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Health Literacy Resources

Contributors

  • Debra Alexander, MLIS, BSBA — Health Sciences Librarian, Tomah VA Medical Center
  • Alkeisha D. Baker DNP, MSN, RN — Veterans Health Education Coordinator, VA Augusta Health Care System
  • Ilene Baltierra, BA — Librarian, Martinsburg VA Medical Center
  • Cheryl Banick, MLIS — Librarian, VA New England VA System
  • Mary Guessferd, MLIS — Librarian, VA New England VA System
  • Thomas Keeler, MLIS — Patient Health Education Librarian, Minneapolis VA Health Care System
  • Patricia L. Lasher, DNP, MSN, RN — Veterans Health Education Coordinator, VA Pittsburgh Health Care System
  • Lora McBrearty, M.Ed., RDN, CDCES — Digital Health Information Specialist, National Center for Health Promotion and Disease Prevention
  • Muswamba Muvundamina, RN — Veterans Health Education Coordinator, James H. Quillen VA Medical Center
  • Heidi M. Patterson, MLIS — Librarian, VA Pittsburgh Health Care System
  • Heather Roth, DNP, MSN, RN — Veterans Health Education Coordinator, Columbia VA Health Care System
  • Jennifer Millwood, RN — Veterans Health Education Coordinator, Birmingham VA Health Care System
  • Erica Wilson, DNP, RN, CM/DN, CNOR — Veterans Health Education Coordinator, Washington VA Medical Center

"Good communication is the bridge between confusion and clarity." — Nat Turner

Table of Contents

Foreword

What is Health Literacy, Plain Language, and Clear Communication?

Health literacy is a multifaceted issue with significant implications for the quality of patient care, patient safety, and overall healthcare satisfaction. Healthy People 2030 offers updated definitions of health literacy, distinguishing between personal and organizational health literacy. Personal health literacy is defined as "the ability of individuals to find, understand, and use information and services to make informed health-related decisions and actions for themselves and others" (ODPHP, n.d., p.1). Organizational health literacy, on the other hand, refers to the capacity of organizations to enable individuals to find, understand, and use such information and services. (ODPHP, n.d.). Addressing both personal and organizational health literacy is crucial for health systems to help patients navigate, comprehend, and access health information effectively, thereby enhancing their overall health and achieving their health goals (U.S. GSA, n.d.).

Federal agencies are also tasked with using plain language and clear communication principles to ensure information is easily understandable by a general audience. Using clear and concise communication, and well-organized writing aims to bridge gaps for readers with different reading levels, information processing speeds, or expertise. As a federal agency, the Department of Veterans Affairs must comply with laws and regulations governing clear communication practices, including plain language.

The International Plain Language Federation founded through the Center for Plain Language defines plain language as "communication that is so clear in its wording, structure, and design that intended readers can easily find what they need, understand it, and use that information" (International Plain Language Federation, n.d.). While this definition aligns closely with concepts of health literacy, both personal and organizational, it is not the same. Literacy in all its forms is related to plain language, as well as other fields such as accessibility, usability, and user experience design (International Plain Language Federation, n.d.). Clear communication for informed decision making is essential, and when organizations do not prioritize it, misunderstandings can arise, leading to increased safety risks for patients. It is essential to consider various aspects of health literacy, plain language, and clear communication when designing information that is easy for patients to understand and act upon.

Why is Health Literacy Important?

According to the US Department of Health and Human Services, only 12% of US adults have proficient health literacy (HHS, 2010). This means 88% of Americans — regardless of education level — have less-than-proficient health literacy levels, a factor strongly linked to health inequities and poorer outcomes, such as higher rates of chronic disease, preventable hospitalizations, repeated visits, and inefficient use of health resources (Goncalves-Fernandez & Pino-Juste, 2025).

Health literacy matters because even well-educated individuals may struggle to understand complex or emotionally charged health information. Factors such as familiarity with the health care system, cognitive or physical limitations, communication barriers, and difficulty interpreting medical terminology all influence a person's ability to navigate their care. The growing volume of online health information adds further challenges in distinguishing reliable sources from misleading content.

