Giving advice on clear communication

Lead health literacy improvements

To address the issues of health literacy, St. Vincent Charity Medical Center in Cleveland, OH, made a radical move. It abolished its patient education committee and formed the Health Literacy Institute that consists of an interdisciplinary team of caregivers who are dedicated to improving health literacy through better communication.

Karen Komondor, RN, director of patient and staff education, heads up the team. All team members developed a passion for improving health literacy through education on that subject, which gave them a different perspective, Komondor says. "We saw that although many of us had been in healthcare a long time, we didn't realize that maybe our patients didn't understand what was being taught, and it wasn't about noncompliance," she explains.

Their tutors were staff members from Project Learn, an adult learning center in Cleveland. The partnership was formed in 2007 when the adult learning center received a grant from Sisters of Charity Foundation of Cleveland to form a partnership with St. Vincent Charity Medical Center to address low health literacy.

Project Learn remains a partner of the Health Literacy Institute, which made its overall goal the institutionalization of health literacy across the continuum of patient care. The first step to reach this goal was to conduct health literacy awareness training, beginning with senior leadership. (For more information about guiding projects, see story, below)

Senior leader buy-in and support is critical when addressing health literacy, says Mary Ann Abrams, MD, MPH, health literacy medical advisor at Iowa Health System Center for Clinical Transformation in Des Moines. "The health literacy focus at this institution began about 2005. Administrators can raise the visibility of the issues and dedicate time, space, and resources for staff to work on them, and they can change policies and procedures," Abrams explains.

One way to engage them is by providing data compiled in national reports, she says. To use national data in making a case for a focus on health literacy within an institution, make it personal by adding state statistics and data from your location, Abrams advises. "People are inclined to say the problem exists somewhere else, but indeed the problem does exist locally," she says.

Another powerful way to engage leadership, as well as colleagues, is by involving patients, family members, and adult learners. Let them share their stories about struggling to understand information. Healthcare providers will see that these people are the same as those patients in their clinic waiting rooms or those admitted to the hospital, Abrams explains.

Komondor says that health literacy education must encompass all staff. It begins with health literacy awareness training, and then it becomes more specific by providing guidance on the use of plain language or teaching techniques.

Members of the health literacy team attend staff meetings in different departments to provide health literacy training. The topic of health literacy is included in general hospital orientation and annual competencies. Administrative policy related to patient education requires the use of plain language and the teach-back method in all provider communication.

Create areas of focus

Health literacy teams within the Iowa Health System are similar to those at St. Vincent Charity Medical Center, with patient education coordinators or managers heading up the teams. However, direction is given to the hospitals within the system by providing three areas of focus for health literacy projects. Abrams says that these include the care environment, interpersonal verbal communication, and written materials.

Under the heading of care environment, teams might implement a program to enhance understanding, such as "Ask Me 3," a patient education program designed to promote communication between healthcare provider and patient. (For more information, see Resource, below.)

Interpersonal verbal communication might entail training on the use of plain language. Work on written materials involves making sure instructional handouts and forms are user- and reader-friendly. Abrams says teams are providing guidelines and training for staff about user-friendly handouts, which encompasses layout, word choice, and organization of content. Although the health literacy teams at the hospitals within the system review written materials, as they teach staff to write in plain language, fewer and fewer revisions are required.

Komondor says that The Health Literacy Institute made rewriting patient education documents to an average sixth-grade reading level its second major focus and has revised more than 100 handouts. Staff members at Project Learn do the major revisions, and team members and experts review content before the document is posted on the Intranet for distribution. Adult learners at Project Learn are sometimes used to gain a patient perspective on written materials and videos.

According to Abrams, gaining the patient perspective is important. Health literacy teams at all the institutions are encouraged to include one or more patients or an adult learner on the team. Adult learners at New Readers of Iowa have helped with documents at the system level, says Abrams. For example, they helped with the development of reader-friendly informed consent documents.

Patient input also can be spontaneous, says Abrams. When creating a new form or handout, ask patients on the hospital floor or in the clinic waiting room to provide feedback. "It helps to make sure we are communicating accurately," says Abrams.


For more information on creating a system-wide focus to address issues of health literacy, contact:

  • Mary Ann Abrams, MD, MPH, Health Literacy Medical Advisor, Iowa Health System Center for Clinical Transformation, 1200 Pleasant St. ERC-2, Des Moines, IA 50309. E-mail:
  • Karen Komondor, RN, Director, Education St. Vincent Charity Medical Center, 2351 E. 22nd St., Cleveland, OH 44115. E-mail:
  • Ask Me 3: These brochures encourage patients to understand the answers to three questions: "What is my main problem?" "What do I need to do?" and "Why is it important for me to do this?" They are available in English and Spanish from the National Patient Safety Foundation. They come in packages of 100 at a cost of $100 plus shipping and handling. Order online at Click on links to downloadable materials at the bottom of the homepage to find resource page. Click on ordering brochures.

7 goals to help guide projects

HHS guides health literacy

Many healthcare institutions are using the seven goals stated in the "National Action Plan to Improve Health Literacy" developed by the Department of Health and Human Services to guide health literacy initiatives. The goals each have specific strategies for different sectors of the health system. The goals include:

  • Develop and disseminate health and safety information that is accurate, accessible, and actionable.
  • Promote changes in the health care system that improve health information, communication, informed decision making, and access to health services.
  • Incorporate accurate, standards-based, and developmentally appropriate health and science information and curriculum in child care and education through the university level.
  • Support and expand local efforts to provide adult education, English language instruction, and culturally and linguistically appropriate health information services in the community.
  • Build partnerships, develop guidance, and change policies.
  • Increase basic research and the development, implementation, and evaluation of practices and interventions to improve health literacy.
  • Increase the dissemination and use of evidence-based health literacy practices and interventions.

Source: "National action plan to improve health literacy." Web: