Health Literacy

Health Literacy in Treating Substance Use Disorders and Mental Health 

Healthcare professionals in the fields of substance use disorder and mental health are often responsible for communicating health messages to clients and patients. Whether you’re a therapist, nurse, psychiatrist, counselor, or play another clinical role, you will likely be sharing information or discussing health with a client in verbal and written forms. As you’ve been going about your day to day, have you been considering health literacy?

What is Health Literacy? 

Health literacy is defined in the Patient Protection and Affordable Care Act of 2010 as “the degree to which an individual has the capacity to obtain, communicate, process, and understand health information and services in order to make appropriate health decisions.” Health literacy issues are common and can be found among people of any gender, race, age and socioeconomic status. Even those who normally have a high level of health literacy may experience a decrease in ability to understand and process information during moments of distress or illness.

Why is Health Literacy Important? 

Low health literacy is tied to poorer health. In a 2006 study, Lincoln and colleagues found that when looking at health literacy levels among people with alcohol and drug dependence, lower health literacy was associated with higher levels of depressive symptoms. Numerous other studies have found that low health literacy is associated with poorer health outcomes in critical aspects of health such as hospitalization rates, use of preventive services, and self-reported health.

How Can A Clinician Improve The Care They Provide Through Considering Health Literacy? 

We cannot see someone’s health literacy. The approach to health literacy in your clinical interactions could be likened in a way to the approach of trauma-informed care. Just as how you start from the standpoint that trauma could have occurred in the life of each individual you work with, it is also a good idea to start from the standpoint that there may be difficulties with each person’s capacity to navigate and integrate information related to health. There are things that you can do to keep health literacy in mind and set your clients and patients up for better understanding in a clinical environment.

Things You Can Do to Be a Proactive Provider for Health Literacy: 
  • Use “Plain Language.” In speaking and in writing. Whenever possible, avoid medical jargon, acronyms, long sentences, inconsistent terminology, and words with 3 or more syllables. offers comprehensive guidelines for using Plain Language.
  • Speak intentionally and not too quickly. When speaking quickly, you may be on to the next component of your message while a client is still processing the one before. Speaking quickly also creates an environment in which it is difficult for them to ask their questions.
  • Encourage questions and foster a shame-free environment. Make it clear in your behavior and state explicitly that you are receptive to questions and that all questions are valid ones.
  • Use the Teach-back Method. After presenting health information or instructions, ask the client to explain them back to you in their own words. Repeat this process until it is clear that the information you wanted to convey has been accurately conveyed. The Teach-back Toolkit is a great resource for information about how to do this well.
  • Offer aid when it comes to filling out forms and paperwork. Some clients may be feeling challenged by paperwork that others complete with ease. Be sure if you offer your assistance to do so in a way that does not make it seem like an unusual occurrence or in a way that invites shame.
  • Choose materials that have literacy in mind and revise any materials that do not. Check that the written materials you provide incorporate Plain Language guidelines. The average American audience requires materials written at a level of 6th grade or lower. Tools like the Flesch-Kincaid Grade Level Score can help you gauge the reading level of your materials. Microsoft Word has a document reviewing feature that allows you to easily see a text’s Flesch-Kincaid Grade Level Score.
  • Consider the possibility of low English proficiency (LEP). Perhaps the person you are speaking to or providing materials to is not comfortable in the language you are using. They may need an interpreter or access to a clinician or counselor who speaks the language that they are the most comfortable using.
  • As the provider, take the responsibility for communicating clearly. Between the two of you, you are the one who is most familiar with the health information that you are sharing and it is your responsibility to convey it in a way that the client can understand and use. When you both walk away from the interaction, it is the client’s own understanding of the material that will make the difference in their health.

These are all great strategies that can offset some of the communication and processing issues that can arise when an individual experiences low health literacy. While it’s best to have these as a foundation in all interactions that involve communicating health information, sometimes you may observe particular signs that an individual may be struggling with health literacy. Presence of such signs would suggest a need to increase your sensitivity and attention to ensuring that the information you want to give is what is being received.

Things to Watch For That May Indicate Low Health Literacy: 
  • Difficulty explaining a medical condition or illness
  • Medication or treatment non-compliance
  • Lack of clarity about medications or steps
  • Not asking questions at all
  • Seeking help late
  • Becoming angry, demanding, walking out, or using humor to redirect attention
  • Possible confusion over written material or clearly bringing them home for family to help interpret
  • Incomplete forms
  • Missed appointments/skipped referrals/skipped tests

Whether this is new information for you or simply a nice reminder, keep these skills and guidelines in your repertoire as you’re communicating health messages and information. When you do so, you will be offering more inclusive care and preventing gaps in understanding.

If you are interested in diving deeper into this subject, we encourage you to check out the following: 
  • Plain Language slideshow – Slides from a presentation by the Minnesota Health Literacy Partnership that include more tips on how to use Plain Language
  • Plain Language Medical Dictionary – A database with plan language alternatives for 1808 terms from the University of Michigan Library
  • Health Literacy Out Loud Podcast – Available most ways that you can find podcasts. Features episodes such as “Deconstructing Stigma: A Very Public Multimedia Project about Mental Illness” and “Talking with Children about Troublesome Family Issues”
  • Institute for Healthcare Advancement – Offers resources such as an annual conference, printed materials, and a discussion forum
  • Health Literacy in Action’s Health Literacy Annual Research Conference (HLiA-HARC) – A virtual event being held October 20-21, 2020
  • Any of the sources listed below


Disclaimer: THIS article DOES NOT PROVIDE MEDICAL ADVICE. The information contained herein is not intended to be a substitute for, or to be relied upon as, medical advice, diagnosis, or treatment. This article is for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.


Behaviors Indicating Problems [Video from a series]. (2010). The challenges of healthcare literacy. Medcom, Inc.
Berkman, N.D., Sheridan, S.L., Donahue, K.E., Halpern, D.J., & Crotty, K. (2011).
Low health literacy and health outcomes: An updated systematic review. Annals of Internal Medicine, 155(2), 97-107.
Brach, C., Keller, D., Hernandez, L.M., Baur, C., Parker, R., Dreyer, B., Schyve, P., Lemerise, A.J., & Schillinger, D. (2012). Ten attributes of health literate health care organizations. National Academy of Sciences.
Lincoln, A., Paasche-Orlow, M.K., Cheng, D.M., Lloyd-Travaglini, C., Caruso, C., Saitz, R., & Samet, J.H. (2006). Impact of health literacy on depressive symptoms and mental health-related: Quality of life among adults with addiction. Journal of General Internal Medicine, 21(8), 818-822.
Nielson-Bohlman, L., Panser, A.M., & Kindig, D.A. (Eds.). (2004). Health literacy: A prescription to end to confusion. National Academies Press. Parnell, T. (2014).
Health literacy in nursing: Providing person-centered care. Springer Publishing Company. ProQuest Ebook Central
Patient Protection and Affordable Care Act, 42 U.S.C. § 5002 (2010).