Health literacy

The way health systems and services are designed and delivered places high health literacy demands on people, families and whānau.

What is health literacy for people, families and whānau?

Health literacy is about knowing how to:

find your way around the many different parts of the health system
understand your health condition(s), including what makes it better or worse
use your medicines safely
give informed consent to medical procedures
prevent illness and your health getting worse
manage long-term health conditions well.

The health literacy you need changes over time as your health changes and health services change.

Historically, the language used to describe the difference between the health knowledge people had and the knowledge they needed implied the problem was with the consumer. People were described as having ‘low health literacy’. This consumer-deficit view of health literacy is unfair as it ignores the role of the health system in creating health literacy demands and how these impact on people’s health literacy.

We now recognise that high literacy demands are created by the way health conditions are explained, managed and resourced by the health system, health services and providers.

The provision of adequate health care includes providing people with the information they need, in a way that works for them, so they can make informed decisions and manage their health. This role is described as meeting health literacy needs. This is reflected in the Ministry of Health’s Framework for health literacy published in 2015.

A framework for health literacy in Aotearoa New Zealand

The framework for health literacy aims to address some of the systemic issues creating barriers to health literacy.

“Because of the way health systems are organised, individuals and whānau can often face a series of demands on their health literacy ... A health-literate health system reduces these demands on people and builds the health literacy skills of its workforce, and the individuals and whānau who use its services. It provides high quality services that are easy to access and navigate and gives clear and relevant health messages so that everyone living in New Zealand can effectively manage their own health, keep well and live well.”

The Ministry of Health developed the framework because it is committed to a health system that enables everyone living in Aotearoa New Zealand to live well and keep well. Building health literacy is an important part of this, and the framework outlines expectations for the health system, health organisations and all the health workforce to take action that:

supports a culture shift so that health literacy is core business at all levels of the health system
reduces health literacy demands
recognises that good health literacy practice contributes to improved health outcomes and reduced health costs.

The framework also identifies some success indicators that individuals and whānau can expect to see from every point of contact with the health system.

Why does understanding health literacy demands matter?

The complexity and accessibility of health information (spoken and written), care and services affects all aspects of health: prevention, acute care, long-term conditions and public health. This complexity leads to more negative health outcomes than if spoken and written information was provided in a way that was clear and easy to access and understand.

This complexity is also an equity issue because Māori and Pasifika are more likely to not have their health information needs met. This is also the case for consumer groups whose first language is not English, have a disability, use NZ Sign Language or are blind or visually impaired. In addition, care and services need to be culturally safe to meet the needs of everyone.

What can healthcare providers do to improve health literacy?

Healthcare providers have a responsibility to provide spoken and written information, care and services in ways that meet the needs of health consumers. Providers also need to help people understand what they need to know to live healthy lives.

In terms of spoken and written information, they need to:

use plain language where possible (written and spoken)
explain clinical language and sector terms
identify what people know or don’t know before providing information, so new information connects to prior knowledge
talk people through referrals to unfamiliar health services to ensure they know what to expect
thoroughly check that people have been given the important information they need, in a way that makes sense to them, before leaving a health service
provide information in different formats, such as videos, apps and tools and support people to use these formats
use photos, illustrations, diagrams and other non-written aids to support written content
translate information into multiple languages
make NZ Sign Language videos.

Understanding medical words

(Health Navigator & Health Literacy, NZ, 2019)

Use techniques such as Ask, Build, Check to improve how we communicate as health providers

View these three videos for examples and then start practicing this approach.

The health literacy focus needs to extend beyond personal communication. Health literacy involves changing the healthcare environment and how knowledge is shared.

What happens if the health system places high literacy demands on people?

High health literacy demands and failing to meet health literacy needs contributes to premature morbidity and mortality, poorer access to health care, inequity, treatment/medicine safety concerns, informed consent and quality of care issues.

