Low Health Literacy: Red Flag Warning Signs

low health literacy

“Given that approximately 89 to 90 million adults in the United States have limited health literacy, you probably see patients every day who have trouble reading and understanding written health-related information.”—The American Medical Association

What Is Health Literacy?

Health literacy is defined as the degree to which individuals have the capacity to obtain, cognitively process, and understand health information to make informed health-related decisions.1

Low health literacy is a significant problem in the United States. Results from the 2003 National Assessment of Adult Literacy Survey (NAALS) found that only 12 percent of adult Americans had proficient health literacy skills to fully participate in the self-management of their health.2

Key Risk Factors for Low Health Literacy

Patients with low health literacy often share key risk factors.3 Pay particular attention to your patients who:

  • Are older adults
  • Have a lower income
  • Are unemployed
  • Did not finish high school
  • Belong to a minority ethnic group
  • Have recently immigrated to the United States
  • Do not speak English or have English as a second language

Common “Red Flags”

It is impossible to tell if your patients have low health literacy simply by looking at them. In fact, patients will often go to great lengths to hide their limited literacy skills from others. Some examples of behavioral and verbal responses commonly observed in patients with low health literacy include:

  • Incomplete or inaccurate registration forms and other paperwork
  • Frequently missed appointments
  • Non-adherence with medications or assigned treatment programs
  • An inability to name their medications or explain why they are taking the medication
  • Lack of follow-through with laboratory tests or referrals

Your patients may be aware of their limited health literacy and feel embarrassed by it, leading them to try to conceal their lack of understanding from you. If you ask them if they understand their instructions, they are likely to say they do—even when they don’t. Another common example is for the patient to say that they “forgot their glasses,” stating that they will read through their paperwork or instructions when they get home. They may also state that they are going to take paperwork home so that they can discuss it with their children.3

patient education explore abnner

Identifying and Addressing Low Health Literacy

It is important to identify patients with limited health literacy so that you can provide additional support and education to ensure that they understand their conditions and treatment plan.

One way to assess a patient’s health literacy is by noting their skills in basic literacy. Ask your patient questions about the education you have provided to assess their understanding. Have them repeat instructions back to you so that you can note and correct any discrepancies. You can find additional quick and valid tools online to help you measure health literacy in clinical settings.

Addressing Low Health Literacy Involves Key Strategies:

  • Use Simple Language: Avoid medical jargon. Use clear, plain language that is easy to understand.
  • Visual Aids: Incorporate images, diagrams, and videos to explain complex concepts.
  • Teach-Back Method: Ask patients to repeat information back to you in their own words to ensure understanding.
  • Limit Information: Provide essential information in small, manageable chunks.
  • Written Materials: Offer easy-to-read brochures and handouts, using large fonts and plenty of white space.
  • Interactive Tools: Use apps or online tools that guide patients step-by-step through their care instructions.
  • Cultural Sensitivity: Be aware of cultural differences and language barriers. Use translators or culturally relevant materials when necessary.
  • Encourage Questions: Create an environment where patients feel comfortable asking questions.
  • Follow-Up: Schedule follow-up appointments or calls to reinforce information and address any confusion.
  • Community Resources: Connect patients with community resources such as health literacy programs and support groups.


MedBridge’s Patient Education resources are suitable for patients of all health literacy levels and feature easy-to-understand, plain language explanations. Video-based resources often include 3D graphics and hands-on demonstrations. For added support and understanding, watch the videos with your patients and answer any questions they have. They can then refer back to the assigned videos at any time using the online patient portal or the MedBridge GO app.

  1. Institute of Medicine [IOM]. (2004). Health Literacy: A Prescription to End Confusion. Washington DC: The National Academies Press.
  2. Kutner, M., Greenberg, E., & Jin, C. (2006). The health literacy of America’s adults: Results from the 2003 National Assessment of Adult Literacy. Washington, DC: U.S. Department of Education, National Center for Education Statistics.
  3. Weiss, B. D. (2007). Health Literacy: A Manual for Clinicians. Chicago, IL: American Medical Association Foundation and American Medical Association.