Integrating health literacy in quality of care approach

Quality of care principles integrated in health systems

Elements of definition

Quality of care is not easy to define. The Word Health Organization advises governments to produce own definitions in which relevant elements are included Download PDF here. These are the elements of the definition of quality of care for organizations:

  • Effective, delivering health care that is adherent to an evidence base and results in improved health outcomes for individuals and communities, based on need;
  • Efficient, delivering health care in a manner which maximises resource use and avoids waste;
  • Accessible, delivering health care that is timely, geographically reasonable, and provided in a setting where skills and resources are appropriate to medical need;
  • Acceptable/patient-centred, delivering health care which takes into account the preferences and aspirations of individual service users and the cultures of their communities;
  • Equitable, delivering health care which does not vary in quality because of personal characteristics such as gender, race, ethnicity, geographical location, or socioeconomic status;
  • Safe, delivering healthcare which minimises risks and harm to service users.


Some governments define quality of care principles in legislation; for example, Australia Download PDF here has recently adopted legislation defining the service package, standards for service providers and service organisations. Other governments mandate national health organisations to formulate standards, like the United Kingdom Find website here or the Netherlands Find website here.

The single common definition of quality of care according to the National Health Service in the UK (Find website here) encompasses

three equally important parts:

  • Care that is clinically effective– not just in the eyes of clinicians but in the eyes of patients themselves;
  • Care that is safe; and,
  • Care that provides as positive an experience for patients as possible

Patients’ experience and acceptance

All quality principles defined in various countries combine desired clinical outcomes with patients’ experience and acceptance. Quality of care therefore incorporates health literacy issues and understandable communication. Factors like age, education and culture have an impact on how patients perceive health information and understand instructions for treatment and care. Integrating principles of health literacy ensures that the clients are optimally involved in care and that the professionals can work fully for the benefit and wellbeing of clients.

Taking health literacy principles into account helps healthcare organisations to serve their patients optimally. Health literacy can be an integral part of health systems. When health literacy is included in health systems it enhances equity in health and social care. Below eight quality principles in the area of health literacy are suggested.

Eight things healthcare organisations need to take care of

  1. The person receiving the care is always the focus of healthcare actions;
    We are not treating diseases or medical problems, but persons with problems and aspirations that should be discussed.
  2. Individual people with low health literacy are able to access and make full use of the services and treatment needed.
    Health facilities create an environment that is conducive for people who find it difficult to find their way in buildings, but also in administration and procedures
  3. Healthcare facilities work on improvements in infrastructure to take into account patients with special needs.
    Persons with physical, mental, or social challenges should feel welcome. Test panels and mystery guests may provide feedback to facility management.
  4. Healthcare facilities aim to improve their methods and processes to include health literacy issues.
    Simplification of procedures: focusing on priorities, taking it step-by-step, repeating and testing understanding by clients are ways to improve compliance.
  5. The patient-provider relationship is open and aiming understanding.
    In consultation rooms nobody should feel intimidated or ill at easy. The aim is to provide a positive experience (even when medically it may be difficult)
  6. Patient education and counselling is conducted in a trustful atmosphere, in particular taking into account the needs and concerns of older patients.
    A good location, privacy, time for explanation, repeating explanation when needed, help people to understand better.
  7. That in all circumstances information is understandable and applicable to older patients. Websites, online registration, folders and brochures should be written in plain language, using readable text formats, or provide audio messages where possible.
  8.  Professionals and healthcare organisations take into account the cultural backgrounds of patients.
    Communication is strongly influenced by culture and persons from other backgrounds may understand advice or prescriptions differently; testing whether messages are well understood, may reveal misunderstanding.

Health literacy is about changing behaviour in prevention and care

To address health literacy issues, professionals and patients (or clients) as well as the people around them need to change their behaviour.

  • Health professionals may need training in communication and stimuli to continue with person-centred care.
  • Relatives and community members may provide useful support to patients in their everyday lives and can help the patient to follow a treatment plan.
  • Interventions become more sustainable if users and providers are involved in developing, training, and follow-up, for example reviewing existing patient education materials, registration procedures, or medication advice.