The Chicken and the Egg: The Connection Between Health Literacy and Health Equity

by Laura Hoffman, DNP, MSN, RN, CPHQ

Vizient Performance Improvement Program Director

Which came first, the chicken or the egg? This is a long-debated question for which there is not necessarily a right or wrong answer. You cannot have one without the other. So why not consider the chicken and the egg? In health care, a similar analogy can be used for health literacy and health equity as related concepts.

Logan et al. postulated that health literacy is associated with social determinants of health and health outcomes. Health literacy principles make information clearer. Health equity principles make it more inclusive. Working to improve health literacy can ultimately improve health equity.

The U.S. Department of Health and Human Services recently expanded the definition of health literacy to include “organizational health literacy” which is defined as “the degree to which organizations equitably enable individuals to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.” As health care leaders, the responsibility for addressing health literacy is ours.

Here are three ways to advance health literacy in your hospital or health care organization.

Perform an assessment—A myriad of reasons exist for individuals missing medical appointments, not following medication regimens, not completing registration forms or not providing a complete medical history. Nierengarten asserted that one explanation might be limited health literacy. Adopt a health literacy assessment process that works for your organization and patient population. The Health Literacy Toolshed provides an online database of health literacy measures while Agency for Healthcare Research and Quality (AHRQ), has developed several assessments of health literacy in speakers of English and Spanish.

Educate patients—When people can access and understand information, they will be more likely to act on it. If you cannot develop your own materials, research companies that can provide accurate online plain language consumer health information. Consider individuals with limited English proficiency, use plain language and ensure that the information can be accessed by people who use assistive technology. There are a number of resources for best practices and additional information, including the Centers for Disease Control and Prevention (CDC), AHRQ, Department of Health & Human Services (HHS) Plain Writing Plan and National Institutes of Health (NIH) Plain Language Training.

Invest in provider education—Ensure your hospital conducts training to improve health literacy skills for clinical caregivers across all settings. The AHRQ website provides links to professional education, such as AHRQ and Joint Commission’s training modules, AHRQ’s SHARE Approach for shared decision making, TeamSTEPPS^® module for patients with limited English proficiency and the teach-back strategy to improve patient understanding. Once you’ve developed your training curriculum, ensure that all new caregivers complete the program and provide refresher training to all providers. A commitment to health literacy education has demonstrated improvement in not only health literacy skills, but also patients’ self-efficacy, adherence to treatment and clinical outcomes.

Health literacy and health equity coexist and an investment in one is an investment in both. The onus is on us as health care professionals, clinicians, or executive leaders to address health literacy. Assess individuals who utilize your health services. Learn if the disparity that prohibits access to services or adherence to regimens could be limited health literacy. Make investments in finding or creating educational resources that enable all individuals to make appropriate health-related decisions. Educate staff and empower each employee to learn about health literacy and their role in improving it. Indeed, the time is now to consider that what comes first is the chicken and the egg.

Vizient will conduct a six-week health equity strategy accelerator program for hospitals to develop and prioritize strategies and accelerate health equity. Reach out to me if you’d like to learn more. Enrollment is open through April 29, 2022.