What is health literacy?

Health literacy involves the information that people need to be able to make good decisions about health. There are two parts:

• Personal health literacy is about how well a person can find and understand the health information and services that they need. It is also about using the information and services to make good health decisions.
• Organizational health literacy is about to how well organizations help people find the health information and services that they need. It also includes helping them use that information to make good health decisions.

Which factors can affect health literacy?

Many different factors can affect a person's health literacy, including their:

• Knowledge of medical words
• Understanding of how the health care system works
• Ability to communicate with health care providers
• Ability to find health information, which may require computer skills
• Reading, writing, and number skills
• Personal factors, such as age, income, education, language abilities, and culture
• Physical or mental limitations

Many of the same people who are at risk for limited health literacy also have health disparities. Health disparities are health differences between different groups of people. These groups may be based on age, race, gender, or other factors.

Why is health literacy important?

Health literacy is important because it can affect your ability to:

• Make good decisions about your health
• Get the medical care you need. This includes preventative care, which is care to prevent disease.
• Take your medicines correctly
• Manage a disease, especially a chronic disease
• Lead a healthy lifestyle

One thing that you can do is to make sure that you communicate well with your health care providers. If you don't understand something a provider tells you, ask them to explain it to you so that you understand. You can also ask the provider to write down their instructions.

Health literacy is important for everyone because, at some point in our lives, we all need to be able to find, understand, and use health information and services.

Taking care of our health is part of everyday life, not just when we visit a doctor, clinic, or hospital. Health literacy can help us prevent health problems, protect our health, and better manage health problems when they arise.

Even people who read well and are comfortable using numbers can face health literacy issues when

• They aren’t familiar with medical terms or how their bodies work.
• They have to interpret statistics and evaluate risks and benefits that affect their health and safety.
• They are diagnosed with a serious illness and are scared and confused.
• They have health conditions that require complicated self-care.
• They are voting on an issue affecting the community’s health and relying on unfamiliar technical information.

When your doctor prescribes a medication for your child, do you know what the correct dosage is or how to measure it?

Are you comfortable asking your doctor questions when you receive a lab report and don’t understand the results?

Do you understand how to use the information on the Nutrition Facts Label on food products when you shop at the grocery store?

If you can answer “yes” to these questions, you might have high health literacy, says Jodi Duckhorn, a social scientist and Director of Risk Communications at the Food and Drug Administration (FDA). Duckhorn’s team is responsible for making sure that messages FDA sends out are understandable to their intended target audiences—a key component of health literacy.

What Is Health Literacy?

What is health literacy? Simply put, it’s the ability to get and understand information on health issues and medical services so that you can make informed decisions about your health, Duckhorn says.

If you don’t have high health literacy, you’re not alone. Only about 12 percent of U.S. adults have the skills to manage their health and prevent disease, according to the National Assessment of Adult Literacy. And without this essential knowledge, it can be hard for many people to learn how to improve their health.

According to the federal Office of Disease Prevention and Health Promotion, health literacy requires basic language skills and knowledge of such health topics as nutrition or heart health. You might not make informed decisions about your health if you don’t have a good grasp on the information your doctor is telling you, or if you are hesitant about asking questions pertaining to your health care.

For instance, the information you get from even a simple physical can be overwhelming, Duckhorn says. “It’s easy to see how someone could be confused if test results for cancer come back negative, for instance,” she adds. “Intuitively, a patient might think that ‘negative’ is a ‘bad’ result rather than a good one.”

Consequences of Low Health Literacy

Low health literacy can have negative consequences. “Reduced health literacy affects your ability to talk with your healthcare professionals and use the healthcare system,” says Duckhorn. “It also limits your ability to interpret basic lab results (such as cholesterol and blood sugar) and numbers that measure medications, and understand nutrition labels.”

Lower health literacy is also linked to higher rates of hospitalization and less frequent use of services that can prevent you or your family from getting sick—often because you don’t know where or how to find available services. And more sick people can lead to higher health costs.

How FDA Promotes Health Literacy

Promoting health literacy is important to FDA which communicates complex science and health topics every day, And it’s a key part of the agency’s effort to help the public make better informed decisions about the use of FDA-regulated products. The agency aims to provide clear and accurate information to patients and to health care professionals in several ways.

For example, FDA strives to:

Use plain language for clear communications. FDA first identifies its audience. Then the agency sends communication materials with well-organized messages that use clear sentences and common words. This easy-to-understand language is especially important for popular FDA webpages, such as those that discuss seasonal flu and vaccines for children, and in FDA-approved patient package inserts (consumer-friendly summaries of patient information), instructions for use, and Medication Guides (paper handouts that come with many prescription medicines). FDA uses best practices in the principles of plain language in other communications, including videos and posts on Twitter and Facebook.

In addition, FDA uses Drug Safety Communications to let health care professionals and consumers know about newly observed potential risks of FDA-approved drugs and to offer advice on how these drugs may be best used in light of this new information. And when a drug or device is identified as unsafe, FDA informs consumers about market recalls and withdrawals.

