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Health Literacy

Health Literacy Month 2009
“It Matters…Your Pharmacist Wants to Help”
Iowa MedCard Initiative
Create FREE printable MedCard online
Ask Me 3
Iowa Literacy Resource Center
Health Literacy Information
Health Literacy Resources

“It Matters…Your Pharmacist Wants to Help”

The Pharmacy Health Literacy Improvement Program was developed by the Iowa Pharmacy Association with funding from the NCSPAE/Merck Grant Program.  The goal of the program is to stimulate positive actions by the pharmacy profession to minimize negative health outcomes associated with low health literacy.  The program’s objectives include increasing the pharmacy profession’s awareness of low health literacy’s impact on healthcare, particularly medication use problems; providing pharmacists with tools and strategies to overcome barriers caused by low health literacy; and establishing a framework to facilitate multidisciplinary approaches to improving health literacy.  To meet these objectives, a packet containing health literacy educational and training materials was created and distributed for use by state pharmacy associations and their members.   

The “It Matters…Your Pharmacist Wants to Help” program also includes materials and practical tools to assist pharmacists in assessing their patients’ health literacy and educational aids to increase patient understanding of pharmacist consultations.  These materials and tools in the “It Matters” kit are specifically related to over-the-counter (OTC) medication use.  OTC therapy presents a unique pharmacy niche where patients’ ability to self-care must often be balanced with professional care.  “It Matters” focuses on health literacy and the pharmacist’s niche in helping patients effectively use OTC medications.  It acknowledges the difficulty patients experience when making OTC selections and promotes the pharmacist’s role in aiding patients when making these important decisions.  Specific materials were developed to promote understanding and appropriate use of the following:

  •  OTC medication in general

  • Cough and cold products

  • Calcium products

  • Iron products

  • Liquid medications for children

The educational materials in the “It Matters” kit were developed through focus groups consisting of patients, new readers (adults recently overcoming illiteracy), pharmacists, and health literacy experts.  These materials are designed to be a helpful tool to assist pharmacists when providing quality patient care.  “It Matters” kits are available through IPA.  If interested, please contact Anthony Pudlo, at

Iowa MedCard Initiative


“Know It. Show It. Tell It.” is a state-wide campaign to provide MedCards to all Iowans and improve health literacy by promoting communication between patients and healthcare providers regarding appropriate medication use.

 Through funding from The Wellmark Foundation, the Iowa Healthcare Collaborative, Iowa Foundation for Medical Care, Iowa Hospital Association, Iowa Medical Society, and the Iowa Pharmacy Association have partnered to help improve Iowans’ health literacy by promoting the use of MedCards and educating patients and healthcare providers to use MedCards during every interaction to discuss appropriate medication use.

 For more information, or to get involved, click here

Know It. Show It. Tell It.” poster

Create FREE printable MedCard online is an online tool that can be used to create pocket-sized printable MedCards as well as medication handouts complete with dosing information, directions, and even pictures of the pills—all free of charge.  The MedCards and handouts include the name, strength, and picture of each drug as well as specific dosing instructions for each medication.  They may be printed in large, easy-to-read font as well as in Spanish.

To create a personalized MedCard or medication handout, go to and click Register Now to create a free MedCard or medication handout that can be printed upon completion.

Ask Me 3

Asking 3 is a quick, effective tool designed to improve health communication between patients and providers.

Through patient and provider education materials developed by leading health literacy experts Ask Me 3 promotes three simple but essential questions that patients should ask their providers in every health care interaction. Providers should always encourage their patients to understand the answers to:

  1. What is my main problem?
  2. What do I need to do?
  3. Why is it important for me to do this?

Health care providers and patients can visit for information on the Ask Me 3 program.

Iowa Literacy Resource Center

The Center is operated under grant authorization from the Iowa Department of Education and is jointly administered by the Northeast Iowa Library Service Area [NEILSA], Hawkeye Community College [HCC], Northeast Iowa Community College [NICC], and the Waterloo Public Library [WPL] where the main collection is located. The Center provides a link to resource materials in Iowa and at a regional and national level for adult literacy practitioners and students. These resources are available in many formats; including print, audio, video and online. The Center operates a toll-free literacy support telephone line providing referral to appropriate resource and persons involved in community literacy programs. 1-800-772-2023. For more information, visit there website at   

Annual New Readers Of Iowa Conference is held each year to bring together health care professionals, educators, and new readers.  This Coalition Conference is a learning opportunity for all who attend.  For more information visit the Iowa Literacy Resource Center website above.  

