Content guide - Health literacy

NHS services are for everyone. But many adults in the UK have low health literacy skills. This means they struggle to read and understand medical content intended for the public.

What is health literacy?

Health literacy is about a person's ability to understand and use information to make decisions about their health.

A user with low health literacy will generally struggle to:

• read and understand health information
• know how to act on this information
• know which health services to use and when to use them

Research shows that:

• more than 4 in 10 adults struggle with health content for the public
• more than 6 in 10 adults struggle with health content that includes numbers and statistics

This is because a lot of health content is written, often unintentionally, for people with higher health literacy skills.

Why health literacy is important

Low health literacy has been linked to a range of important problems.

These include:

• unhealthy lifestyles and poor general health
• low use of preventative services, like vaccinations and screening
• difficulty taking medicines correctly
• increased A&E attendances and hospital admissions
• reduced life expectancy

It's estimated that health literacy-related problems like these account for up to 5% of national health spending.

Health literacy is also a health inequality issue. There is a close link between socio-economic deprivation and low health literacy.

Examples of problems caused by low health literacy

Here are some real examples where low health literacy caused an issue:

• a woman who sprayed her inhaler on her neck because she had been told to spray it on her "throat"
• a man who did not turn up for cancer tests because he did not know Radiology and X-ray department were the same thing
• a man with diabetes who decided to stop taking his medicine because he had trouble understanding the instructions
• a woman who thought chemotherapy would not help because it was given into a vein on the other side of the body to where her cancer was

It's easy to see from this how miscommunication of health information could be very serious, and how clearer information could help.

How you can create better content

You can help reduce the problems caused by low health literacy by making sure your content is written at a level most users can understand.

You can do this by:

• following the NHS design principles when you create content
• following our advice how to write for NHS digital services
• doing user research with users who have low health literacy

We've found that doing these things benefits all users, not just those with low health literacy.

Readability tools

We do not recommend readability tools, except to help you prioritise your content. Tools cannot tell you how usable your content is. It's best to test it with your users.

If you want a tool to help you write clearer, more usable content, you could try the Hemingway Editor. It will show you where you have long sentences, complicated words, adverbs or the passive voice.

Read more about this

• NHS Knowledge and Library Services: health information (includes health literacy toolkit)
• US Office for Disease Prevention and Health Promotion: Health literacy online

Help us improve this guidance

Share insights or feedback and take part in the discussion. We use GitHub as a collaboration space. All the information on it is open to the public.

Read more about how to feedback or share insights.

If you have any questions, get in touch with the service manual team.

Updated: October 2023