Create special initiatives. Many FDA Offices and Centers use special initiatives to promote health literacy, says Duckhorn. For instance, FDA’s Center for Drug Evaluation and Research offers free online resources that teach you how to buy and use medicines safely. The Center for Food Safety and Applied Nutrition offers tips on how to use the Nutrition Facts Label. Plus, the Office of Health and Constituent Affairs operates a web portal called the FDA Patient Network. The Patient Network gives you access to health resources (including a newsletter) and can help you better understand the medical product regulation process.

Translate materials. “Access to important health information in other languages is essential for people with limited English proficiency and those who are learning English,” says CAPT Richardae Araojo, Assistant Commissioner for Minority Health. To that end, FDA offers safety updates and other materials for people with limited English skills. For example, the agency translates FDA Consumer Updates (like this one) into Spanish. It offers free health publications in multiple languages, such as Arabic and Tagalog. “We also initiated a multi-media campaign on Minorities in Clinical Trials with print materials and a video in Spanish”, Araojo says.

How to Improve Your Own Health Literacy

You can start with FDA’s free publications, including those for women’s health and minority health. Then you can read FDA’s online resources for consumers to learn about health topics, such as those about medications and vaccines. FDA Consumer Updates offer free information about the latest agency news and research.

In addition, the agency has a Consumer Hotline for people who have questions and concerns about FDA-regulated products and issues. You can call the general hotline at 1-888-INFO-FDA (1-888-463-6332).

“Don’t ever be afraid to ask questions about your health care,” Duckhorn says. “Often when you’re unwell, you feel out of control. But asking questions actually enables you to take control of your own health.”

Do you ever feel as if you and your doctor weren't speaking the same language? Sometimes even words that you think you understand can have a different meaning to your doctor.

For example: heart attack.

Your uncle experienced the symptoms of what you understand to be a heart attack, including:

• racing heartbeat
• chest pain
• shortness of breath
• passing out

Your uncle's heart stopped beating! Luckily, the emergency responders used CPR and revived him.

Later when you're talking to the doctor, you say how glad you are that he survived his heart attack. The doctor says, "He didn't have a heart attack. He had a cardiac arrest; but no muscle damage." What does the doctor mean?

What is going on? To you, a heart attack means the heart doesn't beat. To the doctor, a heart attack means there is damage to the heart muscle.

Another example: fever. You take your child's temperature and it is 99.5 degrees. You call the doctor and say your child has a fever of 99.5 degrees. She says, "That's not a fever." What does she mean?

What is going on? To you, a fever is anything above 98.6 degrees. To the doctor, a fever is a temperature over 100.4 degrees. You and your doctor sometimes are speaking a different language; but using the same words.

So what can you do? If what you're hearing doesn't make sense, make sure to ask questions!

Now let's look at a couple of tongue-twisting, big words.

• Colonoscopic polypectomy
• Esophagogastroduodenoscopy

These next words sound alike and are similar in spelling, but one is high blood sugar and one is low blood sugar.

• Hyperglycemia
• Hypoglycemia

These next two words also sound alike, but one is a painful problem with your joints and the other is a disease that makes your bones weak.

• Osteoarthritis
• Osteoporosis

What did the doctor just say? Did she say you needed a colonoscopic polypectomy? What on earth do those two words mean?

You need a what? Transesophageal echocardiogram! What is that?

Medical words can be long and confusing. Let's figure out what these words mean.

Some medical words are made up of multiple parts. They might make more sense if you break the word into different parts.

Breaking up isn't hard to do! Long medical words can have a:

• Beginning (or prefix): If there's a beginning, it can be about size, shape, color, direction, and amount.
• Middle (or root): The middle is often a part of the body.
• Ending (or suffix): If there's an ending, it can be about the same thing as the beginning, like size, or it can be about a test or it can describe a problem.

Breaking up long words.

Transesophageal has a:

• Beginning (or prefix) of trans
• Middle (or root) of esophagi
• Ending (or suffix) of eal

Echocardiogram has a:

• Beginning (or prefix) of echo
• Middle (or root) of cardio
• Ending (or suffix) of gram

Things to remember:

Not all medical words have a beginning or ending. Sometimes word pieces can appear in different places, like cardi in these words cardiologist and myocardial.

Let's begin with some basic body parts. The root of a medical word is usually a body part.

• Bone is oste
• Muscle is myo
• Nerves is neur
• Skin is derm

The root of echocardioogram is cardio. It means heart. Here are some roots for your heart and blood vessels.

• Your heart is cardio
• Your veins and arteries are vas or vasc
• The system of heart and blood vessels is sometimes called the cardiovascular system

Here are more roots for your heart and blood vessels.

• Blood is hem or hemo or sangu
• Blood vessels are angi or angio
• Veins are ven or veno or phleb or phlebo
• Aorta is aort
• Heart is cardi or cardio
• Arteries are arteri or arterio

Here are word roots for parts of your head.

• Brain is enceph
• Nose is rhino
• Eardrum is tympan or myringo
• Tooth is odont or dento
• Skull is crani
• Eye is ophthalm or oculo
• Ear is oto
• Tongue is lingu

Here are word roots for your digestive organs.