Although clinicians may believe they are communicating clearly, patients often hesitate to ask questions. As a result, health care organizations play a critical role in helping patients, families, and caregivers understand and use medical information effectively. Strong health literacy equips individuals to:

  • Make informed health decisions
  • Access appropriate medical and preventative care
  • Take medications safely
  • Manage health conditions
  • Maintain healthier lifestyles

Role of this Document in Supporting Health Literacy

To support this, VA Librarians and Veterans Health Education Coordinators created this guide to provide VA staff with strategies for conveying medical information clearly, thereby improving patient understanding and satisfaction. The guide includes resources to help health care professionals bridge the gap between medical terminology and patient comprehension, enhancing overall health literacy among Veteran patients.

Note: Topics noted with an asterisk (*) indicate internal VA websites available only to VA Staff.

If further guidance is needed, please reach out to your facility Veteran Health Education Coordinator* or VALNET Librarian.

For remote access to the VHA Desktop Library, please request remote access.

Breakdown of Health Literacy

Chapter 1: Organizational Health Literacy

As primary sources of health information and services, organizations play a critical role in reducing barriers, simplifying systems, and improving access to care. Consistently personalizing health information based on everyone's health literacy level across all points of care is crucial.

Organizational health literacy directly influences personal health literacy (ODPHP, n.d.). Aligning both to support patient-centered care can decrease health disparities, improve public health, and promote the development of health-literate organizations (Pelizzari et al., 2025).

Many resources are available to organizations on their journey toward becoming health-literate health care entities. A brief resource list is provided below:

Chapter 2: Cultural Health Literacy and Cultural Competency

Racial and ethnic health disparities contribute to poorer health outcomes and lower quality of care. Cultural health literacy is the ability of individuals from diverse cultural and linguistic backgrounds to find, understand, evaluate, and use health information and services in ways that respect their cultural beliefs, values, and communication styles (CDC, 2024). It integrates health literacy and cultural competence to ensure information and care are clear, accessible, and culturally appropriate so that these health disparities are addressed (Center for Health Care Strategies, 2013).

The following resources offer guidance on considering cultural differences when building effective relationships with patients from racial and ethnic minority populations, as well as American Indians and Alaska Natives.

Chapter 3: Digital (eHealth) Health Literacy

Digital health literacy (or eHealth literacy) is defined as "the ability to seek, find, understand, and appraise health information from electronic sources and apply the knowledge gained to address and solve a health problem" — includes telehealth, patient portals, apps, AI-driven tools, and wearable devices (Seidel, et al., 2023, p. 1). By proactively assessing needs, simplifying digital tools, providing support, and integrating digital literacy into care pathways, clinicians can reduce disparities, enhance patient engagement, and contribute to better health outcomes (Soares et al., 2024).

Patient portals and eHealth platforms are used to teach patients to schedule appointments, view results, and access trustworthy resources which boost their digital health literacy and support informed decision-making (Johnson, et al., 2023).

The below resources help show how integration of digital tools can help improve healthcare delivery and patient access to digital information:

Chapter 4: Artificial Intelligence in Health Literacy

Artificial Intelligence (AI) is transforming health literacy by making health information more accessible, personalized, and effective. It includes generative AI, machine learning, and systems that function with minimal human oversight (VHA Chief AI Officer Team, 2025). In healthcare, AI supports clear, tailored communication, answers questions in simple terms, and helps clinicians create culturally appropriate material, but users must scrutinize information received due to limitations and inaccuracies of AI content.

AI Chatbots

AI chatbots, or conversational agents, have emerged as significant tools in health care, driven by advancements in artificial intelligence and digital technology. These programs are designed to simulate human conversations, addressing various health care needs and can improve health literacy by delivering clear, understandable information and guiding patients toward informed decisions. Their effectiveness depends on design quality and user trust.

Strategies and Tools to Create and Assess Materials and Patients

Chapter 5: Strategies for Developing Health Literate Patient Education Materials

Health education materials become more effective, inclusive, and actionable by using clear language, plain words, logical structure, thoughtful design, and interactive tools. These practices help patients make informed decisions and confidently follow care plans. The following best practices, tools, resources, and guidelines can assist in creating informative and user-friendly educational materials by addressing language complexity, style, and visual aspects.

Chapter 6: Assessing Document Readability

Overly complex materials can cause misunderstandings, poor treatment adherence, and worsen health outcomes. Patient educational materials are recommended to be written at no higher than an 8th grade reading level. Therefore, readability checks ensure educational materials are clear, concise, and accessible, and at an appropriate readability level, reducing barriers for those with limited literacy skills.

