Health Literacy

Building Health Literacy Programs One Step at a Time

Article from the Boston Globe’s On Call Magazine, August/September 2004

By Helen Osborne, M.Ed., OTR/L
President of Health Literacy Consulting

Health literacy is starting to get the attention, both on a national and on a local level, that it deserves. Nationally, the Institute of Medicine recently has released its report, Health Literacy: A Prescription to End Confusion. The report states that “nearly half of all American adults — 90 million people — have difficulty understanding and acting upon health information.” It then highlights how these difficulties negatively impact healthcare access, costs, quality, and safety.

Locally, many health facilities are creating health-literacy programs to address the difficulties that patients have accessing, understanding, and using health information. The Patient Education Committee at Boston Medical Center (BMC), for example, is raising awareness about the importance of understandable communication, teaching staff how to write easy-to-read materials, building collaborations with influential leaders, and studying the effectiveness of their health-literacy efforts.

Lauren Smith, MD, is co-chair of BMC’s Patient Education Committee. As a pediatrician, she knows how important it is that parents understand their children’s diagnosis, treatment instructions, and need for follow-up care. For example, when she treats a baby for a urinary tract infection, the parents need to learn what this condition is and how to care for their child at home. And they also need to know the importance of bringing their baby back to BMC for follow-up tests to check for more serious medical conditions.

Health literacy matters to Luann Sweeney, RN, CCE, as well. She is an active member of BMC’s Patient Education Committee and coordinator of the childbirth education program. Sweeney knows that women can avoid some serious medical problems when they learn what to expect during pregnancy and what to do if something goes wrong. Sweeney is also sensitive to how difficult it can be for patients to learn new healthcare concepts. Even her experience as a nurse did not fully prepare her for what to expect when she was a patient anticipating surgery. As Sweeney said, “It’s a different matter when it’s your own body.”

Smith, Sweeney, and their colleagues on the Patient Education Committee are working to build a health-literacy program. Their goal is to have everyone at BMC aware of the importance of understandable health communication. Ideally, all written materials (including those in English or translated into other languages) would be easy-to-read. Staff would always confirm that patients understand health information. And patients would have unlimited access to health information, including computers available in all waiting areas. This ideal program would also have a full-time staff member who provides training, consultation, and coordination of all health-literacy efforts throughout the organization.

But these ideals are not yet fully realized. BMC’s health-literacy program, like many across the country, competes for limited resources with numerous other equally worthy initiatives. Optimistic yet realistic, Smith and Sweeney appreciate that building a health-literacy program happens one step at a time, and they are happy to share some things they have learned along the way.

Offer training. Funded by a grant from Pfizer’s Clear Health Communication Initiative, BMC offered a day-long health-literacy workshop last year. The morning session introduced the concept of health literacy and raised awareness about how health literacy (or the lack thereof) impacts patient care. The afternoon session focused on ways to write easy-to-read print materials.

Those who attended this workshop left with new enthusiasm and skills. But due to patient-care responsibilities, not everyone who wanted to attend this workshop could. To educate more staff about health literacy, Sweeney is offering or considering additional training options. These include:

  • Having multiple copies available of the American Medical Association video Help Your Patients Understand, so that staff can learn about health literacy without leaving their units
  • Asking managers to include health literacy as a topic in mandatory, discipline-specific competency programs
  • Offering a follow-up “Train the Trainer” workshop, so interested individuals can learn more advanced health-literacy skills they will then teach to others

Collaborate. Smith and Sweeney recognize that people from all professions, programs, and perspectives must collaborate to improve health literacy. BMC’s Patient Education Committee, for example, brings together clinicians and managers from across the organization, including medicine, nursing, pharmacy, nutrition, social work, and the office of patient advocacy.

Work with “health-literacy champions.” Smith says that health-literacy champions — influential individuals from inside and outside the organization — can help apply pressure in all the right places. At BMC, health-literacy champions include members of its Institutional Review Board (IRB) who want to make sure that patients understand written consent forms. Risk managers and legal counsel are also health-literacy champions, as they know full well the financial and legal implications when patients do not understand information.

Health-literacy champions can also be from outside the organization. This includes regulatory and accreditation agencies such as the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), which requires that all patient-education materials be written at appropriate literacy levels and languages.

Build on materials from others. In an ideal health-literacy program, all patient materials — including those to be translated — would be written in ways that are easy to read. Admittedly, it costs money and takes time to meet this ideal. Working within a tight budget, Sweeney often builds on what other organizations have created when she needs new teaching aids. These include materials from the March of Dimes, Baby Basics, and the Massachusetts Department of Public Health. Another good source of easy-to-read and translated materials is MedLine Plus from the National Library of Medicine.

Measure effectiveness. Study your health-literacy program to make sure it accomplishes its goals. Staff from BMC’s inpatient cardiac unit attended last year’s health-literacy workshop. They now are using what they learned in order to write easy-to-read brochures about how cardiac medications sometimes cause people to fall. One measure of how effective these brochures are is a comparison of readmission and fall data before and after they give patients these brochures.

Think creatively about new opportunities. Smith and Sweeney are understandably proud of all that BMC has achieved in regard to health literacy. They are also impatient to do more. Looking ahead, they plan to continue building a health-literacy program by taking steps to identify opportunities, find resources, and measure success.

How to Find Out More

  • Luann Sweeny, RN, CCE, is coordinator of childbirth education and a member of the Patient Education Committee at BMC.
  • Lauren Smith, MD, is a pediatrician and co-chair of BMC’s Patient and Family Education Committee. You can email Dr. Smith at

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Article reprinted with permission from On Call magazine and published by a division of Boston Globe Media.