Health Literacy Information

 Health literacy is the ability to read, understand, and act on health information. This widespread but hidden health challenge is both a warning and a call to action.  Understanding health information is everyone’s right; improving clear health communication is everyone’s responsibility.

  • Nearly 90 million Americans—39% of adults in the U.S.—are limited in their ability to read and understand health information.

  • 38% of adult Iowans read below high school level.

  • Health information can be confusing for anyone.  Clear health communication is an important part of a patient’s ability to understand and act on health information.  This can include following instructions after a physician visit, managing a chronic illness, or taking medications properly.  For health care providers, clear health communication guides which words are used, how directions are given, and what materials are presented when communicating with patients

Low health literacy is one of the least recognized yet most widespread challenges to achieving better health outcomes and lowering health care costs in the United States.

  • The 2004 Institute of Medicine Report, Health Literacy:  A Prescription to End Confusion, found that health literacy “…is fundamental to quality care…” and relates to three of the six aims in the Quality Chasm report:  safety, patient-centered care, and equitable treatment.
  • In Priority Areas for National Action: Transforming Health Care Quality, the IOM identified self-management and health literacy as cross-cutting priorities for improving health care quality and disease prevention in the U.S.
  • The 2007 Joint Commission report, “What Did the Doctor Say?:”  Improving Health Literacy to Protect Patient Safety, reported that health literacy issues and ineffective communications place patients at greater risk of preventable adverse events, and that among the key systems for which leaders of health care organizations must provide stewardship is communications.  It recommended the following:
  •    Make effective communications an organizational priority to protect the safety of patients.

  •    Address patients’ communication needs across the continuum of care.

  •    Pursue policy changes that promote improved practitioner-patient communications.

 Health literacy involves more than a measurement of reading skills.  It also relates to listening, speaking, and conceptual knowledge.  Low health literacy can affect any population segment, regardless of age, race, education or income.  It can affect anyone, in the context of illness, worry, pain, fear, anxiety, medications, unfamiliar settings, or preoccupation with other concerns.

Those with limited health literacy cannot:

  • Circle the date of a medical appointment on a hospital appointment slip.
  • Identify how often a person should have a specified medical test, based on information in a clearly written pamphleto       
  • Identify what it is permissible to drink before a medical test, based on a set of short instructions
  • Explain why it is difficult for people to know if they have a specific chronic medical condition, based on information in a one-page article about the medical condition
  • Give two reasons a person with no symptoms of a specific disease should be tested for the disease, based on information in a clearly written pamphlet.

Low health literacy affects everyone, but some more than others.

  • Almost one-third of adults over the age of 65 have very poor health literacy skills.  Only 10.4 million seniors nationwide can perform the most simple and  concrete literacy skills.  Adults who receive Medicare or Medicaid, and those with no insurance, have lower than average health literacy.
  • Among Hispanic adults, 41% have poor health literacy skills, and among Black adults, 24% have poor health literacy skills.

Adults with low health literacy:

  • Are less likely to comply with prescribed treatment and self-care regimens
  • Make more medication or treatment errors
  • Fail to seek preventive care
  • Are at higher risk for hospitalization than people with adequate literacy skills
  • Remain in hospital nearly 2 days longer
  • Lack the skills needed to navigate the health care system.

Estimates by the Georgetown University Center on an Aging Society indicate that additional health care expenditures due to low health literacy skills are about $73 billion in 1998 health care dollars.

Strategies can be used to improve communication with patients and families:

  • Encourage all patients to maintain an accurate MedCard, and use the MedCard as a tool to talk with patients about appropriate medication use.

  • Create a welcoming, supportive environment that offers help proactively and encourages questions.

  • Ensure all staff can recognize signs that patients may not understand or not read well--red flags for low health literacy--and respond appropriately.

  • Ensure all staff--including physicians and those not involved in direct patient care—are aware of health literacy, its prevalence, the adverse health impact of low health literacy, and strategies to address it.

  • Help patients remember instructions with the “teach-back” method— asking them to repeat in their own words what they need to do when they leave. This allows providers to check patients' understanding of their health instructions.

  • Use Plain Language principles in interpersonal and written communications
       1. Slow down.
       2. Use everyday words and analogies.
       3. Limit information to the 2-3 most important concepts.

  • Use visual aids and illustrations

  • Use principles for reader-friendly print materials for all materials intended for use by patients, including forms and signs.

