Guide · updated 2026-10-08
Health literacy: a practical guide for healthcare organizations
What health literacy is, why it matters, what the standards measure, and how organizations improve the materials people receive.
Send a blank template, not a copy with a patient's or member's details.
In 30 seconds
- Health literacy has two sides: what a person can do with health information, and what an organization does to make it easy to find, understand and use.
- Most adults in the US do not have proficient health literacy. The share is higher among people on Medicare and Medicaid.
- A grade level shows only whether text can be read. Standards such as N-PLAT and PEMAT, and testing with readers, show whether people understand it and can act on it.
- Rules such as Section 1557, 42 CFR 438.10 and the ADA Title II and Section 504 web rules ask for clear or accessible communication.
What health literacy is
Health literacy has two sides. One is what a person can do with health information. The other is what an organization does to make that information easy to find, understand and use. Healthy People 2030 defines both.
- Personal health literacy
- “the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others” Healthy People 2030
- Organizational health literacy
- “the degree to which organizations equitably enable individuals to find, understand, and use information and services to inform health-related decisions and actions for themselves and others” Healthy People 2030
- The earlier definition
- “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions” Institute of Medicine, Health Literacy: A Prescription to End Confusion (2004)
Why it matters
Most adults in the US do not have proficient health literacy, and the share is higher among people on Medicare and Medicaid. When people can't understand what they are told or sent, they are less able to take medicines correctly, use preventive care or follow instructions after a visit. AHRQ PSNet, Health Literacy primer
- 12%
- of US adults had proficient health literacy
- NAAL 2003, reported in Kutner et al., NCES 2006-483, 2003
- 36%
- of US adults had Basic or Below Basic health literacy
- NAAL 2003, reported in Kutner et al. (2006), 2003
- 57%
- of Medicare enrollees had Basic or Below Basic health literacy
- NAAL 2003, reported in Kutner et al. (2006), 2003
- 60%
- of Medicaid enrollees had Basic or Below Basic health literacy
- NAAL 2003, reported in Kutner et al. (2006), 2003
- 28%
- of US adults aged 16–65 scored at or below Level 1 in general literacy, up from 19% in 2017
- NCES PIAAC, 2023 cycle (released 2024), 2023
- 78%
- of emergency-department patients showed gaps in understanding at least one part of their care or discharge instructions
- Engel et al., Annals of Emergency Medicine, 2009
- 27.7%
- of health center patients are best served in a language other than English
- HRSA Uniform Data System, 2024
The financial case
These are national estimates, not a forecast for your organization. To size your own case, start from your own volumes and costs. Build an estimate from your numbers
- $106–$238 billion
- a year: the cost of low health literacy to the US economy
- Vernon et al., Low Health Literacy: Implications for National Health Policy, 2007
- About 50%
- of patients with long-term conditions don’t take medicines as prescribed
- World Health Organization, Adherence to Long-Term Therapies, 2003
- About $290 billion
- a year in avoidable US costs is linked to medication non-adherence
- NEHI (New England Healthcare Institute), 2009
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Achieving it
Proven practices
Plain language.
Lead with what the reader needs to do. Use common words, short sentences and active voice.
Teach-back.
Ask people to explain in their own words what they need to know or do, then clarify and check again.
Universal precautions.
Assume anyone may have trouble understanding, and make every communication clear for everyone.
AHRQ, Health Literacy Universal Precautions Toolkit, 3rd edition (2024)
The SHARE approach.
A five-step method for shared decision-making that helps people weigh their options.
Standards at a glance
| Standard | What it measures | Scoring | Source |
|---|---|---|---|
| PEMATAHRQ (2013) | How understandable and actionable patient education materials are, in print and audiovisual form | 0–100% for understandability and for actionability | AHRQ, the Patient Education Materials Assessment ToolOur PEMAT page |
| SAMDoak, Doak and Root | How suitable materials are: content, literacy demand, graphics, layout, learning stimulation and cultural fit | 0–39% not suitable, 40–69% adequate, 70–100% superior | Doak, Doak and Root, Teaching Patients with Low Literacy Skills (SAM chapter) |
| CDC Clear Communication IndexCDC | Research-based items on the main message, calls to action, language, numbers and risk | A percentage of the items that apply; 90 or higher passes | CDC, the Clear Communication Index |
| N-PLATIHA (Institute for Healthcare Advancement) | Plain-language assessment of the text and design of health materials | Item by item against the N-PLAT criteria | IHA AcademyOur N-PLAT page |
Reading-level targets
- AMA: Grade 6 or lower. PubMed Central, readability formulas in patient education research
- NIH: Grade 8 or lower. NIH, Clear Communication: Health Literacy
A grade level answers only whether text can be read. Whether people understand it and can act on it needs the standards above, and testing with readers.