Learn more

About health literacy Health Literacy NZ
Health Literacy NZ
Ask, Build, Check training module Self-Management Support Toolkit website
Health literacy review – a guide Ministry of Health, NZ, 2015
A framework for health literacy Ministry of Health, NZ, 2015
Equity of health care for Maori – a framework Ministry of Health, NZ, 2014
Kōrero mārama – health literacy and Māori Ministry of Health, NZ, 2010

For more information about care planning, visit our dedicated Self-Management Support (SMS) Toolkit website for health providers and healthcare staff.

References

Rudd RE. Health literacy considerations for a new cancer prevention initiative The Gerontologist, 2019 Jun; 59(1):S7–S16.
Brega AG, Hamer MK, Albright K. Organizational health literacy: Quality improvement measures with expert consensus Health Lit Res Pract. 2019 Apr; 3(2): e127–e146.

Credits: Health Navigator Editorial Team. Reviewed By: Health Literacy NZ Last reviewed: 29 May 2021 Page last updated: 07 Dec 2022

On this page you will find a selection of resources on health literacy, including some training options.

Resource	Organisation
	Health Literacy NZ Key health literacy website in Aotearoa that offers: information resources training support.
	Three steps to better health literacy – a guide for health professionals Health Quality & Safety Commission, NZ, 2014
	The phrase “people with low health literacy” only tells one side of the story NZMJ Digest, NZ, 2020
	Health literacy review – a guide Ministry of Health, NZ, 2015 Individuals and whānau face a series of demands on their health literacy when navigating the health system. These demands impact on consumers’ ability to access health information, care and services. Support is growing for a stronger focus on how health systems, healthcare providers and practitioners can support people to access care, manage and maintain their own health and wellbeing. This guide, developed by the Ministry of Health and Workbase NZ, takes healthcare providers through a review process and shows you how to develop a health literacy action plan. It provides: advice from 3 DHBs that have trialled the guide videos and documents to help you conduct a review and design the action plan.
	Ten attributes of health literate organisations Institute of Medicine, US, 2012 A health literate healthcare organisation: has leadership that makes health literacy integral to its mission, structure, and operations integrates health literacy into planning, evaluation measures, patient safety and quality improvement prepares the workforce to be health literate and monitors progress includes populations served in the design, implementation, and evaluation of health information and services meets the needs of populations with a range of health literacy skills while avoiding stigmatisation uses health literacy strategies in interpersonal communications and confirms understanding at all points of contact provides easy access to health information and services and navigation assistance designs and distributes print, audiovisual, and social media content that is easy to understand and act on addresses health literacy in high-risk situations, including care transitions and communications about medicines communicates clearly what health plans cover and what individuals will have to pay for services.
	Kōrero mārama – health literacy and Māori Ministry of Health, NZ, 2010
	A–Z index of easy to read patient information Medline Plus, US
	Health literacy resources for community pharmacists Health Quality & Safety Commission, NZ, 2012 Health literacy information leaflet Three steps to meeting health literacy needs 10 questions about health literacy and answers 10 more questions about health literacy and answers

Some excellent resources and programmes have been developed to help improve the health literacy demands of the health system. (Note: Most are from outside New Zealand).

Resource	Organisation
	Rauemi atawhai – a guide to developing health education resources in New Zealand Ministry of Health, NZ, 2012 This guide was developed to help the Ministry of Health and its contractors produce effective and appropriate health education resources that meet the needs of the intended audience, are easy to understand and support improved health literacy.
	Simply put Centers for Disease Control, US A useful plain language guide from the Centers for Disease Control, US, offering dozens of tips for clear communication. Check how well you do against the 4 most important steps: Know your audience and the purpose of your information. Organise the information from your readers’ or listeners’ perspective. Choose your words carefully: use active voice, short sentences, everyday words and personal pronouns. Use presentation elements, such as bulleted lists and graphics that match and reinforce text.
	Ask me 3 Institute for Healthcare Improvement, US An excellent health communication programme by the Partnership for Clear Health Communication at the National Patient Safety Foundation. 3 questions for patients to ask their doctor, pharmacist or nurse at every encounter to better understand their health: What is my main problem? What do I need to do? Why is it important for me to do this?
	Health literacy Department of Health & Health Services, US Health literacy online Health literate care model and resources for implementation Other resources