Health literacy interventions

There is some evidence that interventions designed to address limited health literacy increase health-related knowledge (Dong 2023, Perazzo 2017, Brainard 2016, Brijnath 2016, Jacobs 2014a, Manafo 2012, DeWalt 2009, Pignone 2005) and comprehension (Sheridan 2011), and improve adherence to treatment (Perazzo 2017, Miller 2016). Additional evidence is needed to confirm effects and determine which interventions are most effective.

Health literacy interventions that use written, print-based materials which are easy to read and understand have been shown to increase health-related knowledge among children and adults more than traditional materials (DeWalt 2009, Pignone 2005). Primary care-based group education programs designed to be sensitive to health literacy limitations also appear to increase health-related knowledge among adults (Brega 2013). Health literacy programs for older adults offered in community settings can build capacity to retain and apply relevant health information (Manafo 2012). Similarly, broader health intervention programs tailored for older adults and designed to be sensitive to health literacy limitations, like education and income (Fleary 2019), can increase participants’ knowledge and capacity to find relevant health information (Brainard 2016). Complex diagnoses, such as cancer, can create barriers in health literacy for patients as they navigate the decisions and experiences required for their treatment; tailored health literacy interventions may help overcome these barriers (Holden 2021, Housten 2021). More intense interventions appear to increase the likelihood of improvement (Dennis 2012), particularly when they use individual focus (Marshall 2025).

Health literacy interventions that combine multiple approaches (e.g., written and visual materials that are easy to read and understand, video tutorials, health literacy training for physicians, and in-person patient assessments) appear to increase patients’ comprehension and appropriate use of health care (Sheridan 2011). Interventions that use multi-media approaches, focus on interpersonal interactions (Wilson 2012a), or face-to-face communication appear to promote improved communication between patients and providers (Miller 2016). Health literacy interventions that use technology or the internet (i.e., eHealth interventions) can increase knowledge of HIV (Perazzo 2017, Jacobs 2014a), colorectal cancer (Jacobs 2014a), and mental health conditions such as post-traumatic stress disorder (PTSD) (Brijnath 2016). Web-based interventions can reduce symptoms of depression and anxiety (Brijnath 2016).

Health literacy interventions can improve adherence to medical treatment, particularly for patients following non-medication regimens or with cardiovascular disease (Miller 2016). Interventions that include in-person counseling with interactive or technology-assisted education can also increase treatment adherence for those taking HIV medications (Perazzo 2017).

Health literacy interventions that include skill-building in communication and self-management techniques can increase patient satisfaction and improve chronic disease management for older adults (Brainard 2016). Health literacy driven diabetes self-management interventions may reduce HbA1C levels and improve diabetes related self-management outcomes (Butayeva 2023), particularly for patients with low health literacy levels (Kim 2016b). One study found that promoting health literacy in primary schools can support good health literacy development in children, which could lead to improved health literacy in adulthood (Otten 2022).

Classes that teach participants how to access health information on the internet may increase self-efficacy in health information seeking and health information comprehension, improving the ability to find, evaluate, and use online health information (Cochrane-Car 2011).

Experts suggest that health care providers may have difficulty accurately identifying patients’ health literacy limitations (Kelly 2007, Rogers 2006) and recommend that health professions curriculums train medical students, residents (Hildenbrand 2020, Rogers 2006), and pharmacy students (Murphy 2022) to assess health literacy for all patients.

Health literacy interventions have the potential to decrease disparities in health-related knowledge, if they are designed and tailored for specific populations (Stormacq 2019) like migrants (Aldin 2024) and refugees (Bitterfeld 2025) or caregivers and parents (Belfrage 2025). Disparities in health literacy disproportionately impact older women, individuals with lower educational attainment, and individuals experiencing barriers caused by socio-economic status and race (Farid 2025, Fleary 2019). Health literacy interventions can improve adherence to medical treatment with benefits appearing greater for minorities and individuals with low incomes than for non-Hispanic whites and those with higher incomes (Miller 2016, Mantwill 2015).

Tailoring interventions to minorities, those with low levels of education, or limited experience with computers can promote patient engagement (Jacobs 2014a).

For migrant women, specifically women of Afghan and Mexican backgrounds, gender roles may affect their health decisions (Aldin 2024). Available evidence suggests that culturally tailored health literacy interventions can reduce these barriers and create a more comfortable environment that is culturally appropriate for patients (Aldin 2024). In Spanish-speaking communities, Hispanic community health workers and communication strategies that are linguistically and culturally tailored and appropriate may help inform decisions regarding health (Hernandez 2024).

Both in-person and digital community-based health literacy interventions have the potential to enhance parental health literacy (Belfrage 2025). However, challenges to accessing digital health literacy resources should be considered, such as lack of broadband access and reduced availability of computers and smartphones (Smith 2019b).

Health literacy interventions may help improve health outcomes for individuals with neurodevelopmental and chronic conditions when the interventions are targeted to caregivers and parents (Nevill 2025).

The phrase ‘health literacy’ was first published in 1974 in an article that discussed whether health education was a policy issue that impacted health care systems, education systems, and mass communication (Pinheiro 2021). Since then, the field has expanded in scope and breadth to explore the role health literacy plays in patient’s decision-making and its impact on health and healthcare. Experts have investigated reading skills, information accessibility, and many other factors to understand methods to improve health literacy for patients.

More recently, findings from the National Assessment of Adult Literacy Survey has found that 36% of U.S. adults had basic or below-basic health literacy and non-white Americans are more likely to have limited health literacy (Coughlin 2020). To improve health literacy in the United States, public health experts have advocated for mass communication campaigns that are accessible and use plain language (CDC-Develop & test materials).

