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Starting to identify patients with limited health literacy

Health care providers should be able to identify “red flags” mostly present in patients with limited health literacy.
Red flag

While exploring the content of the systematic review, we have focused on the patient’s perspective. What about that of the health professional?

If a Universal Precautions approach is to be used, then all interactive communication should be clear and understandable for everyone. Nevertheless, when considering person-centred interaction, it can be of benefit for healthcare providers to tailor their communication to individual patients’ communication and information needs. This is especially so, as health professionals often underestimate patients/clients’ health literacy abilities (Kelly & Haidet, 2007) and at the same time patients/clients often over report their level of ability in relation to health literacy (Kirsch et al., 2005).

This suggests it would be helpful for health professionals to have some idea of a patients’ health literacy abilities, so they can adapt their practice accordingly when applying what we have discussed about the person-centred approach in previous steps.

For instance, if the healthcare provider could notice that a patient probably has limited health literacy, then the healthcare provider could understand how this patient might feel during consultations. Knowing limited health literacy patients usually avoid asking questions because they can feel ashamed to do so, the healthcare provider can specially focus on effectively communicating with the patient. This can be done by using clear and realistic information to improve understanding, so when shared decisions over their health have to be made, the patient can make an informed decision. This is all an example of the engagement healthcare providers could have if they can identify patients with limited health literacy, engagement that can lead to a better carer-patient partnership.

Red flags

An approach taken on how the healthcare provider can get insight into the health literacy of patients can be found in one of the online resources suggested by the Universal Precautions Toolkit we reviewed before. Additionally, you were introduced to “warning signs” present in patients who might have limited health literacy. When those red flags are present, they should help us know that we need to adapt our practice:

  1. Frequently missed appointments. Patients may be unable to understand the appointment slip or don’t have a reminder system set on.
  2. Incomplete registration forms. This could mean the form is too complicated for the patient.
  3. Non-compliance with medication. Patients seem not to understand the importance of the medication or not know they should get more medication even if the bottle is empty.
  4. Unable to name medications, explain purpose or dosing.
  5. Identifies pills by looking at them, not reading labels. This could be because they can’t read that well.
  6. Unable to give coherent, sequential history. Patients may have had trouble at school, so they don’t know how to present a coherent story.
  7. Ask fewer questions. This could mean the patient is hiding the fact that they don’t understand.
  8. Lack of follow-through on tests or referrals. Maybe the patient does not know how to interpret the tests or the scheduled follow-up works.

Have you had any experience with patients presenting any of these red flags? Did you think they did this because they did not care for their health? We invite you to reflect on that, and if you want, you can leave a comment with your thoughts.

Find out more about red flags here. Here you will also find information on hidden barriers and practical strategies.


Jager, M., de Zeeuw, J., Tullius, J., Papa, R., Giammarchi, C., Whittal, A., & de Winter, A. F. (2019). Patient Perspectives to Inform a Health Literacy Educational Program: A Systematic Review and Thematic Synthesis of Qualitative Studies. International journal of environmental research and public health, 16(21), 4300.

Kelly, P. A., & Haidet, P. (2007). Physician overestimation of patient literacy: a potential source of health care disparities. Patient education and counseling, 66(1), 119-122.

Kirsch, I.S., Jungeblut, A., Jenkins L, & Kolstad A. (2005). Executive summary of adult literacy in America: A first look at the results of the National Adult Literacy Survey.

© IMPACCT consortium
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Working with Patients with Limited Health Literacy

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