  • Check reading level (ideal 5th-6th grade)

  • Show or draw simple pictures

  • Focus only on key points

  • Emphasize what the patient should do

  • Minimize information about anatomy & physiology

  • Simple words (1-2 syllables)

  • Short sentences (4-6 words)

  • Short paragraphs (2-3 sentences)

  • No medical jargon

  • Headings and bullets

  • Lots of white space

  • Highlight or circle key information

  • Simplify & avoid duplicative paperwork

  • Offer to read aloud & explain

Health Literacy Resources

HRSA Health Literacy
HRSA's health literacy activities assist the Agency in accomplishing its mission: to improve and expand access to quality health care for all. HRSA's health care delivery sites, along with training and education programs, work to reach out to those with low health literacy skills to improve their quality of life.

Building a Health Literacy Curriculum
The University Of Virginia School Of Medicine has developed a Health Literacy Curriculum. The guidelines include basic lectures and tools to use in teaching the important skills of recognizing which patients are unable to understand their medical needs and how to help those patients reach that understanding.

Harvard School of Public Health Department of Health and Social Behavior Health Literacy Studies
A research program of the National Center for the Study of Adult Learning and Literacy.

HEALTH - University of Cincinnati
Located in the Area Health Education Center Program of the University of Cincinnati. Robert E. Burket, Executive Director of Health Learning Resource Center at the University of (HEALTH-UC) compiled a list of the Center's health literacy materials. An institution's library or health education coordinator can borrow these materials.

Health Literacy (CBM 2000-1)
National Library of Medicine: Current Bibliographies in Medicine

Health and Literacy Compendium
An annotated bibliography of print and Web-based health materials for use with limited-literacy adults.

Health Literacy Month
Join with health literacy advocates around the world to promote the need for understandable health information. Health Literacy Month is a grassroots campaign. This means that individuals, organizations, and communities can participate in whatever ways make sense for them.

Health Resources and Services Administration: Office of Minority Health
Study on Measuring Cultural Competence in Health Care Delivery Settings: This study includes information on the cultural factors affect the consumer-provider communication.

Institute of Medicine (IOM) Report: Priority Areas for National Action: Transforming Health Care Quality
This report identifies 20 priority areas for quality improvement. Two areas are identified as cross-cutting -care coordination and self management/ health literacy- because these areas cut across specific conditions and would benefit many patients.

Institute of Medicine (IOM) Health Literacy Study
"Health Literacy: A Prescription to End Confusion". Recommendations to address the problem of health literacy within a public health/public education framework

Let Everyone Participate (
Promotes a positive and cooperative understanding of the importance of language access to federal programs and federally assisted programs.

National Medical Association (NMA)
Focuses primarily on health issues related to African Americans and medically underserved populations, however its principles, goals, initiatives and philosophy encompasses all ethnic groups. Resource: NMA Cultural Competence Primer

Partnership for Clear Health Communication
A coalition of national organizations that are working together to promote awareness and solutions around the issue of low health literacy and its effect on health. Site includes a patient education program: Ask Me 3.

Plain Language Action & Information Network
A government-wide group of volunteers working to improve communications from the federal government to the public.

Strategies to Improve Communication Between Pharmacists and Patients:                      This AHRQ training program is designed to introduce pharmacists to the problem of low health literacy in patient populations and to identify the implications of this problem for the delivery of health care services. The program also explains techniques that pharmacy staff members can use to improve communication with patients who may have limited health literacy skills.

The American Medical Association Foundation
Helping Your Patients Understand: health literacy toolkits, news and grants.

The El Paso Collaborative Health Literacy Curriculum
This curriculum includes lessons developed to meet the educational and health needs of students attending El Paso Community College/Community Education Program.
Lessons can serve as a guide and may be replicable in entirety in certain communities. Note ideas for collaboration and online resources on this site.

The Institute for Healthcare Advancement
This California non-for profit, has published a "What to Do for Health Series". The series is a set of books written at the 3rd-5th grade reading level for pregnant women, parents, seniors and caregivers. There is a link to a fact sheet on Research-Supported Solutions under "Research Shows What to do for Health Series Works".

The National Assessment of Adult Literacy (NAAL)
These surveys are nationally representative and continuing assessment of English language literacy skills of American adults.

The National Institute for Literacy (NIFL)
A federal organization that shares information about literacy and supports the development of high-quality literacy services so all Americans can develop essential basic skills.

The Providers Guide to Quality and Culture
A web resource designed to assist health care professionals in providing quality culturally and linguistically appropriate services to multicultural populations.

The State Official's Guide to Health Literacy
Reports the results of a 2002 national survey conducted to find out what states are doing to improve health literacy or to make the health care system easier to navigate. The Guide provides an understanding of the problem, what can be done to improve health literacy and access to health care.

What’s New in Health Literacy Consulting
Health Literacy Consulting helps organizations communicate health information in ways that people can understand.  Resources available include articles, free newsletters, and consulting options.


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