• Liver is hepat or hepato
• Gallbladder is cholecyst
• Esophagus is esoph or esopha
• Large intestine is colo
• Stomach is gastr or gastro
• Small intestine is ileo

A quick review of what we covered so far.

• Brain is enceph
• Eye is ocul or oculo
• Nose is rhino
• Liver is hepat or hepato
• Head is ceph
• Heart is cardi or cardio
• Stomach is gastr or gastro
• Large intestine is colo

These are root words for the other areas of your body.

• Chest is thorac or thoraco
• Lung is pneumo or pleura
• Breast is mamm or mammo
• Blood clot is thromb or thrombo
• Kidney is neph

Root words for specific bones and muscles areas of your body.

• Muscles is myo
• Shoulder is scapula
• Arm is brachi or brachio
• Wrist is carp or carpo
• Rib is cost or costo
• Back is dorsa
• Bones are oste or osteo
• Foot is pod or podo or ped or pedo

Beginnings and endings, also called prefix and suffix, are added to word roots to change the meaning or add more information.

Is it a beginning or an ending? In this section, we will use a dash after the word part to show it's a beginning.

Example: hepat -

We will use a dash before the word part to show it is an ending.

Example: - itis

Beginnings and endings that are about size:

• Macro - is very large
• Megalo - or - megaly is large
• Micro - is small

Beginnings on level or speed:

• Hyper - is above normal
• Hypo - is below normal
• Tachy - is fast
• Brady - is slow

Beginnings about where:

• Peri - is around
• Trans - is across
• Endo - is within or inside
• Inter - is between

Here are beginnings about tests and procedures:

• Echo - means using ultrasonic waves
• Electro - means using electricity

Here are endings about tests and procedures:

• - Ectomy means removal of
• - Gram means a picture
• - Graph or - graphy means the process of making a picture
• - Otomy means making a cut in
• - Scopy means use of instrument for viewing
• - Stomy means create an opening

Beginnings and endings about problems:

• Dys - is not working correctly
• Mal - is bad
• - Emia is blood condition
• - Itis is inflammation
• - Osis is condition or disease
• - Pathy is disease

Beginnings and endings about specialties and specialists: who are you going to see?

• - Ology is the study of a part of the body
  So...
• An - ologist means a person working with a specific part of the body or a specific disease


• - Iatry is a medical treatment
  So...
• An - iatrist means a person providing specific treatment

Now let's see how those beginnings, roots, and endings get combined:

• Derma - is skin and - itis equals inflammation
  So...
• Dermatitis is inflammation of the skin


• Colo - is colon and - ostomy is opening of
  So...
• Colostomy is creating an opening in the colon

Now that you know cardi or cardio means heart, look at what else you know!

• Carditis is inflammation of the heart
• Cardiology is study of the heart
• Cardiomyopathy is disease of the heart muscle
• Echocardiography is heart test using ultrasonic waves

You now know that colo is colon , look at what else you know!

• Colitis is inflammation of the colon
• Colectomy means removal of the colon
• Colonoscopy is view of the colon

Now, you know that the word ending - itis means inflammation, look at what else you know!

• Hepatitis is inflammation of the liver
• Pneumonitis is inflammation of the lungs
• Gastritis is inflammation of the stomach
• Encephalitis is inflammation of the brain
• Otitis is inflammation of the ear

You also now know that the work ending of - ectomy equals removal, so....

• Gastrectomy means removal of the stomach
• Colectomy means removal of the colon
• Nephrectomy means removal of the kidney
• Tonsillectomy means removal of the tonsils
• Appendectomy means removal of the appendix

Now if you go to the doctor and say, "It hurts to swallow. My nose is running and I can't stop coughing."

Your doctor says, "Open wide and say ahh." After looking your doctor says, "You have pharyngitis ."

You now know what that is, inflammation ( itis ) of your throat ( pharyng .)

Now back to the phrase transesophageal echocardiogram, which is the name of a medical test.

We can break up transesophageal into the following three parts:

• Trans is across
• Esophag is esophagus
• Eal means pertaining to

Transesophageal means a test that involves going across the throat.

We already figured out that echocardiogram breaks into three parts:

• Echo means using ultrasonic waves
• Cardio means heart
• Gram means recording

Echocardiogram is a recording of a heart test using ultrasonic waves.

During a transesophageal echocardiogram, you swallow a tube that does a heart test using ultrasonic waves.

Some final tips about "alphabet soup." You know—those strings of letters that you see on requests for lab work or other tests.

They aren't words—the letters are shorthand for longer words. They may be abbreviations or acronyms (words made of letters from several words.)

Here are some examples:

• CBC is Complete Blood Count, a lab test that measures the number of different types of blood cells.
• UTI is urinary tract infection, an infection of the kidney or bladder.

Who invented these? And why? Health professionals use abbreviations so they don't have to repeatedly write out those long medical words!

Sometimes the shortcut is the first letters of a group of words. Sometimes the shortcut is selected letters from one long word.

More examples:

• MRI is magnetic resonance imaging, a type of diagnostic test using images.
• CMV is cytomegalovirus, a virus that causes a variety of infections.

