The World Health Organisation (WHO) defines health literacy as:

The cognitive and social skills which determine the motivation and ability of individuals to gain access to, and understand and use information in ways which promote and maintain good health.[#world-health-organisation.-2009]

According to the Australian Bureau of Statistics, 60% of Australians lack basic health literacy skills. [#australian-bureau-of-statistics-2009] In patients with chronic conditions, inadequate health literacy is associated with poor knowledge of their disease and medications.[#buchbinder-r-batterham-r-ciciriello-s-et-al.-2011] Patients with inadequate health literacy skills may be difficult to identify; they may be verbally articulate but unable to grasp disease concepts or understand their medications.

Risk factors for inadequate health literacy include patients who:

• Are elderly
• Have low income
• Did not finish high school
• Are in a minority ethnic group
• Speak English as a second language
• Are recent immigrants

Health literacy communication principles:

• Use plain language
• Include visual images
• Limit the amount of information provided at one time and repeat it
• Encourage questions

Developing printed education materials for patients

Design:

• Make sure the purpose is clear to the patient
• Use at least 12-point type font
• Write in the active voice
• Aim for year 5-6 reading level

Organisation:

• Keep content clear, simple and concise
• Use one- and two-syllable words understood by intended reader
• Use short sentences with one idea to a sentence
• Use short paragraphs; discuss important ideas first
• Focus content on what the patient should do
• Provide examples
• Avoid jargon; define medical terminology
• Base content on the patient’s information needs
• Ensure content is evidenced-based
• Ensure information is up to date by including a publication date
• Acknowledge sources of information

Layout:

• Use a structured format with clear headings
• Use bullet points

Presentation:

• Use adequate spacing with adequate white space
• Use dark print on a light background
• Use illustrations that are recognisable, clearly labelled, informative and complementary to the written text