Barriers to Achieving Health Literacy

February 2026 | Vol. 70, No. 1
By Angela Zawisza, DO, DMUCOM '07

“I don’t know how my parents would have managed this if I wasn’t a physician.”

This statement came from a colleague of mine, as we were discussing her father’s recent heart attack and my own father’s traumatic hemopneumothorax and subsequent hospitalizations. I echoed her sentiments, and my mind started down the rabbit hole of health care literacy in the United States.

The definition of health care literacy changed with the release of the US Government’s Healthy People 2030 initiative, compared to the Healthy People 2010 and 2020 definition. According to the newest initiative, health care literacy is defined as the following:

  • “Personal health literacy is 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.
  • Organizational health literacy is 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.”

The changes in the definition, according to the CDC, “emphasize people's ability to use health information rather than just understand it, focus on the ability to make ‘well-informed’ decisions rather than ‘appropriate’ ones, acknowledge that organizations have a responsibility to address health literacy, and incorporate a public health perspective.”

Why does health literacy matter? There is a clear, direct correlation between health literacy and health equity, which is defined as the attainment of the highest level of health for all people. Health equity can only be achieved when there is a high level of health literacy among all our patients.

Health care literacy relies on trust, something that is much harder to come by these days with the interference of social media and the spread of misinformation. As physicians, we all try our best to communicate with our patients and to educate them as much as possible, with the time constraints imposed on us. It is part of our osteopathic training to NOT treat every patient identically and recognize individual nuances that will affect our patients’ understanding of the information we provide to them. And yet, we still find situations where we think we communicated the information clearly, and the patient still did not understand our instructions.

Complicating the situation is the fact that many patients will not come right out and say, “I don’t understand what you’re telling me.” Often, they are too embarrassed to admit that they don’t understand or can’t read the written instructions you have provided. A patient who identifies the pills they take based on sight rather than reading the prescription label, who consistently fills out forms incorrectly, who states that they forgot their reading glasses and will read the written information you provided when they get home, or who consistently misses appointments might all be examples of a patient who is not able to read and understand the written communication.

Verbal communication comprises a large majority of our interactions with patients, and can also be a source of disparities leading to decreased health literacy. More than 25 million Americans speak English less than “very well”. According to U.S. Physician Language surveys, 40% of physicians speak English plus one other language, but that does not necessarily translate to those 25 million Americans being able to adequately communicate with their primary care physician for routine medical care and preventative visits. Communication experts suggest employing a “teach-back” method, in which you ask the patient to state what they’ve learned from the encounter.

Improving health literacy requires a multi-faceted approach, not only from the health care providers, but also from hospital systems, public health institutions, the government, and patients themselves. Patients who have physicians as immediate family members involved in their care do have a distinct advantage over others who do not. However, it is our job, and the job of health organizations, to continue to advocate for improving health literacy within our population.