City and Hackney

Health Literacy Toolkit

This toolkit has been created to help colleagues and partners across City and Hackney to ensure health information is accessible and easily understood by all.

What is health literacy?

Why health literacy is important

Examples

What improving health literacy means to people

How you can help people better understand health information and improve health literacy

Spoken and written communication

Written Communication

Use pictures

Help with paperwork

Keep paragraphs and sentences short and simple

Write in a friendly, conversational tone

Additional guide to writing in plain English and NHS style guide

Health literacy is an individual’s ability to find, understand, and use health information and services, in order to inform health-related decisions and actions for themselves and others.

Understanding health information (health literacy) is essential for taking medications correctly, knowing which health services to use, and managing long-term conditions.

Around half of the population struggle with health information, including those with lower literacy skills. This creates a barrier to staying healthy, especially for those already facing challenges.

The most disadvantaged groups are often most affected.

Improving both health literacy and general literacy empowers everyone to take charge of their well-being and closes the gap in health inequalities.

Why health literacy is important

Personal health literacy

Health literacy is a balance between the skills of a person, family, community and the environment in which they live (health systems, education systems, social care systems etc.)

Consequences of not understanding health information

Limited health literacy is linked with unhealthy lifestyle behaviours such as having a poor diet, smoking and lack of physical activity. People with limited health literacy are less likely to use preventive services, less likely to respond well to public health campaigns, and less likely to successfully manage long-term health conditions.

Not understanding health information can also increase the risk of morbidity and premature death.

Groups at risk of having low levels of health literacy

Older Adults (65+): People in this age group are more likely to have lower health literacy, especially those who rate their health as fair or worse. Additionally, retirement, long-term illness, or disability can limit social interaction and internet access, further hindering health information comprehension.
Limited Social Support: Individuals with fewer close contacts to discuss health concerns and limited internet access face challenges in accessing and understanding health information.
Autism, Learning Disabilities, and Dementia: These factors can significantly hinder a person's ability to understand and use health information.
Communication Differences: When individuals have english as a second language.
People with Low Socioeconomic Status: Individuals with lower income and education levels are more likely to have limited health literacy skills.
Global Majority Communities: Language barriers and cultural differences can create challenges in understanding health information, particularly for non-english speakers
People Experiencing Acute Illness or Injury: Focusing on managing a new health issue can make it difficult to absorb complex information.

Examples

Problems caused when information is unclear, insufficient or wrong, as mentioned by the NHS

A woman who sprayed her inhaler on her neck because she claimed she'd been told to spray it "on her throat".

A man who did not turn up for cancer tests because he did not know that the radiology and X-ray departments were the same thing.

A man with diabetes who decided to stop taking his medicine because he had trouble understanding the instructions

A woman who thought that she should only take her blood pressure medication when she felt symptoms.

It's easy to see from this how miscommunication of health information could be very serious, and how clearer, more thorough information could help.

What improving health literacy means to people

Helping someone to become more health literate enables them to:

Access the right services at the right time
Navigate health services
Attend appointments
Engage with disease prevention e.g. cancer screening, immunisation
Understand when they need help and feel confident accessing it in a timely manner
Communicate better with service providers
Reduce unhealthy behaviours; excess alcohol consumption, unhealthy eating, smoking
Engage in healthy behaviours; good diet/normal weight, physical activity
Better understanding of labelling and how to take medicines correctly.

How you can help people better understand health information and improve health literacy

Spoken and written communication

Use simple language

Clear communication is key, especially during times of stress when understanding health information can be challenging.

Public health professionals often use jargon and acronyms that can be confusing for our communities

Imagine explaining this information to a friend or family member – that's the level of clarity we should strive for.

Using simple language and providing clear examples will empower people to understand their health options and access available services.

Visit The Health Literacy Place website for more details.

Define complex terms

When introducing a new term, explain it clearly within the context you're using it. Imagine you're explaining it to someone unfamiliar with medical jargon. A glossary might be helpful for some, but a clear definition within the conversation is even better.

Think about whether it benefits the user to learn a jargon term, or if it makes sense to work around it. For example, a person with epilepsy needs to know the term “neurologist,” while in a different context it may be enough to say “specialist.”

If a complex medical term is the most accurate choice, provide a plain language definition the first time you use it. Everyday examples can further bridge the gap between technical concepts and everyday understanding.

Spoken Communication

Teach Back

The "teach back method" goes beyond the simple question of "do you understand?". It is a valuable tool to confirm if explanations are clear and the information provided has been grasped by the recipient.

This method involves asking the person to "teach back" the information shared, essentially explaining it back in their own words. This allows you to identify any areas where understanding might be incomplete and adjust your communication style accordingly.

This approach focuses less on verifying comprehension and more on ensuring your explanations are effective. It empowers a two-way conversation and fosters a more collaborative learning environment.

Chunk and Check

To ensure understanding, consider the "chunk and check" technique. Break down the information into smaller, manageable pieces, and utilise tools like "teach back" to check understanding after each point.

By chunking information and checking for understanding throughout the discussion, we ensure everyone is on the same page and key takeaways are retained.

Instead of leaving explanations until the end, weave them into the conversation as you introduce each concept. This allows for clarification and empowers individuals to ask questions and take action throughout the discussion.

Written Communication

Use pictures

Spoken and written words are often misheard or misread and also misunderstood. Pictures and visuals may be effective in improving understanding when communicating new or complex ideas to people.

It may be that pictures are used to compliment text, for example, when explaining a self-management procedure such as giving an injection or caring for a wound, it may assist people if they have it explained to them in words but also shown what to do using images.

Help with paperwork

All services should take a universal approach to offer support to those who have to fill in forms and paperwork. Ask colleagues to operate in this way across your service to ensure that support is available at all points of contact. You may also wish to consider the paperwork that you send to people (or digital forms and links) and whether this may cause unneeded anxiety and stress for people.

Keep paragraphs and sentences short and simple

Try to keep sentences to 20 words and under and try to keep paragraphs to 3 lines or less.
Always use language that is familiar to your users.
Avoid jargon terms when you can. Choose the language that your users can relate to.
Write in the active voice. Writing in the active voice means that the subject of your sentence performs the action.
1. Passive: Tests may be needed to find out what’s wrong.
2. Active: You may need a test to find out what’s wrong.

Write in a friendly, conversational tone

Formal language can make health content feel less accessible, so write how you speak. Simple language examples:

Smoking cessation - stop smoking.
Diet - what you eat and drink.
Referral - being sent to see someone else.

Additional guide to writing in plain English and NHS style guide

You can also find an additional guide to writing in plain English. The NHS style guide helps create easy-to-read communications

If you want a tool to help you write clearer, more usable content, try the Hemingway Editor. It highlights long sentences, complicated words, adverbs, and passive voice.

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