Managers need to tackle health literacy

Given our current financial woes, managers need to examine the costs of health literacy as low health literacy has financial implications for the health services, writes Norma Deasy.

At a conference on tackling health literacy, a speaker recalled how she had accompanied a friend (who could neither read nor write) to her GP to discuss her friend’s medication. Following the consultation the doctor halved her daily prescription. One could justifiably assume that the reason the lady was taking 50% too many tablets daily was because she could neither read nor write, (an issue which affects 25% of the Irish population). Not so, according to the results of a 2012 EU health literacy study which convey that 40% of Irish people encounter difficulties with health literacy.[1] So even if patients can read and write they are still at risk of misunderstanding health information.

Norma Deasy
Norma Deasy

Health literacy can be defined as “the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions.”[2]

The survey results, which represent the first European attempt to measure health literacy in eight countries, convey to health care managers that over one third of our patients are unable to meet health literacy requirements to access information and understand and manage their health conditions. Tackling health literacy will make life easier for sick and vulnerable patients and save HSE time and money.

Health care managers can start with small changes: Consider how healthcare professionals speak to patients, how facilities are sign posted and how well you convey health messages in HSE printed materials:

Over one third of our patients are unable to meet health literacy requirements to access information and understand and manage their health conditions.

The spoken word: Mangers need to examine how staff talk to patients and the language they use. They should use familiar terms such as heart, stroke and cancer rather than cardiac, myocardial infarction and oncology. Results from a 2007 Irish Landsdowne study[3] found that 20% of respondents could not relate heart to the cardiology department and that 60% did not fully understand the word “prognosis”. At the end of a consultation staff should be encouraged to take a few minutes to find out if the patient understands the advice given, by asking open ended questions such as:

  • We have covered a lot about your asthma today and I want to make sure I explained it clearly. So let’s review what we discussed. What three things will you do when you feel an asthmatic attack coming on?
  • Chemotherapy is hard to take in, so I want to be sure that I have explained it properly. How will you get your chemotherapy drugs?

If a patient goes home without understanding the advice, they may have to go to their GP for further consultation, may not attend their next hospital appointment or may not follow the health advice. This would result in staff time and health resources being expended unnecessarily.

Signage: Hospital managers should ask themselves:

  • Is the name of the building clearly displayed on the outside?
  • Is there a map of the inside on display when you go in?
  • Are the signs to the various departments clear and easy to follow?

If your responses are negative, then how can patients and visitors confidently navigate their way around the hospital? Time is lost through patients being late for appointments and staff having to direct and accompany patients/visitors to their destination.

The written word: Printed materials should be easy to understand and be jargon free. Illustrations or pictures can assist with complex terms or instructions. Write the document for your audience. Think about who the audience is and what it needs to know. Research reveals that most people find it easier to read dark colours on a light background. Use clear typefaces and make them large if your audience is older and most probably wearing glasses. If the reader doesn’t get the message then time and money have been wasted writing and printing the material.

A growing number of Irish health care staff are working together to increase awareness of health literacy and to introduce initiatives to tackle the issue. The HSE in partnership with the National Adult Literacy Association has published the following guides:

  • “Literacy Audit for Health Care Settings”, which staff can use to determine how health literacy friendly their workplaces are; and
  • “Plain language style guide for documents”, which goes through the dos and donts of writing health materials for patients.

Both are available to download on http://www.healthpromotion.ie/health/health_literacy/

Given our current financial woes, managers need to examine the costs of health literacy. Low health literacy has financial implications for the health services. The 2012 EU wide survey also reports that “People with very poor health status that use health services more than six times a year are also very likely to possess a low level of health literacy.” While no research has been done in Ireland into the costs to the HSE of health literacy, Swiss research reveals that 4.3% of health expenditure is spent on health literacy.[4]

Until health literacy becomes government policy in Ireland, it won’t be embedded into health managers’ working day. The HSE (Governance) Bill 2012 includes a “Health and Wellbeing” directorate which could well be the directorate to shape a health literacy policy. Carpe Diem.

Norma Deasy
Information and Publications Manager
Communications Directorate, HSE Offices, Cork



[1] Doyle G, Cafferkey K, Fullam J. European Health Literacy Survey (HLS-EU), 2012.


[2] Ratazan SC, Parker RM. Introduction. In: Selden CR, Zorn M, Ratazan SC, Parker RM, compilers. National Library of Medicine Current Bibliographies in Medicine: Health Literacy. NLM publication No. CBM 2000-1. Bethesda, Md: National Institutes of Health, US Department of Health and Human Services; 2000.


[3] Lansdowne Market Research Omnibus Survey. September 2007.


[4] Wieser S, Moschetti K, Eihler K, Holly A, Brügger U. Health Literacy – An economic perspective and data for Switzerland. 2008.