The following links provide evidence-based tools to help assess document readability:

Chapter 7: Assessing Patient Health Literacy

Whether assessing patient literacy or the readability of patient education materials, these tools and toolsheds offer valid and reliable screening tools that can help identify patients at risk for low health literacy. In clinical settings, these tools allow clinicians to appropriately adapt their communication practices to the patient's health literacy level.

Chapter 8: Gathering Veteran Feedback and Establishing Focus Groups

It is important to use approved processes and established channels when gathering Veteran feedback. Focus groups should include members of the target audience. If the target audience is Veterans, it is similarly important to follow established VA methods of creating focused groups.

Tools to Help Patients Better Understand and Increase Engagement

Chapter 9: Increasing Patient Engagement in their Health Care

Engaged patients actively participate in their healthcare by understanding their conditions, managing treatments, and collaborating with providers through shared decision-making, goal setting, and transparent communication (CDC, 2023). Empowering patients requires giving them the information, tools, and support needed to take charge of their health. While healthcare is a team effort, the patient remains central; their active involvement is essential for achieving health goals.

To optimize each visit, patients should prepare questions in advance, confirm next steps before leaving, and fully comprehend resources and treatment options to advocate effectively for their care and maintain well-being. Below are resources with practical ways for patients to become more involved in their care:

Chapter 10: Safe Searching and Addressing Health Misinformation

Safe internet searching involves using secure search engines, verifying website credibility, enabling privacy settings, and being cautious with personal information. Addressing health misinformation is crucial as it ensures access to accurate, reliable health information, which is essential for informed decision-making. Health misinformation can lead to harmful practices, delayed treatment, and worse outcomes. Safe internet searching helps avoid harmful, unverified information and promotes informed decision-making and health literacy. By identifying and rejecting misinformation, users support public health efforts to combat false information and maintain trust in health information found online.

Lateral Reading

Vetting a website's authenticity involves reviewing trusted sources related to the site, not just its content, to validate the accuracy of the information. Anyone can post content online, which can lead to misinformation, bias, and poorly researched material. Using vetting methods ensures the information is reliable and trustworthy.

Evaluating Websites

The internet is unregulated, enabling authors to post any content, which may include inaccuracies, biases, or misleading information. Evaluating a website helps ensure the accuracy, reliability, quality, and safety of its content.

Quackwatch

Consumers can be misled by unproven health claims, expensive treatments, and harmful advice. This periodic newsletter highlights some of the ineffective and fraudulent treatments that may be offered to health care consumers.

Health Misinformation

Regularly evaluating information helps address erroneous beliefs, answer patient questions more competently, and promote good healthcare.

Health Biases

Recognizing and mitigating biases in care, which can be based on race, gender, age, socioeconomic status, or other factors, ensures equitable care and helps maintain patient trust and adherence to treatment plans.

How to Find Reliable Health Information

Research sources should be current, balanced, from reliable professionals, and peer-reviewed to support evidence-based care.

Chapter 11: Patient Education Resources

The first source for patient education material should be from VA or other federal agency resources. For additional materials, use trusted sources to access evidence-based, peer-reviewed information. Tailor information to Veterans' specific needs and assess readability by choosing plain language materials at appropriate reading levels, including multilingual options. Incorporate multimedia formats like videos and interactive tools to cater to different learning styles. Review patient feedback to refine selections, cross-check information for consistency, and ensure ethical and cultural sensitivity in all materials. The following vetted resources offer reliable information on multiple health topics:

Understanding Health Information and Conditions

These resources offer tips and easy-to-read information to help patients understand their health conditions and navigate health care options:

Chapter 12: Online Patient Education Videos

Clinical staff should assess each patient's ability and willingness to engage with video education and ensure accessibility. Patients may need full assistance to view videos, especially in a hospital setting, while others may access content independently on personal devices.

Chapter 13: Health Clip Art, Graphic Images, and Other Illustrations

Visual aids such as infographics, comics, and multilingual materials help accommodate patients with varying health literacy levels. Integrating clip art and infographics into printed materials simplifies instructions, highlights key steps, and supports patients with low literacy. Video and interactive content further enhance understanding of procedures, medications, and appointment preparation, especially when paired with captions or transcripts. By combining these visual tools strategically, clinicians can make health information more understandable, memorable, and actionable. Most resources are free to use, but it is important to review each site's copyright guidelines before incorporating them into patient education materials.

