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A large body of research shows that health literacy affects nearly every aspect of health, from medical knowledge to mortality.3 Below are some of the key research findings and examples. On average, adults with low health literacy have:

  • Less knowledge about their medical conditions4
    • May not know what their blood pressure or blood glucose should be
    • May not recognize signs and symptoms of common medical conditions
  • Less use of preventive health services5, 6
    • Less use of mammography, Pap smears, vaccines
  • Difficulty in performing disease self-management
    • May not use an asthma inhaler correctly7
    • Have difficulty reading and understanding prescription drug labels8
    • May not effectively manage early signs of a heart failure exacerbation9
  • Poorer disease control3
    • Tend to have higher blood pressure and glucose values
  • Excess health care utilization9
    • Are more likely to seek care in Emergency Departments and be admitted to the hospital
  • Higher mortality10, 11

Low health literacy is a key contributor to health care disparities. Research has shown that, in most contexts, health literacy is a more important predictor of health than race, socioeconomic status, or educational attainment.3


Health literacy and patient engagement

Today's models of health care, including patient centered medical homes, often place more demands on patients to be active participants in their own health care. However, patients with low health literacy

  • may have less familiarity with the medical context
  • have less knowledge about medical conditions3
  • ask fewer questions in medical office visits12
  • may not express that they are having difficulty completing forms or understanding health information13

Patients with low health literacy are therefore at risk of not being as engaged in their care. This has implications for the quality of care that is delivered. Particularly in environments that expect a high level of patient participation, clear communication is of utmost importance.


  • 3Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Crotty K. Low health literacy and health outcomes: an updated systematic review. Ann Intern Med. 2011;155(2):97-107.
  • 4Gazmararian JA, Williams MV, Peel J, Baker DW. Health literacy and knowledge of chronic disease. Patient Educ Couns. 2003;51(3):267-275.
  • 5Bennett IM, Chen J, Soroui JS, White S. The contribution of health literacy to disparities in self-rated health status and preventive health behaviors in older adults. Ann Fam Med. 2009;7(3):204-211.
  • 6White S, Chen J, Atchison R. Relationship of preventive health practices and health literacy: a national study. Am J Health Behav. 2008;32(3):227-242.
  • 7Paasche-Orlow MK, Riekert KA, Bilderback A, et al. Tailored education may reduce health literacy disparities in asthma self-management. American Journal of Respiratory & Critical Care Medicine. 2005;172(8):980-986.
  • 8Davis TC, Wolf MS, Bass PF, III, et al. Literacy and misunderstanding prescription drug labels. Ann Intern Med. 2006;145(12):887-894.
  • 9Murray MD, Tu W, Wu J, Morrow D, Smith F, Brater DC. Factors associated with exacerbation of heart failure include treatment adherence and health literacy skills.Clinical Pharmacology and Therapeutics. 2009;85(6):651-658.
  • 10Baker DW, Wolf MS, Feinglass J, Thompson JA, Gazmararian JA, Huang J. Health literacy and mortality among elderly persons. Arch Intern Med. 2007;167(14):1503-1509.
  • 11Sudore RL, Yaffe K, Satterfield S, et al. Limited literacy and mortality in the elderly: The Health, Aging, and Body Composition Study. J Gen Intern Med. 2006;21(8):806-812.
  • 12Katz MG, Jacobson TA, Veledar E, Kripalani S. Patient literacy and question-asking behavior in the medical encounter: a mixed-methods analysis. J Gen Intern Med. 2007;22(6):782-786.
  • 13Parikh NS, Parker RM, Nurss JR, Baker DW, Williams MV. Shame and health literacy: the unspoken connection. Patient Educ Couns. 1996;27:33-39.