It's all Greek to me! Or Latin! Sometimes the shortcut has Greek or Latin roots.

Your doctor gives you a prescription. It says b-i-d. What does that mean?

When you get the prescription, the bottle says, "Twice a day." Where is b-i-d?

B-i-d comes from the Latin " bis in die " which means twice-daily dosage.

Sometimes medical words really ARE a foreign language!

Getting creative with shortcuts. To test the function of your thyroid gland, your doctor may order two tests.

She's written T3 and T4. What's are these?

• T3 stands for triiodothyronine. Tri is Greek for three.
• T4 stands for tetraiodothyronine or thyroxine. Tetra is Greek for four.

Which would you rather write?

Your doctor might order an electrocardiogram, a test that measures electrical waves from your heart.

He might write EKG on the prescription pad. Why is electrocardiogram abbreviated E-K-G ?

It is to make sure that you get a heart test instead of a brain test called an electroencephalogram, which is written as EEG. That could look like ECG if the doctor wrote it in a hurry.

Our plain-English glossary helps you make sense of the terms doctors often use.

A

Acid Reflux: A condition in which food or liquid leaks backwards from the stomach into the tube from the mouth to the stomach (the esophagus). Also known as gastroesophageal reflux disease, or GERD, the condition can irritate the esophagus, causing heartburn and other symptoms.

Allergy: An abnormally high sensitivity to certain substances, such as pollens, foods, or microorganisms. Common indications of allergies may include sneezing, itching, and skin rashes.

Anesthesia: A loss of feeling or awareness caused by drugs or other substances. Anesthesia keeps patients from feeling pain during surgery or other procedures. Local anesthesia is a loss of feeling in one small area of the body. Regional anesthesia is a loss of feeling in a part of the body, such as an arm or leg. General anesthesia is a loss of feeling and a complete loss of awareness that feels like a very deep sleep.

Antibiotic: A drug used to treat infections caused by bacteria and other microorganisms. Atrial Fibrillation: A heart rhythm disorder (arrhythmia) that usually involves a fast heart rate that is not regular.

B

Benefit: Something that promotes or enhances well-being; an advantage.

Bipolar Disorder: A condition in which people go back and forth between periods of feeling very good (mania) and irritable or depressed. The change between mania and depression can occur quickly.

C

Clinic: A facility, often associated with a hospital or medical school, that is devoted to the diagnosis and care of outpatients.

Co-morbidity: The presence of one or more diseases or disorders in addition to a primary disease or disorder.

Comparative Effectiveness: A type of health care research that compares the results of one approach for managing a disease to the results of other approaches. Comparative effectiveness usually compares two or more types of treatments, such as different drugs, for the same disease. Comparative effectiveness also can compare types of surgery or other kinds of medical procedures and tests.

Complication: A medical problem that occurs during a disease or after a procedure or treatment. The complication may be caused by the disease, procedure, or treatment or may be unrelated to them.

Condition: A health problem with certain characteristics or symptoms.

Congenital Heart Disease: A problem with the heart's structure and function as a result of abnormal heart development before birth.

Coronary Artery Disease: A narrowing of the small blood vessels that supply blood and oxygen to the heart. It is the leading cause of death in the United States for men and women.

D

Diabetes: Any of several diseases in which the kidneys make a large amount of urine. Diabetes usually refers to diabetes mellitus in which there is also a high level of glucose (a type of sugar) in the blood because the body does not make enough insulin or use it the way it should.

Diagnosis: The process of identifying a disease from its signs and symptoms using patient history, examination, and laboratory and other test results.

Disease: A disordered or incorrectly functioning organ, part, structure, or system of the body resulting from the effect of genetic or developmental errors, infection, poisons, nutritional deficiency or imbalance, toxicity, or unfavorable environmental factor; illness; sickness; ailment.

E

Elective Surgery: A surgery that is optional and not required.

Electronic Health Record: A computerized record of patient health in a care delivery setting. Typically, the data collected are created by and for health professionals while providing treatment.

Emergency: A serious situation that happens unexpectedly and demands immediate action.

Estrogen: A type of hormone made by the body that helps develop and maintain female sex characteristics and the growth of long bones.

G

Generic Drugs: Generic drugs are safe, effective, and approved by the U.S. Food and Drug Administration (FDA). They have the same dosage, safety, quality, performance, and strength as brand-name drugs. The color or flavor of a generic medicine may be different, but the active ingredient is the same. After the patent runs out on a brand-name drug, companies can apply to the FDA to make a generic copy of that drug. Generic drugs usually cost less than brand-name drugs.

H

Health History: A regularly updated record of a person's past and present health status.

Hepatitis B: A serious disease that affects the liver. It is caused by the hepatitis B virus. It ranges in severity from a mild illness, lasting a few weeks (acute), to a serious long-term (chronic) illness that can lead to liver disease or liver cancer.

Hospital: An institution that provides medical, surgical, or psychiatric care and treatment for the sick or the injured.

