Using health literacy environment assessment tools

Health literacy environmental interventions: why use them?

Certain environmental barriers can impact on the participation and quality of life of patients with low health literacy. A health literacy environmental intervention comprises assessment, action planning and evaluation for optimal health service delivery. Core components are assessment of  navigation, interpersonal communication, design of printed, audio-visual and digital materials and  guidance in the implementation of actions in social and healthcare organisations. Health literacy environmental assessments have components that can be tailored to the needs of specific healthcare environments.

Health literacy environmental assessment tools are effective if they are tested with their indicated user groups to ensure that they find a solid base in the health and social care environment.

Tools are helpful in assessing understanding health information

Health literacy environmental assessment tools are helpful to ensure that all relevant measures are conducted and so that the patient understands the information. Assessment tools help healthcare professionals verify that the environment is health literate friendly. Most health literacy environmental interventons are comprehensive tools. The health literate environment can include the infrastructure, policies, processes, materials and relationships. These make up the health system and have an impact on the way in which people access, understand, appraise and apply health-related information and services.

Health literacy environment assessment tools can improve understanding of information in signals, written and verbal communication. The tools can also make it easier for healthcare providers and patients to communicate with and understand each other. Health literacy tools can vary from checklists to step-by-step guides. They can include activities relating to the physical navigation of the healthcare environment, assessment of written materials (both printed and online), and oral exchange in person or mediated by phone.

The ten components of a health literate health care organization defined by Brach et al. 2012 served as the conceptual framework for the review of health literacy assessment tools and the telephone interviews during the IROHLA project Download PDF here.

Components of a health literate health care organization according to Brach et al:

  1. Has leadership that makes health literacy integral to its mission, structure, and operations.
  2. Integrates health literacy into planning, evaluation measures, patient safety, and quality improvement.
  3. Prepares the workforce to be health literate and monitors progress.
  4. Includes populations served in the design, implementation, and evaluation of health information and services.
  5. Meets the needs of populations with a range of health literacy skills while avoiding stigmatization.
  6. Uses health literacy strategies in interpersonal communications and confirms understanding at all points of contact.
  7. Provides easy access to health information and services and navigation assistance.
  8. Designs and distributes print, audiovisual, and social media content that is easy to understand and act on.
  9. Addresses health literacy in high-risk situations, including care transitions and communications about medicines.
  10. Communicates clearly what health plans cover and what individuals will have to pay for services.

Currently available health literacy assessment tools

There is a range of tools available to assess health literacy of healthcare. Many of the tools are evidence based and have their roots in care practices. Most meant for healthcare personnel. They may be applicable for different healthcare settings. Many tools include recommendations, have implications for care practice, and include examples of use.

Health literacy environment assessment tools at their best are comprehensive and facilitate practical applications.

Example environmental health literacy assessment toolkits

Please find below some proposals for possible health literacy toolkits for your use. Two of them were developed in Europe, and one in the United States. The operating contexts of healthcare systems have to be taken into account. Thus, the toolkits may need to be adapted to the local system context.

  • Health Literacy Universal Precautions Toolkit

    The US Agency for Healthcare Research and Quality has developed the Health Literacy Universal Precautions Toolkit. It is intended for all levels of staff of primary care for adults and/or paediatric patients. It includes tools to test patients’ use of medications and tips for communicating clearly. It also provides advice on the “Teach-Back” method of communicating with patients. It helps to plan measures to improve health literacy of health settings. Download PDF here.

  • NALA National Adult Health Literacy Agency

    Irish Nala ToolKit for Literacy Friendly Healthcare Settings describes the benefits of investing in health literacy. It also includes a health literacy audit and recommendations for health literacy plans. NALA’s aim is to make Irish health services literacy friendly. It helps to analyse the skills of individuals and the literacy demands of the health service. Find website here.

  • The Toolbox Quick Scan Health Literacy (available in Dutch only)

    A Dutch toolbox has been developed to be implemented in hospitals. With its assistance, hospitals can screen their communication with patients who are less health literate. A ‘quick scan’ toolbox includes screening tools on written and oral information as well as access to and navigation within the hospital. The toolbox was developed by CBO, the Dutch Institute for Healthcare Improvement, in co-operation with six Dutch hospitals and low health literate people. Both professionals and patients benefited from the use of Toolbox Quick Scan Health Literacy.