Registered Nurses' Association of Ontario

Principles of Health Literacy

Health Literacy

  • Health literacy is “the ability to access, understand, evaluate and communicate information as a way to promote, maintain and improve health in a variety of settings across the life-course.” .
  • Health literacy is dependent on person and system factors, including:
  • Knowledge of health topics,
  • Culture,
  • Mother language,
  • Age,
  • Literacy and numeracy, and
  • Communication skills of health-care providers.
  • Persons who have low health literacy may lack the skills necessary to manage their own care and navigate the health-care system. They are more likely to have chronic medical conditions, be admitted to hospital, have higher use of the emergency department, and rate their health as poor.



Plain Language

Plain language is a strategy to make written and oral information easier to understand, and is an important tool for improving health literacy.

Key elements of plain language include:

  • Organizing information so the most important points are first;
  • Breaking up complex information into smaller segments that are easier to understand;
  • Using simple, everyday language;
  • Omitting unnecessary words;
  • Avoiding medical jargon, and defining any complex terms or medical terminology that does need to be used;
  • Using headings, lists, and tables to make reading easier;
  • Using the active rather than the passive voice;
  • Focusing on behaviour rather than on underlying medical principles;
  • Using visuals to convey a message, not simply to decorate a page; and
  • Using a minimum 12-point font and avoiding all capitals, italics, and fancy fonts.


Teach-Back Method

  • Teach-back is a method that places the accountability for learning on the provider. It engages the person (or key learner) in a shame-free manner by asking him to repeat, in his own words, what was just explained.
  • This creates an opportunity for the provider to clarify any miscommunication or misunderstanding, and to evaluate the effectiveness of the education in a way that engages the person and their family. For example, after educating the person on different types of inhalers, the provider may ask: “Please tell me when you would use your blue rescue inhaler?”
  • When closing the conversation, open-ended questions are preferred over yes/no questions, as they open the dialogue and let the person know that you expect them to have questions about the material taught. For example, asking: “What questions do you have for me?” is preferable to asking, “Do you have any questions?”
  • For further information on health literacy and facilitating learning, please refer to the RNAO BPG Facilitating Client-Centred Learning .
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