Hysterectomy: Surgery to remove the uterus and, sometimes, the cervix. When the uterus and the cervix are removed, it is called a total hysterectomy. When only the uterus is removed, it is called a partial hysterectomy

L

Long-Term Care: Services that help meet the medical and nonmedical needs of people with a chronic illness or disability.

M

Medical Error: An unintended but preventable adverse effect of care, whether or not it is evident or harmful to the patient.

Medical Record: Documentation of a patient's medical history and care.

Medication/Medicine: Any substance or substances used in treating disease or illness.

Morbidity: A disease or the incidence of disease within a population. Morbidity also refers to adverse effects caused by a treatment.

Mortality: The state of being mortal (destined to die). Mortality also refers to the death rate, or the number of deaths in a certain group of people in a certain period of time. Mortality may be reported for people who have a certain disease, live in one area of the country, or who are of a certain gender, age, or ethnic group.

N

Nursing Home: A place that gives care to people who have physical or mental disabilities and need help with activities of daily living (such as taking a bath, getting dressed, and going to the bathroom) but do not need to be in the hospital.

O

Outpatient Surgery: A surgical procedure in which the patient is not required to stay overnight in a hospital.

P

Pharmacist: A person licensed to prepare and give out (dispense) prescription drugs and medicines and who has been taught how they work, how to use them, and their side effects.

Pharmacy: A place where drugs are sold; a drugstore.

Prescription: A direction written by the physician to the pharmacist for the preparation and use of a medicine or remedy.

Privileges: A clinician's right to practice his or her profession, such as medicine or surgery, at a particular hospital or health care facility.

Prognosis: The likely outcome or course of a disease; the chance of recovery or recurrence.

Pulse Rate: The number of times the heart beats per minute.

R

Readmission: Being admitted to a hospital or health care facility after being treated and discharged for the same condition or as a result of a complication.

Recovery: Restoration or return to health from sickness.

Risk: The possibility of suffering harm or loss; danger.

S

Second Opinion: When a patient seeks the recommendation or differing point of view of a doctor or other clinician other than the one a patient has previously been seeing.

Side Effect: An effect of a drug, chemical, or other medicine that is in addition to its intended effect, especially an effect that is harmful or unpleasant.

Specialist: A doctor or other health care professional who is trained and licensed in a special area of practice. Examples of medical specialists include oncologists (cancer doctor) and hematologists (blood doctor).

Surgery: A procedure to remove or repair a part of the body or to find out whether disease is present; an operation.

Symptom: A sign or indication that a person has a condition or disease. Some examples of symptoms are headache, fever, fatigue, nausea, vomiting, and pain.

T

Test Result: The conclusion or result of a particular test, performed on a particular specimen, such as a patient’s blood.

Treatment: Administration or application of remedies to a patient or for a disease or injury.

Treatment Option: A medicine or therapy to treat a problem. A treatment option may be a pill, a shot, exercise, operation, or a combination of things. Often, patients may have choices when there is more than one way to treat a health problem.

Treatment Plan: A road map or plan that a patient will follow on his or her path through treatment of a medical condition.

Here are some tips to use before, during, and after your medical appointment to make sure you get the best possible care.

One way you can make sure you get good quality healthcare is to be an active member of your healthcare team.

Patients who ask questions and make sure they understand the answers tend to get more timely, accurate diagnoses and have better outcomes.

Before Your Appointment

• Bring all the medicines you take to your appointment. This includes:
  • Prescription medicines.
  • Non-prescription medicines, such as aspirin or antacids.
  • Vitamins
  • Dietary or herbal supplements.
• Write down the questions you have for the visit. Use this brochure to list your questions.
• Know your current medical conditions, past surgeries, and illnesses.

During Your Appointment

• Explain your symptoms, health history, and any problems with medicines you have taken in the past.
• Ask questions to make sure you understand what your doctor is telling you.
• Let your doctor know if you are worried about being able to follow his or her instructions.
• If your doctor recommends a treatment, ask about options.
• If you need a test, ask:
  • How the test is done.
  • How it will feel.
  • What you need to do to get ready for it.
  • How you will get the results.
• If you need a prescription, tell your doctor if you are pregnant, are nursing, have reactions to medicines, or take vitamins or herbal supplements.
• Find out what to do next. Ask for:
  • Written instructions.
  • Brochures.
  • Videos.
  • Web sites.

After Your Appointment

• Always follow your doctor's instructions.
• If you do not understand your instructions after you get home, call your doctor
• Talk with your doctor or pharmacist before you stop taking any medicines that your doctor prescribed.
• Call your doctor if your symptoms get worse or if you have problems following the instructions.
• Make appointments to have tests done or see a specialist if you need to.
• Call your doctor's office to find out test results. Ask what you should do about the results.

My Questions for This Visit

You might have questions about:

• Your medicines.
• A medical test you need.
• A surgery you need.

Write down what are the top three questions you want to be sure to ask during your appointment.

Answers to simple questions can help you feel better, take better care of yourself, or even save your life.

The questions below can get you started.