• Does your community have health literacy interventions? If not, what organizations, health clinics, and/or health systems can you partner with to develop a health literacy program?
• Are there individuals or groups in your community that are more likely to have low health literacy? Are there health literacy interventions in your community that could be tailored for them?
• What resources are available to fund health literacy programs? What partnerships could help develop or expand health literacy programs in your community?

Federal initiatives including the Affordable Care Act (ACA), the National Action Plan to Improve Health Literacy, and the Plain Writing Act emphasize health literacy (Koh 2012).

There are a number of statewide programs that aim to improve health literacy; at least 25 states maintain health literacy coalitions or working groups, including Kentucky, Ohio, and Texas (CDC-Health literacy). Specific examples include the North Carolina Health Literacy: Health Literacy Basics guide, the Colorado Health Literacy Coalition (Colorado-HL), and Engage for Health, a Pennsylvania-based program that uses the Agency for Healthcare Research and Quality’s (AHRQ’s) “Questions are the Answer” patient engagement tools and resources (AHRQ-Tools).

The National Institutes of Health has established the Clear Communication initiative that focuses on reaching all Americans with health information they can understand and use (NIH-Plain language at NIH). Many states are collaborating with local partners and non-profit groups to improve health literacy in their communities to meet the goals outlined in the National Action Plan to Improve Health Literacy (CDC-Health literacy action plan, CDC-Health literacy activities by state).

Research organizations such as Duke University Medical Center, the Harvard T.H. Chan School of Public Health, and the University of Maryland provide information and training materials for patients, providers, and educators on strategies to improve health literacy (Duke-HL, Harvard-Health literacy, Maryland-Health literacy resources).

AHRQ-Health literacy toolkit - Brega AG, Barnard J, Mabachi NM, et al. AHRQ Health literacy universal precautions toolkit, 2nd edition. Rockville: Agency for Healthcare Research and Quality (AHRQ); 2015.

AHRQ-Shoemaker 2014 - Shoemaker S, Wolf M, Brach C. The patient education materials assessment tool (PEMAT) and user’s guide: An instrument to assess the understandability and actionability of print and audiovisual patient education materials. Rockville: Agency for Healthcare Research and Quality (AHRQ); 2014.

AHRQ-Teach-Back - Agency for Healthcare Research and Quality (AHRQ). Teach-Back intervention: Patient and family engagement in primary care.

CDC-Cross-cultural tools - Centers for Disease Control and Prevention (CDC). (2024, October 16). Culture and Language: Tools for cross-cultural communication and language access can help organizations address health literacy and improve communication effectiveness.

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* Journal subscription may be required for access.

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Belfrage 2025 - Belfrage, S., Husted, M., Fraser, S., Patel, S., & Faulkner, J. (2025). A systematic review of the effectiveness of community-based interventions aimed at improving health literacy of parents/carers of children. Perspectives in Public Health, 145(1), 25–31.

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Brijnath 2016 - Brijnath B, Protheroe J, Mahtani KR, Antoniades J. Do web-based mental health literacy interventions improve the mental health literacy of adult consumers? Results from a systematic review. Journal of Medical Internet Research. 2016;18(6):e165.

Butayeva 2023 - Butayeva, J., Ratan, Z. A., Downie, S., & Hosseinzadeh, H. (2023). The impact of health literacy interventions on glycemic control and self‐management outcomes among type 2 diabetes mellitus: A systematic review. Journal of Diabetes, 15(9), 724–735.

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Dennis 2012 - Dennis S, Williams A, Taggart J, et al. Which providers can bridge the health literacy gap in lifestyle risk factor modification education: A systematic review and narrative synthesis. BMC Family Practice. 2012;13(1):44.

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Dong 2023 - Dong, Q., Liu, T., Liu, R., Yang, H., & Liu, C. (2023). Effectiveness of digital health literacy interventions in older adults: Single-arm meta-analysis. Journal of Medical Internet Research, 25, e48166.

Duke-HL - Duke University Medical Center Library and Archives. Health literacy (HL): Initiatives, research, and tools for patients, clinicians, multi-lingual patients, and educators.

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Farid 2025 - Farid, G., Mahmood, K., Khalid, S., Khalid, F., & Iftikhar, S. (2025). Health information literacy of cardiac patients: A systematic literature review. Journal of Health Literacy, Online First.

Fleary 2019 - Fleary, S. A., & Ettienne, R. (2019). Social disparities in health literacy in the United States. HLRP: Health Literacy Research and Practice, 3(1).

Harvard-Health literacy - Harvard T.H. Chan School of Public Health, Department of Social and Behavioral Sciences. Health literacy studies.

Hernandez 2024 - Hernandez, J., Demiranda, L., Perisetla, P., Andrews, L., Zhang, K., Henderson, R., Mittal, A., Norton, H. F., & Hagen, M. G. (2024). A systematic review and narrative synthesis of health literacy interventions among Spanish speaking populations in the United States. BMC Public Health, 24(1), 1713.

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Holden 2021 - Holden, C. E., Wheelwright, S., Harle, A., & Wagland, R. (2021). The role of health literacy in cancer care: A mixed studies systematic review. PLOS ONE, 16(11), e0259815.

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Maryland-Health literacy resources - University of Maryland, Health Sciences and Human Services Library. (n.d.). Health literacy resources: Plain language resources. Retrieved September 9, 2025.

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Nevill 2025 - Nevill, T., Keeley, J., Hunt, S., Skoss, R., Lindly, O., Downs, J., & Blackmore, A. M. (2025). Efficacy of health literacy interventions for caregivers of individuals with neurodevelopmental and chronic conditions: A rapid review. Children, 12(1), 9.

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Wisconsin Literacy - Wisconsin Literacy. Strengthening Wisconsin’s workforce, families and communities through literacy.