Speaking, Reading, Writing

Communicating is essential to being healthcare smart!


  • One out of five American adults reads at the 5th grade level or below, and the average American reads at the 8th to 9th grade level.
  • Most health care materials are written above the 10th grade level.
  • Limited health literacy increases the disparity in health care access for vulnerable populations (such as racial/ethnic minorities and the elderly).
  • According to the Center for Health Care Strategies, a disproportionate number of minorities and immigrants are estimated to have literacy problems: 50% of Hispanics, 40% of Blacks, 33% of Asians¹

Providers need to tailor information to the health literacy level of patients/parents.

Behaviors That May Indicate Low Health Literacy

  1. Frequently missing appointments
  2. Failing to complete registration forms
  3. Unable to name medications or explain their purpose or dosing
  4. Identifying pills by looking at them, not reading label
  5. Being unable to give coherent, sequential medical history
  6. Showing lack of follow-through on tests or referrals
  7. Repeatedly use statements such as “I forgot my reading glasses,” “I’ll read through this when I get home,” or “I’m too tired to read,” when asked to discuss written material.

(See Resources for 1-7)


Focus on 3 communication domains:³

  • Use plain language.
  • Avoid jargon/acronyms.
  • Partition information to avoid overwhelming families.
  • Use interpreter services for limited English families.
  • Encourage families to ask questions.
  • Summarize key points at the end of each visit.
  • Use the teach-back technique to confirm understanding.
  • Make information culturally relevant and personal.
  • Use print materials to enhance health education.
  • Use print materials in the appropriate language for the family.
  • Ideally use materials at the 4th-6th grade reading level.
  • Use materials that have pictures to help explain text.
  • Use materials to summarize key points.
  • Avoid materials with dense areas of text. Long lists of bullets also
  • Include families in any action steps.
  • Set concrete, realistic goals.
  • Assess family’s confidence in meeting the goals and adjust accordingly.
  • Set a time frame for accomplishing the steps/goals and review at a follow-up visit.
  • Acknowledge challenges/barriers (socioeconomic, cultural, etc)


1. Statistics from Center for Health Care Strategy – www.chcs.org

2. Center for Health Care Strategy Fact Sheet #2

3. Three communication domains appeared in “Mastering the Language”: April 12 issue of Contemporary Pediatrics