1. What is the test for?
2. When will I get the results?
3. How do you spell the name of that drug?
4. Are there any side effects?
5. Will this medicine interact with medicines that I'm already taking?
6. Why do I need this treatment?
7. Are there any alternatives?
8. What are the possible complications?
9. Which hospital is best for my needs?
10. How many times have you done this procedure?

Health literacy is how well someone is able to obtain, process, and understand basic health information and health care services. It includes the ability to read and understand prescriptions, directions from a nurse or physician, medical forms and patient education materials. When families understand health information, they can make good health choices.

Understanding What Your Doctor Tells You

Health literacy is how well you understand health information and make good choices about health and medical care.

Why Is It Important?

Many people find it hard to understand the health information they need to take care of themselves and their families.

When Parents and Caregivers Understand Health Information and How to Use it, Children Are More Likely to:

• Miss fewer days of school
• Make fewer trips to the pediatrician or the emergency room that are not needed
• Live healthier lives
• Get preventive care like flu shots
• Have a safe home where fewer accidents happen

Learning Ways to Understand and Use Health Information Can Help With:

• Talking with your doctor
• Asking questions
• Following a doctor’s directions
• Taking or giving medicine the right way
• Getting needed medical tests and care
• Knowing what to do when your child gets sick
• Preventing diseases like diabetes, asthma, and cancer
• Making healthy choices for you and your family
• Asking for help

Things You Can Do to Help Your Child

• ASK for help if you do not understand a health form or do not know how to fill it out
• ASK for handouts in the language that is easiest for you to read
• WRITE DOWN questions you have before you go on any health care visit
• TELL YOUR DOCTOR if you do not understand what he or she is saying
• Go to the library and ask how to find accurate information about your health concerns and medicines
• Ask your Head Start or child care program for information on health issues that concern you
• Go to health workshops at your child’s Head Start program and in your community

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

Low health literacy is more prevalent among:

• Older adults
• Minority populations
• Those who have low socioeconomic status
• Medically underserved people

What is our role in promoting health literacy?

Health literacy is a common thread through all of our programs. A large portion of the people we serve are poor and medically underserved.

They need help understanding and navigating a complex health care system. They require culturally competent providers who speak their language so they can make informed health care choices.

A number of patients may be confused with certain medical language, have difficulty understanding English, struggle with filling out forms, or have limited access to health providers in their community.

With the proper training, health care professionals can identify patients' specific health literacy levels and make simple communication adjustments.

Reasons for a patient's low health literacy

• Health care providers use words patients don’t understand
• Low educational skills
• Cultural barriers to health care
• Limited English Proficiency (LEP)

Instances when patients with low health literacy may have difficulty

• Locating providers and services
• Filling out complex health forms
• Sharing their medical history with providers
• Seeking preventive health care
• Knowing the connection between risky behaviors and health
• Managing chronic health conditions
• Understanding directions on medicine

How health care professionals can help

• Identify patients with limited literacy levels
• Use simple language, short sentences and define technical terms
• Supplement instruction with appropriate materials (videos, models, pictures, etc.)
• Ask patients to explain your instructions (teach back method) or demonstrate the procedure
• Ask questions that begin with “how” and “what,” rather than closed-ended yes/no questions
• Organize information so that the most important points stand out and repeat this information
• Reflect the age, cultural, ethnic and racial diversity of patients
• For Limited English Proficiency (LEP) patients, provide information in their primary language
• Improve the physical environment by using lots of universal symbols
• Offer assistance with completing forms

Health Literacy Terms & Definitions

Culture
Attitudes and behaviors, which are characteristic of a group or community.

Cultural Competence
A set of similar behaviors, attitudes, and policies that come together in a system, agency, or among professionals that enables effective work in cross-cultural situations.

Limited English Proficiency
Individuals who do not speak English as their primary language. They have a limited ability to read, speak, write, or understand English and may be limited English proficient, or "LEP."

These individuals may be entitled language assistance with respect to a particular type or service, benefit, or encounter.

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

Plain Language
Writing that is clear and to the point. It helps to improve communication. And, it takes less time to read and understand.

The definition of health literacy was updated in August 2020 with the release of the U.S. government’s Healthy People 2030 initiative. The update addresses personal health literacy and organizational health literacy and provides the following definitions:

• Personal 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.
• Organizational health literacy is the degree to which organizations equitably enable individuals to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.

These definitions are a change from the health literacy definition used in Healthy People 2010 and Healthy People 2020: “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.”

The new definitions:

• Emphasize people’s ability to use health information rather than just understand it
• Focus on the ability to make “well-informed” decisions rather than “appropriate” ones
• Acknowledge that organizations have a responsibility to address health literacy
• Incorporate a public health perspective

From a public health perspective, the organizational definition acknowledges that health literacy is connected to health equity. Health equity is the attainment of the highest level of health for all people. We will achieve health equity when everyone has the opportunity to be as healthy as possible.

What Are Adult Literacy and Numeracy?

The U.S. Department of Education defines adult literacy and numeracy in terms of skills that help people accomplish tasks and realize their purposes. Researchers can measure literacy and numeracy skills, but skills are not static. People can build their skills, and even adults with limited skills can get better results when their environments accommodate the skills they have.

