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Helping Organizations Address Health Literacy


By Tina Cordero, PhD, Project Director, Department of Standards and Survey Methods

On any given day, a native English speaker with a college education can struggle to completely understand a doctor’s instructions, especially when stressed or alone. 

For those functioning at an elementary school reading level or who aren’t fluent in English, low health literacy—defined as the degree to which an individual has the capacity to obtain, communicate, process, and understand basic health information and services to make appropriate decisions—can lead to poor health outcomes.  

Research shows that patients with low health literacy have:

  • higher risk of medication errors
  • higher readmission rates
  • less preventive care than patients with adequate health literacy.

Health Literacy in Joint Commission Standards
The Joint Commission has embedded the concept of health literacy into several requirements and initiatives focused on the broader issue of patient and provider communication.  Though our standards may not specifically use the term “health literacy,” we have many requirements that incorporate health literacy issues, such as:

  • providing information in a manner that the patient can understand
  • patients using information to make care decisions
  • providing written information in plain language
  • patient engagement
  • participation in care discussions

Low-Tech Strategies
Healthcare organizations don’t always need to implement something elaborate to improve patient understanding during the patient/provider encounter. One easy-to-implement strategy is the simple “Teach Back” method. When providers ask their patients to reverse roles and essentially repeat what they’ve just learned, they are quickly clued in when their patients aren’t fully comprehending the information or when something needs to be explained again.  

Another simple yet effective approach is simply changing your verbiage to ask patients “What questions do you have for me?” instead of the standby “Do you have questions?” It gives the patient an opening to voice their concerns and be more engaged in the discussion.  

It is also important for healthcare providers to communicate health information that is appropriate for their patients. The more we can improve patient/provider communication, the more opportunities patients have to make informed decisions about their health and health care.

Free Resources and Toolkits
The Joint Commission has an online health equity portal with free resources that address patient/provider communication and health literacy.  There are also a number of free resources and toolkits geared toward health care and public health professionals that are available from other national organizations:

  • The CDC released Health Literacy Guidance & Tools, an online educational module for public health professionals on health literacy, numeracy, and effective communication techniques.
  • The AHRQ Health Literacy Universal Precautions Toolkit provides tools to improve spoken and written communication, self-management and empowerment, and supportive systems.
  • The National Academy of Medicine released a discussion paper focused on strategies to enhance numeracy skills.
  • HHS has a Health Literacy Online Guide for web designers, content specialists, and other public health communication professionals that addresses the development of health websites and digital tools for online health information.

Christina Cordero, PhD, is a Project Director in the Department of Standards and Survey Methods, Division of Healthcare Quality Evaluation at The Joint Commission. Dr. Cordero is focused on standards development projects for the hospital and laboratory accreditation programs. She developed the patient-centered communication standards and The Joint Commission monograph Advancing Effective Communication, Cultural Competence, and Patient- and Family-Centered Care: A Roadmap for Hospitals.  Dr. Cordero has also provided research and technical support to The Joint Commission’s Hospitals, Language, and Culture: A Snapshot of the Nation study, and she is a contributing author of One Size Does Not Fit All: Meeting the Health Care Needs of Diverse Populations. Prior to joining The Joint Commission, Dr. Cordero conducted basic science and public health research at Northwestern University’s Feinberg School of Medicine.