Health literacy and adherence: actions to improve

Actions to improve adherence in older people with low health literacy

Europe needs to do more to improve adherence. Doing so would improve the health and quality of life of Europeans, and improve the efficiency and sustainability of health services. The EIP-AHA suggests various categories and target populations for action, addressed to their specific needs.


Strategies are:

  • Older people need good information on improvement of health, prevention, screening and use of diet. Appropriate information materials are needed, tailored to their information needs. For example, the Academic Medical Centre in Amsterdam develops special information materials for colorectal cancer screening. The American Cancer Society has put together five strategies to improve screening attendance: reaching clients, reminders, photonovels, multimedia and health advocates.
  • Adjustment of information for persons with low health literacy is a widely used strategy: using simple language, larger font sizes, pictures and diagrams, etc., in prevention as well as in treatment.
  • Relevant strategies in healthcare first of all focus on person-centred care. Health professionals and health organisations have to recognise that every person is unique and has his or her own body constitution preferences, social and economic position. Personalised medicine is an important new concept in this regard. Self-efficacy (confidence in own capacities to manage therapies) is the starting point for improved adherence.

The term “personalised medicine”  is often described as providing “the right patient with the right drug at the right dose at the right time”. More broadly, personalised medicine (also known as precision medicine) may be thought of as the tailoring of medical treatment to the individual characteristics, needs and preferences of a patient during all stages of care, including prevention, diagnosis, treatment, and follow-up.Shared decision making is a relevant concept in patient empowerment matching individual needs and capacities of clients with evidence-based medical advice from health professionals. Decision aids have been developed that can guide clients through a step-by-step process of selecting an appropriate treatment.

  • Deployment of healthcare internet technology is very helpful in assisting patients to improve adherence. Electronic patient records, which contain the medical history and prescriptions, help in maintaining an overview. IT-based systems to remind patients of medical treatment and prescriptions are also useful.


  • Peer group support is a powerful tool in improving adherence: people with similar socio-economic and cultural backgrounds are better able to motivate each other and help to improve adherence.
  • An important way to achieve good adherence is to improve prescription. Part of this involves developing tools that ensure drug safety and efficacy in the population. Another part involves avoiding poly-pharmacy.
  • The retail pharmacy industry is transforming itself from simply dispensing drugs to improving more patient services. Infrastructures, service platforms and e-prescription continue to grow, facilitating both professional and patient involvement. Increasingly the role of pharmacies is increasing the patient’s self-efficacy with regard to implementing medical plans and taking prescriptions. Pharmacies contribute to the physician’s capability to monitor treatment.
  • The European Innovation Partnerships on Active and Healthy Ageing with its partnership approach offers an advantage in formulating more effective strategies and interventions to address the complex nature of adherence in a more co-ordinated and holistic way.

Benefits from adherence interventions by persons with low health literacy

Research shows that interventions which aim to improve adherence by persons with low health literacy in fact benefits all groups.



Further reading personalized medicine: European Alliance for Personalised Medicine Find website here

Further reading colorectal screening: Find website here

Further reading on improving adherence to screening: Find website here

Further reading on patient involvement: Coulter A and Ellens J. Effectiveness of strategies for informing, educating, and involving patients BMJ, 7 JULY 2007, Volume 335. Download PDF here