Professional Role · Topic 20 of 21

Patient Education & Health Literacy

Professional role · patient education

Patient Education & Health Literacy

Assume anyone may struggle with health information: speak and write plainly, then confirm understanding with teach-back — every patient, every time.

Key numbers

Write at or below 6th–8th grade≤ 6th–8th grade

Print at least 14-point font≥ 14-point font

01 · TeachTeach-back: the patient explains in own words

Confirm understanding with teach-back: the patient explains in their own words what they need to know or do ("I want to make sure I explained this clearly…"); if wrong, re-explain differently and recheck.

02 · The ruleHealth literacy universal precautions for everyone

Use health literacy universal precautions — simplify communication and confirm understanding with everyone — because you cannot know who is struggling at any moment; even capable people falter when tired, sick or anxious.

03 · The ruleWrite at or below 6th–8th grade

Write patient materials at or below a 6th–8th-grade reading level (NIH: 6th grade or lower; AHRQ: 4th–6th); the average US adult reads at about an 8th–9th-grade level, and materials are often written far above it.

What it is

Core idea

Personal and organizational health literacyHealthy People 2030 defines personal health literacy as the ability to find, understand and use information and services for health decisions, and organizational health literacy as how equitably an organization enables people to do so.

Causes & risk factors

Why it happens

Limited health literacy is common, worst after 65In the 2003 National Assessment of Adult Literacy, over 75 million US adults had basic or below-basic health literacy, and adults 65 and older had the lowest average scores.

Teaching children or teaching adults?

Commonly confused

Self-concept	Dependent on the teacher
Experience	Little to draw on
Orientation	Subject-centered
Need to know	Learn what they are told

Teach & follow up

Patient education

Adults learn self-directed, problem-centered, needing why must knowKnowles' andragogy: adults are self-directed, draw on experience, become ready to learn through life roles, are problem-centered, need to know why, and are mainly internally motivated — so tie teaching to the patient's own problem.

Show-me: demonstrate the skill or doseFor a new medicine, dose change or skill, use the show-me method (return demonstration): even patients who say the dose correctly often make mistakes when asked to demonstrate it.

Never ask "Do you understand?""Do you understand?" and "Does that make sense?" are not teach-back: patients usually answer yes whether or not they understand. Ask open, non-shaming questions that require an explanation.

Ask Me 3: problem, what to do, whyAsk Me 3 (IHI) prompts patients to ask: What is my main problem? What do I need to do? Why is it important for me to do this? Make sure every visit answers all three.

Plain language: main message first, short sentencesPlain language: lead with the main message, use everyday words and active voice, keep sentences short (about 20 words, one idea each), break text into chunks with headings, and cut unneeded words.

Older adults: slower speech, face-to-face, written takeawaysWith older adults, speak plainly and more slowly, do not interrupt, face the patient (not the screen) so lips can be read, and give written or printed takeaway points — especially with several conditions.

Hearing loss: normal tone, no shouting, less noiseAbout one-third of older adults have hearing loss: check the hearing aid works and look for cerumen, reduce background noise, and speak clearly in a normal tone — shouting distorts speech sounds.

Print at least 14-point fontFor visual deficits, use good lighting without glare, confirm glasses are worn, and print materials in at least 14-point, easy-to-read type; offer audio, large pictures or marked pillboxes for low vision.

More detail

Reference

Show 5 reference facts

Patients may look at a handout during teach-back, but they must explain in their own words rather than read it back; teach-back is not a memory test.

Teach-back improves understanding and adherence and reduces call-backs and cancelled appointments; in one residency practice, visits got shorter, not longer, as clinicians practiced it.

Use professional interpreters and translated written materials when the patient's preferred language differs from yours (see Cultural Humility, Equity & Language Access).

Include family and caregivers in teaching when the patient agrees, but speak to the patient directly; ask companions to step out when sensitive topics need private time.

If an older patient stays confused despite clear teaching, evaluate for causes — medication effects, metabolic or endocrine change, delirium or untreated depression — rather than attributing it to age.

Pearl

Teach-back tests the teacher, not the patient: if the patient cannot explain it, re-explain it a different way and check again.

Sources · AHRQ Health Literacy Universal Precautions Toolkit — Tool 5: Use the Teach-Back Method · AHRQ Health Literacy Universal Precautions Toolkit, 3rd edition — Introduction (why universal precautions) · Institute for Healthcare Improvement — Ask Me 3: Good Questions for Your Good Health · CDC — Plain Language Materials & Resources (health literacy) · CDC — What Is Health Literacy? (Healthy People 2030 definitions) · National Institute on Aging — Talking With Your Older Patients (reviewed Jan 2023) · Knapke JM et al. Andragogy in practice: applying a theoretical framework to team science training. Br J Biomed Sci 2024;81:12651 (Table 1: Knowles' six principles) · Smith GB et al. Evaluating the readability of online patient education materials for avascular necrosis. J Patient Cent Res Rev 2026;13:108–114 (NIH ≤ 6th grade; average US reading level ≈ 8th grade) · Hayes DS et al. Readability, quality and source evaluation of online content on inherited pediatric orthopaedic conditions. J Pediatr Soc North Am 2026;17:100420 (recommended 6th–8th grade) · AHA Team Training — TeamSTEPPS Pocket Guide, Feb 2024 (teach-back as closed-loop communication with patients; return demonstration) · National Center for Education Statistics — National Assessment of Adult Literacy: Health Literacy results (2003) · AHRQ Health Literacy Universal Precautions Toolkit — Tool 11: Assess, Select, and Create Easy-to-Understand Materials (average US adult reads at 8th–9th grade; 4th–6th grade recommended) · Starter sheet built from the verified AGACNP fact map (facts reviewed 2026-10-15).