• Literacyis understanding, evaluating, using, and engaging with written text to participate in the society, to achieve one’s goals and to develop one’s knowledge and potential.
• Numeracyis the ability to access, use, interpret, and communicate mathematical information and ideas, to engage in and manage mathematical demands of a range of situations in adult life.

Population Measures of Literacy, Numeracy, Health Literacy, and Technology Skills

Adult Health Literacy Skills

Literacy and health literacy are not the same, but they are related. The U.S. Department of Education collects and reports data on adult literacy and numeracy skills. In 2006, they published the only national data on health literacy skills. The study found that adults who self-report the worst health also have the most limited literacy, numeracy, and health literacy skills.

• The Health Literacy of America’s Adults: Results from the 2003 National Assessment of Adult Literacy

Adult Literacy & Numeracy Skills

The most current adult literacy data come from the Program for the International Assessment of Adult Competencies, a 24-country comparative study. This study assessed adults’ proficiency in three domains: literacy, numeracy, and problem-solving in technology-rich environments. Below we present select findings on literacy and numeracy.

In each of these domains, adults perform tasks with different levels of complexity. Their skills with these tasks are quantified and categorized into “proficiency levels.” The proficiency level “below level 1” is the lowest level and “level 5” is the highest proficiency level. If they can perform the most complex tasks, they are rated as having proficient skill.

Only 12% of U.S. adults scored in the highest literacy proficiency levels, and only 9% scored in the highest numeracy levels.

Figure 1: Percentage of U.S. adults age 16 to 65 at each level of proficiency on the PIAAC literacy scale

Figure 2: Percentage of U.S. adults age 16 to 65 at each level of proficiency on the PIAAC numeracy scale

As a health literacy ambassador, it’s up to you to make sure your colleagues, staff, senior leadership, and community leaders understand the importance of using health literacy concepts. Use these talking points when making the case for building a health literate organization.

1. Nearly nine out of 10 adults struggle to understand and use personal and public health information when it’s filled with unfamiliar or complex terms.
2. Limited health literacy costs the healthcare system money and results in higher than necessary morbidity and mortality. Improving health literacy could prevent nearly 1 million hospital visits and save over $25 billion a year.
3. We can improve health literacy if we practice clear communication strategies and techniques. Clear communication means presenting familiar concepts, words, numbers, and images in ways that make sense to the people who need the information.
4. Testing information products with your intended audience and asking for feedback are the best ways to know if you’re communicating clearly. Test and ask for feedback before releasing information to the public.
5. Clear communication builds trust with your audience. When your audience trusts you, they’re more likely to follow your recommendations.
6. Choosing to use jargon is an act of exclusion. Using clear communication advances health equity.
7. Clear communication streamlines the translation process. That means you can more quickly share your information with people who are non-native English speakers and readers.

We’ve all read federal tax forms or school loan applications and been left scratching our heads, asking, “What does this mean? What do I need to do?” Hopefully, we’ll be doing less head-scratching now, as federal agencies, including FDA, work to carry out the requirements of the Plain Writing Act.

The law, signed by President Obama in October 2010, requires federal agencies to follow plain language guidelines when writing print and Web documents that help the public:

• Obtain a government service or benefit (like get a school loan); or
• Understand how to comply with a federal requirement (like fill out a tax form).

The Plain Writing Act of 2010 is a big weapon in the “War on Gobbledygook,” a war started by Lyndon B. Johnson’s administration in 1965 to get rid of governmentese. The war rages on today.

Governmentese

The public has been crying out for simple, clear language in government writing for decades. The first known use of the word “governmentese” dates to 1944. The term has several definitions, all with a common theme:

• “Complicated or obscurantist language thought to be characteristic of government bureaucratic statements; officialese” (Dictionary.com)
• “A jargon spoken in government” (Wiktionary.org)
• “Jargon held to be characteristic of government officials” (Merriam-Webster.com)

By following the plain language guidelines, governmentese will hopefully become an obsolete language.

Principles of Plain Language

Plain language is the form of communication we use most often in our daily lives. It’s how you talk to a friend sitting at your kitchen table and you want to make sure she understands what you’re saying.

A document written in plain language allows readers to:

• Find what they need;
• Understand what they find; and
• Use what they find to meet their needs.

When writing in plain language, use these elements:

• A logical organization – Organize the writing so it answers questions in the order the reader will ask them.
• Common, everyday words –

  Instead of:	Say this:
  Implement	Start, Carry out
  Submit	Send, Give
  Demonstrate	Show, Prove
  Obtain, Procure, or Receive	Get

• Short sentences and short paragraphs – Smaller “bites” of information are easier for the reader to digest. Sentences should have 20 words or less. Paragraphs should have no more than seven lines of text, not sentences. It’s better to have only three to four lines of text.
• Pronouns – Use “We” for the agency and “You” for the reader. If writing in a question-and-answer format, use “I” in the questions and “You” in the answers.
• Active voice – Active voice is clear, concise, and direct. It sounds natural and tells the reader who is doing the action. For example, “The applicant’s submission was reviewed by FDA” is passive voice. In active voice, the sentence reads, “We reviewed your submission.”
• Lists and tables –
  • Lists make it easy for the reader to identify all items or steps in a process. They also help the reader see your document’s structure. A word of caution, though – don’t make lists too long because longer lists make it hard for the reader to take in the information.
  • Tables save words and make the logic and order of the document clear. They also make it easy for the reader to locate specific items and quickly take in complex material.

