Table 2 List of health literacy knowledge

K1. knows that years of educational attainment is an inadequate marker for health literacy skills

K2. knows which kinds of words, phrases, or concepts may be jargon to patients

K3. knows that cultural and linguistic differences between patients and health care professionals can magnify health literacy issues

K4. knows that adults with low literacy tend to experience shame, and hide their lack of skills from health care professionals

K5. knows that “you can’t tell who has low health literacy by looking”

K6. recognizes “red flag” behaviors which may suggest a patient has low health literacy

K7. knows that health literacy is context-specific; individuals with high general literacy may have low health literacy

K8. knows that transition points, or “hand-offs” in health care (e.g., moving from in-patient to out-patient settings) are especially vulnerable to patient communication errors

K9. knows rationale for, and principles underpinning the need for a universal precautions approach to all health communication interactions

K10. knows best practice principles of plain language and clear health communication for oral and written communication

K11. knows examples of the direct relationship between health literacy and

 • knowledge about one’s chronic disease(s) and medications

 • adherence to medications and treatment plans

 • receipt of preventive health services

 • health outcomes or risk of harm

K12. recognizes potential legal implications for inadequately conveying health information to patients with low literacy or health literacy

Items not retained

 • knows one or more definitions of health literacy

 • knows the basic literacy skill domains (reading, writing, speaking, listening, numeracy), and gives examples of health care related demands put on patients for each domain, including difficulties navigating health care systems

 • knows the difference between the ability to read, and reading comprehension, and why general reading levels do no not ensure patient understanding

 • estimates the prevalence of low literacy (or low health literacy) among adults, and knows that certain subgroups are at increased risk

 • knows that the average adult reads at an 8th–9th-grade reading level, but that most patient education materials are written at a much higher reading level

 • knows that tools are available for estimating individuals’ health literacy skills, but that routine screening for low health literacy has not been proven safe or acceptable

 • knows that health literacy may decrease during times of physical or emotional stress

 • knows that everyone, regardless of literacy level, benefits from and prefers clear plain language communication

 • knows that patients learn best when a limited number of new concepts are presented at any given time

 • recognizes potential legal implications for inadequately conveying health information to patients with low literacy or health literacy

 • knows that low health literacy has been associated with excess healthcare costs

 • knows that community resources exist for helping adults improve their general literacy skills