Chapter 14: Graphic Medicine

Graphic medicine is the intersection of comics and healthcare, utilizing graphic novels and comics to convey medical narratives and health-related information. It enhances understanding by combining visual and textual storytelling, making complex medical concepts more accessible and easier to digest. This approach is particularly effective in addressing health disparities, as it can be tailored to various cultural backgrounds and literacy levels, thus breaking down barriers to understanding. By presenting health information in an engaging and relatable format, it improves patient education and engagement, ultimately boosting confidence and self-efficacy in managing health conditions.

Graphic Medicine Novels

Graphic medicine novels can serve as valuable resources for healthcare professionals aiming to improve patient education. They cater to visual learners and are accessible to individuals with diverse literacy levels and linguistic backgrounds. These formats offer an engaging and innovative approach to conveying complex medical information in a clear and understandable way.

Chapter 15: Interactive and Immersive Virtual Reality Technologies

Interactive and immersive/virtual reality (VR) health tools improve health literacy by providing engaging, easy-to-understand, and actionable learning experiences. Interactive tools — such as mobile apps, checklists, quizzes, and decision aids — deliver personalized information that strengthens understanding and supports informed self-care. VR technologies create realistic simulations of medical situations, helping patients visualize procedures, practice coping strategies, and learn treatment routines in a safe environment. These approaches reduce information overload and support different learning styles (Adeghe et al., 2024).

Key health literacy benefits for these tools include:

  • Simplifying complex concepts through visual, hands-on learning
  • Improving retention and confidence through active engagement
  • Supporting behavior change by allowing safe practice of health routines
  • Reducing anxiety by familiarizing patients with procedures ahead of time

By integrating interactive and immersive VR platforms like those listed below, healthcare teams can offer accessible, patient centered education that enhances comprehension, engagement, and outcomes across diverse VA patient populations.

Staff References

Chapter 16: Books, Ebooks, Journals, and Journal Articles

To strengthen understanding of health literacy principles, it is essential to use reputable libraries and trusted databases to access peer-reviewed, evidence-based books, journals, and articles. Verifying the credibility of sources, selecting works authored by qualified healthcare professionals or academic experts, and ensuring content is current by reviewing publication dates are critical steps. Prioritizing materials that reflect the latest research and guidelines, presented in clear and accessible language, enhances comprehension. By applying these strategies, learners can deepen their understanding of health literacy and appropriately integrate this knowledge into professional practice.

Books and ebooks further support clinician education by establishing foundational frameworks and defining the key dimensions of health literacy. The following are available on the VA Library Network; please request remote access.

Books

  • Lega, F., & Kreutzer, P. (2023). Building and improving health literacy in the 'new normal' of health care: Frameworks and actions. Emerald Publishing Limited.
  • Osborne, H. (2011). Health Literacy From A to Z. Jones & Bartlett Publishers.
  • Rudd, R. E., Anderson, J. E., Oppenheimer, S., & Nath, C. (2023). Health literacy: an update of medical and public health literature. In Review of Adult Learning and Literacy, Volume 7 (pp. 175–204). Routledge.

Ebooks

Journals

Journal Articles

Chapter 17: Websites

Websites play an important role in learning about health literacy concepts because they provide quick, accessible, and up-to-date information. Many reputable organizations — such as government agencies, academic institutions, and healthcare systems — publish clear, evidence-based resources online that help users understand health terminology, navigate healthcare systems, and evaluate information quality. Websites also allow learners to explore multimedia tools, interactive modules, and real-world examples that reinforce key concepts.

Chapter 18: Podcasts, Trainings, Webcasts, Workshops, and Community of Practice Calls

Health literacy podcasts, trainings, webcasts, workshops and community of practice calls feature expert interviews, case studies, interactive tools, and CE credit opportunities, and these resources can empower clinicians to improve patient understanding, engagement, and outcomes.

Podcasts

Trainings

Webcasts, Workshops & Community of Practice Calls

Chapter 19: Online Videos for Clinicians

Research indicates that online videos for healthcare professionals enhance knowledge, attitudes, skills, and professional practices. Patient-centered health literacy videos are particularly effective in supporting the development of clinical reasoning and communication competencies. Additionally, evidence suggests that the use of online videos is associated with improved clinical outcomes.

References

Adeghe, E. P., Okolo, C. A., & Ojeyinka, O. T. (2024). A review of the integration of virtual reality in healthcare: Implications for patient education and treatment outcomes. International Journal of Science and Technology Research Archive, 6(1), 79–88.

