Responding to health literacy

The diagram below shows some of the causal pathways between limited health literacy and health outcomes, highlighting the need to address health literacy issues at a number of levels within the health system:

Taken from: "The causal pathways linking health literacy to health outcomes." Paasche‐Orlow, M.K. and M.S. Wolf (2007). AmJHealthBehav31 Suppl 1:S19‐26.[86]

Health literacy interventions can benefit everyone using the service, in the same way that improved signage within a hospital can help everyone to find their way, not just those who have trouble following directions.


A robust response to health literacy addresses the issue at a number of levels:

  • Individual services users and communities: strategies to support and build the knowledge, skills and capacity of individuals and community groups.
  • Health professionals: strategies to support and build capacity of health professionals and wider staff.  Read more. 
  • Service design, systems and processes: strategies at an organisation-wide and service level to improve the accessibility and responsiveness of services.  Read more.
  • Health economy / commissioning: strategies to increase health literacy within communities; engage people with low health literacy in the design of services; and use health literacy as a framework for understanding needs and commissioning improvement in accessibility, appropriateness and health outcomes of services.

The table below further sets out the impact of low health literacy, some of the barriers and challenges experienced by people with low health literacy, and some potential responses at different levels.  This is not intended to be an exhaustive list but to demonstrate some of the linkages and possible ‘system’ solutions.


Impact for people with low health literacy

Challenges of low health literacy

Potential responses

Caring for themselves and their families in the community

People with low health literacy:

  • have difficulty managing their own health and wellbeing, that of their children, and of anyone else they care for
  • are at increased risk of developing multiple health problems
  • are less likely to engage with health promotional activities

Challenges relating to:

  • Ability to adapt knowledge for application in personal life situations

Potential responses:

  • Tailor health information to people’s learning styles and needs
  • Provide tailored and responsive education specific to individual health needs
  • have greater difficulty looking after themselves when they have long-term conditions


  • Commission peer networks and support such as health coaching for people with long term conditions


  • have higher rates of avoidable and emergency admissions


  • Provide tailored and focused education and support based on episodes of crisis (with greater focus on preventative care for exacerbations)

Access to and uptake of services

People with low health literacy:

  • wait until they are sicker before going to the doctor
  • find it harder to access appropriate services

Challenges relating to:

  • Knowledge of services and their roles
  • Confidence to approach services
  • Ability to explain their needs
  • Trust in services

Potential responses:

  • Design access and referral routes to promote accessibility
  • Build knowledge and capacity within community groups to support people to navigate health services
  • Commission care navigators to help people navigate health, statutory and third sector services

Fully understanding engagement with providers

People with low health literacy:

  • are less able to communicate with healthcare professionals and take part in decisions


Challenges relating to:

  • Ability to engage providers to explain needs, ask questions and negotiate


Potential responses:

  • Train health professionals in evidence-based approaches to health literacy (see below)
  • Provide support to people to engage with their health professional, such as agenda setting sheets and health diaries.
  • find it harder to understand labelling and take medication as directed
  • Services fail to accommodate learning needs and styles
  • Train health professionals and pharmacists in evidence-based approaches to health literacy
  • Ensure written information meets the Information Standard

All resources on health literacy