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AHRQ--Agency for Healthcare Research and Quality: Advancing Excellence in Health Care
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National Action Plan on Health Literacy Launched

Hispanic woman reading prescription.According to research from the U.S. Department of Education, only 12 percent of English-speaking adults in the United States have proficient health-literacy skills. The overwhelming majority of adults have difficulty understanding and using everyday health information that comes from many sources, including the media, Web sites, nutrition and medicine labels, and health professionals. A 2004 AHRQ systematic research review of the impact of health literacy found associations between limited health literacy and adverse outcomes such as increased disease prevalence and severity, lower utilization of screening and preventative services, and higher hospitalization rates.

To help address these issues, the United States Department of Health and Human Services (HHS) launched a National Action Plan to Improve Health Literacy. According to the National Action Plan (NAP) document published in May, 2010, the national effort seeks to “engage organizations, professionals, policymakers, communities, individuals, and families in a linked, multisector effort to improve health literacy.” The Institute of Medicine defines health literacy 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.”

Two principles guide the NAP: (1) everyone has the right to health information that helps them make informed decisions and (2) health services should be delivered in ways that are understandable and beneficial to health, longevity, and quality of life.

Organized into four sections and three appendixes, the NAP reviews the research on limited health literacy as a public health problem, discusses the development of a “health literate society” that “supports lifelong learning and skills to promote good health,” and outlines seven goals for the improvement of health literacy, with several that are immediately relevant to the translation and dissemination of AHRQ research:

  1. Develop and disseminate health and safety information that is accurate, accessible, and actionable.
  2. Promote changes in the health care system that improve health information, communication, informed decisionmaking, and access to health services.
  3. Incorporate accurate, standards-based, and developmentally appropriate health and science information and curricula in child care and education through the university level.
  4. Support and expand local efforts to provide adult education, English-language instruction, and culturally and linguistically appropriate health information services in the community.
  5. Build partnerships, develop guidance, and change policies.
  6. Increase basic research and the development, implementation, and evaluation of practices and interventions to improve health literacy.
  7. Increase the dissemination and use of evidence-based health literacy practices and interventions.

The plan presents a set of strategies per goal that can be employed by particular organizations or professions to accomplish the seven goals. For example, in the section of the NAP that discusses goal 6 — increase basic research and evaluation of practices and interventions — some of the suggestions for researchers, evaluators and funders include:

  • Identify and address gaps, such as numeracy and visual communication, in health literacy research.
  • Collaborate to develop a national research agenda and include health literacy innovations and interventions in research plans and goals.
  • Develop more rigorous and comprehensive methods to measure individual and population health-literacy skills that capture the full range of skills, including listening and speaking, writing, numeracy, and cultural and conceptual knowledge.
  • Develop methods to measure the full range of health literacy skills of health professionals and organizations.
  • Conduct studies of the economic impact of limited health literacy.
  • Explore technology-based interventions to improve health literacy.
  • Assess barriers and strategies to improve access to health information and navigation of the health care system.

The Effective Health Care Program is currently in the process of updating its 2004 systematic review of research on health literacy, with a draft available this month for public comment. In alignment with the NAP, the update, titled Health Literacy Interventions and Outcomes: An Update of the Literacy and Health Outcomes Systematic Review of the Literature, expands its synthesis beyond the outcomes of limited health literacy and also includes research findings on literacy assessment tools and interventions.

The NAP was led by the Health Literacy Workgroup of the U.S. Department of Health and Human Services. The information within the plan was based on the 2006 Surgeon General’s Workshop on Improving Health Literacy, a series of town hall meetings held in 2007 and 2008, and feedback from stakeholder organizations in 2009.