Centers for Disease Control and Prevention. (2026). Find training. https://www.cdc.gov/health-literacy/php/find-training/get-training.html

Centers for Disease Control and Prevention. (2024). Culture and language. https://www.cdc.gov/health-literacy/php/develop-materials/culture.html

Center for Health Care Strategies. (2013). Fact sheet #3: Health literacy and the role of culture. https://www.chcs.org/media/Health_Literacy_Role_of_Culture.pdf

Gonçalves-Fernández, M. L., & Pino-Juste, M. (2025). Health literacy in healthy adults: A systematic review of recent evidence. Atencion Primaria, 57(11), 103300. https://doi.org/10.1016/j.aprim.2025.103300

Johnson, A. M., Brimhall, A. S., Johnson, E. T., Hodgson, J., Didericksen, K., Pye, J., Harmon, G. J. C., & Sewell, K. B. (2023). A systematic review of the effectiveness of patient education through patient portals. JAMIA Open, 6(1). https://doi.org/10.1093/jamiaopen/ooac085

Office of Disease Prevention and Health Promotion. (n.d.). Health literacy in Healthy People 2030. In Healthy People 2030. U.S. Department of Health and Human Services. https://odphp.health.gov/healthypeople/priority-areas/health-literacy-healthy-people-2030

Pelizzari, N., Covolo, L., Ceretti, E., Fiammenghi, C., & Gelatti, U. (2025). Defining, assessing, and implementing organizational health literacy: Barriers, facilitators, and tools – A systematic review. BMC Health Services Research, 25(1). https://doi.org/10.1186/s12913-025-12775-w

Seidel, E., Cortes, T., & Chong, C. (2023). Strategies to improve organizational health literacy. PSNet. Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services. https://psnet.ahrq.gov/primer/strategies-improve-organizational-health-literacy

Soares, S., Hoffmeister, L. V., Fernandes, M. D. F., Henriques, A., & Costa, A. (2024). The use of digital technologies in the promotion of health literacy and empowerment of informal caregivers: Scoping review. JMIR Aging, 7, e54913. https://doi.org/10.2196/54913

Transforming the Veterans Health Administration into a health literate care organization. (2025). Journal of Communication in Healthcare, 18(4). https://doi.org/10.1080/17538068.2025.2577062

U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. (2010). National Action Plan to Improve Health Literacy. Washington, DC. Based on data from: National Center for Education Statistics. (2006). The Health Literacy of America's Adults: Results from the 2003 National Assessment of Adult Literacy (NCES 2006-483).

Appendix: Abbreviations

ADA
American with Disabilities Act
AHRQ
Agency for Health Research and Quality
CDC
Centers for Disease Control and Prevention
GSA
General Services Administration
HHS
Department of Health and Human Services
IHI
Institute for Healthcare Improvement
NCP
National Center of Health Promotion and Disease Prevention
NIA
National Institute on Aging
NIH
National Institutes for Health
NLM
National Library of Medicine
NNLM
Network of the National Library of Medicine
OASH
Office of the Assistant Secretary for Health
ODPHP
Office of Disease Prevention and Health Promotion
PCL
Patient Centered Learning
PEMAT
Patient Education Materials Assessment Tool
VA
Department of Veterans Administration
VALNET
VA Library Network
VHEC
Veteran Health Education Coordinator
VHL
Veterans Health Library
VR
Virtual Reality
WHO
World Health Organization

Acknowledgement

We'd like to extend special thanks to Janet Schneider for her invaluable contribution in creating "Health Literacy Resources." We are also deeply appreciative of the collaborative efforts of Mason Baldwin, Jessie Casella, Lucinda Edwards, Jennifer Pickerell, Thomas Keeler, and Jane Rish, who assisted Janet in the development of these resources in 2018, and Dr. Bianca Brilliant, Jennifer L. Coale, Mary L. Jakoby, Dr. Patricia L. Lasher, Muswamba Muvundamina, Heidi Patterson, Dr. Heather Roth, Amy D. Vandewalker, and Dr. Erica Wilson who updated the document in 2023. Furthermore, we express our gratitude to Vincent Slatt and Angela Sankarkumar for their pivotal roles in assembling the most recent Health Literacy Workgroup to update and maintain the resource to ensure its continued relevance.

This is a work of the U.S. Government and is not subject to copyright protection in the United States. Foreign copyrights may apply. Non-governmental resources are provided for educational purposes and do not indicate endorsement.

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