Use cases
- Health plans
- Member notices, renewal letters, approval-before-care letters and gap-in-care outreach.
- Health systems
- Discharge instructions, consent forms and patient education.
- Public health and Medicaid agencies
- Eligibility and renewal notices, in the languages people speak.
- Pharmaceutical companies
- Patient materials and plain-language summaries.
Regulations
Rules that ask for clear or accessible communication. Each row was reviewed on 2026-10-08.
The rules add up: each bar starts when its rule applies
Upcoming
ADA Title II web and document accessibility
State and local government entities serving a population of 50,000 or more
DOJ interim final rule, 91 FR 20902 (Federal Register 2026-07663) · checked 2026-10-08
Upcoming
HHS Section 504 web and document accessibility
Recipients of HHS funding with 15 or more employees
HHS interim final rule, 45 CFR 84.84(b) (Federal Register 2026-09266) · checked 2026-10-08
Upcoming
ADA Title II web and document accessibility
Smaller state and local government entities and special districts
DOJ interim final rule, 91 FR 20902 (Federal Register 2026-07663) · checked 2026-10-08
Upcoming
HHS Section 504 web and document accessibility
Recipients of HHS funding with fewer than 15 employees
HHS interim final rule, 45 CFR 84.84(b) (Federal Register 2026-09266) · checked 2026-10-08
Plain Writing Act of 2010
Pub. L. 111-274 · Enacted 2010-10-13
Requires federal agencies to write the documents they issue to the public in clear, plain language.
ACA Section 1557, 2024 final rule
45 CFR part 92; notice of availability at 45 CFR 92.11 · Effective 2024-07-05
Nondiscrimination in health programs and activities, including language access and effective communication.
Medicaid managed care information requirements
42 CFR 438.10 · In effect since the 2016 managed care final rule, as amended
Information for enrollees must be easy to understand, with taglines and help in other languages and formats.
ADA Title II web and document accessibility
28 CFR part 35; DOJ interim final rule, 91 FR 20902 (2026-04-20) · Compliance 2027-04-26 (population 50,000 or more); 2028-04-26 (smaller entities and special districts)
State and local government web content and documents must meet WCAG 2.1 AA.
HHS Section 504 web and document accessibility
45 CFR 84.84(b); HHS interim final rule (2026-05-11) · Compliance 2027-05-11 (15 or more employees); 2028-05-10 (fewer than 15)
Recipients of HHS funding must make web content and documents meet WCAG 2.1 AA.
Applicability depends on the entity, funding, content, and relevant exceptions. These dates do not mean existing accessibility obligations are suspended. This guide is general information, not legal advice.
AI and technology
General-purpose AI tools can simplify text when asked. On their own they do not score text against health-literacy standards, check that a rewrite kept its meaning, or record who approved it. Whatever tool you use, a qualified person should review AI output before it reaches patients or members.
How a built-for-healthcare tool differs from general-purpose AIHow HealthLiteracyCopilot helps
HealthLiteracyCopilot scores content against N-PLAT and PEMAT, revises it toward your target grade with a meaning check, applies your organization's rules, and keeps a record of every approval. A person approves every change. HealthLiteracyCopilot is a HealthcareGPS product, with health literacy standards by Institute for Healthcare Advancement (IHA).
See the Platform MapQuestions
What is health literacy?
Healthy People 2030 describes two sides: personal health literacy, what people can do with health information, and organizational health literacy, what organizations do to make information easy to find, understand and use.
What reading level should patient materials be written at?
The AMA recommends grade 6 or lower, and NIH recommends grade 8 or lower. A grade level shows only whether text can be read, so pair it with a standard such as PEMAT.
What is the difference between PEMAT and a readability formula?
A readability formula estimates a grade from word and sentence length. PEMAT rates whether material is understandable and actionable, item by item.
What is teach-back?
A way to check understanding: you ask people to explain in their own words what they need to know or do. AHRQ includes it in its Health Literacy Universal Precautions Toolkit.
Does the Plain Writing Act apply to private health plans?
The act applies to federal agencies. Other rules, such as Section 1557 and the Medicaid managed care rules, may apply to plans and providers. Applicability depends on the entity, funding and content.
Can AI make content health literate?
AI can help draft and revise. A qualified person should still review each change, and the result should be checked against standards and, where possible, with readers.
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