but do not assume they don’t have any! Instead of asking, “Do you have any questions?” consider reframing the question to “What questions do you have?” This lets patients know that it is normal and expected to have questions and helps to create a safe environment to ask them.


The gold standard for determining the reading level of healthcare-related materials is the Simple Measure of Gobbledygook (SMOG). Yes, that is its real name! SMOG uses several criteria to analyze text and assign a reading level based on grade level. This formula was developed in 1969 and is still in use today.