Health Literacy
Learning materials to support health literacy across NHS Scotland health and social care.
What is health literacy?
We can think of health literacy at two levels - individual and organisational. The definitions below are taken from Joanne Naughton and Geoff Walton's book chapter ‘Health Literacy, Patient Information and Combatting Misinformation’.1
- For an individual, health literacy describes the extent to which a person can find, understand, use and apply health information as well as interact with healthcare services to make health-related choices for themselves and others.
- For a society or healthcare system, health literacy relates to the provision of information and services in a way that is accessible to all and empowers people to make informed healthcare decisions.
Health literacy relates to a range of communications including written, spoken and visual. And it is the responsibility of all health and social care staff in Scotland to support health literacy and ensure that the information they are providing is understood.
Impact of poor health literacy
The impact of poor health literacy is that we are more likely to experience poor health outcomes. We are more likely to wait until we are sicker before we go to the doctor; more likely to misinterpret messages regarding health and healthy behaviours; more likely to have difficulty accessing the right services, and be less skilled in navigating the healthcare system.
The Patient Information Forum outlines some of the difficulties created when health information is not accessible for everyone:
- 5 million adults cannot find relevant data in standard health information
- 1.7 million are unable to explain symptoms and feelings over the phone
- 1 million cannot follow a letter from a GP surgery or hospital department
- 6.5 million cannot measure or record height and weight on a chart
- 9 million people are unable to use digital tools without help2
References
1. Walton, G., Johnson, F., Stewart, D., Young, G., & Wyatt, H. C. (Eds.). (2024). Introduction to healthcare knowledge and library services. Facet Publishing.
2. Health Literacy Matters, Patient Information Forum, accessed 12.08.2025
Techniques to help communicate
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Teach back
You cannot tell if a person has understood you just by looking at them, or by asking them.
Teach-back is a really simple way to check patient's understanding. It involves asking patient's to explain in their own words, what you've discussed with them, for example:
- I would like to check that I have explained things properly, would you mind telling me what it is we have discussed and what I’ve asked you to do?
It should be clear that this is not a test of the patient’s knowledge, it is a test of how well you have explained things
Show me
Show me is similar to teach back. It should be used when showing patients how to carry out actions. It is very easy to assume that patient’s have more knowledge than they really do.
There are lots of examples where an action has not been correctly understood by the patient or the patient’s carer, and it has caused distress for the patient and cost to the NHS such as unnecessary admission to accident and emergency.
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Chunk and check
Patients are often presented with a lot of information at once. Chunk and check can be used alongside teach-back to aid understanding.
Break the information down into small pieces or chunks and check for understanding after each piece before moving on. This will help avoid information overload.
Providing people with more time to absorb information will also encourage patients to ask questions.
Encourage patient questions
It is important to encourage patient questions. Individuals better informed about their own healthcare, will make better decisions about their own care and treatment. The NHS Inform ‘It’s o.k. to ask' campaign recommends four key questions to aid a discussion between a health professional and a patient.
- What are the benefits of my treatment?
- What are the risks of my treatment?
- Any alternative treatments I can try?
- What if I do nothing?
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Use simple language
Think about your day to day practice and the terms, acronyms and words that you routinely use but that could cause confusion
Unfamiliar and technical language can be another hurdle for people to overcome.
We should use plain and simple language to explain things.
Medical terminology
Medical terminology often makes it difficult for non-health professionals to understand.
For example, if you are talking about a long term condition, you might hear this described as persistent or chronic. Recent studies have shown the word chronic is often misunderstood as ‘severe’.
There are lots of anecdotal stories about people who cannot find their way to a hospital appointment because they are confused with signage – are they going to x-ray, radiology or imaging?
For written information, readability checkers can help you think about the complexity of language and indicate where changes should be made. The NHS Medical Document Readability tool was developed as a collaboration between Newcastle University and NHS England
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Use Pictures
Pictures can help improve understanding when communicating new information.
Images should be used in addition to, not instead of written or spoken information.
They should be used to support discussion and encourage questions.
As well as improving understanding, pictures can also help people recall information.
Further support
Your local NHS library service may be able to offer further support and guidance. For contact details please visit The Knowledge Network local library services page.