• Avoid hidden verbs – Eliminating hidden verbs gets rid of unnecessary words and makes the text simpler.

  Instead of:	Say this:
  Conduct an analysis	Analyze
  Do an assessment	Assess
  Came to the conclusion of	Concluded

Identify your Audience

It’s important to know your audience before you start writing. Your document should serve the reader’s needs and interests first. It should include only the information the reader needs to know, with the right amount of detail, and in a sequence that is easy to follow.

Limit Acronyms

Governmentese is chock-full of acronyms, and deciphering the alphabet soup isn’t always easy. Acronyms are barriers to effective communication and their overuse in a document is distracting. The reader will skip right over acronyms without understanding, or caring, what they all mean.

Some plain language acronyms rules are:

• Avoid them if possible;
• Try to have no more than two to a page;
• Use them only if they are convenient for your readers or if spelling the full name out each time is annoying to read;
• Change as many as possible into full words or use an alternative word or phrase (use “the center’s experts” rather than “CVM experts”);
• Use the acronym if that’s what the public is more familiar with (if you’re writing about NASA, use the acronym instead of writing out “National Aeronautics and Space Administration”); and
• If an organization or program is only mentioned once, there’s no need to include the acronym.

Format for Readability

Have you ever looked at an article and groaned because it’s just one wall of black text with no white space? Those kinds of articles are hard to get through and aren’t very reader-friendly.

When writing in plain language, you format the document so it’s easy to read and pleasing to look at. Headings and lists increase the blank space on the page, giving the reader’s eye a place to rest. Headings are also good because they:

• Allow the reader to quickly find relevant information;
• Break up the information, especially if it’s complex; and
• Help the reader navigate the document.

Plain Language and the Web

In our Age of Technology, most people get their information on the Internet. Web users scan a Web page, they don’t read it. Many Web pages, especially government ones, are too dense. When Web users see a too-dense Web page, they tend to quickly move on to another page.

Plain language keeps Web content as short and readable as possible. People read 25 percent slower on the Web, so when writing a document for the Web, cut out 50 percent of your text. Headings and lists are good to have in any document, but especially ones for the Web, because online readers focus on headings and information in bulleted lists.

Plain Language Myths

Legal and scientific experts commonly have some misconceptions about plain language. To clear up these myths, here’s a list of what plain language is not:

• Baby talk, or an attempt to be folksy, playful, or politically correct;
• Removing necessary technical or legal information;
• Simply editorial “polishing;”
• Imprecise;
• Just using pronouns in a question-and-answer format; or
• Easy.

Benefits of Plain Language

Federal agencies, including FDA, should use plain language because the public is full of busy people who don’t want to waste time or energy translating difficult or wordy documents. If the information is too hard to read and understand, the public will simply go to another, possibly less accurate, source for the information they want. When a federal agency writes in plain language, it shows a commitment to the public and a desire to communicate effectively.

Federal agencies should use plain language to make their message stand out and to get their message out correctly and clearly the first time. This reduces the time spent re-explaining something and lessens the frustration for both the public and the agency’s employees who answer questions from the public. Documents written in plain language improve compliance because people are more likely to follow instructions if they understand what they’re supposed to do. They won’t ask you to “say that in plain English, please.”

Plain language isn’t just for federal agencies. No matter what type of document you’re writing – an article for a scientific journal, layman’s publication, or newsletter – your readers benefit from clear, concise language that doesn’t require a road map to navigate.

Three Examples

Let’s end by taking a look at some before-and-after examples from PlainLanguage.gov.

Example 1

Before

This regulation governs disaster assistance for services to prevent hardship caused by fire, flood, or acts of nature that are not provided by FEMA or the Red Cross.

After

This regulation governs disaster assistance that:

(a) Consists of services to prevent hardship caused by fire, flood, or acts of nature; and

(b) Is furnished by a provider other than FEMA or the Red Cross.

Example 2

Before

When the process of freeing a vehicle that has been stuck results in ruts or holes, the operator will fill the rut or hole created by such activity before removing the vehicle from the immediate area.

After

If you make a hole while freeing a stuck vehicle, you must fill the hole before you drive away.

Example 3

Before

Under 25 CFR §1.4(b), the Secretary of the Interior may in specific cases or in specific geographic areas, adopt or make applicable to off-reservation Indian lands all or any part of such laws, ordinances, codes, resolutions, rules or other regulations of the State and political subdivisions in which the land is located as the Secretary shall determine to be in the best interest of the Indian owner or owners in achieving the highest and best use of such property.

After

Section 1.4(b) of 25 CFR allows us to make State or local laws or regulations apply to your off-reservation lands. We will do this only if we find that it will help you to achieve the highest and best use of your lands.