Finding 6-1 Demands for reading, writing, and numeracy skills are intensified because of health-care systems’ complexities, advancements in scientific discoveries, and new technologies. These demands exceed the health-literacy skills of most adults in the United States.

Finding 6-2 Health literacy is fundamental to quality care, and relates to three of the six aims of quality improvement described in the IOM Crossing the Quality Chasm report: safety, patient-centered care, and equitable treatment. Self-management and health literacy have been identified by IOM as cross-cutting priorities for health-care quality and disease prevention.

Finding 6-3 The readability levels of informed consent documents (for research and clinical practice) exceed the documented average reading levels of the majority of adults in the United States. This has important ethical and legal implications that have not been fully explored.

Recommendation 6-1 Health-care systems, including private systems, Medicare, Medicaid, the Department of Defense, and the Veterans Administration should develop and support demonstration programs to establish the most effective approaches to reducing the negative effects of limited health literacy. To accomplish this, these organizations should:

• Engage consumers in the development of health communications and infuse insights gained from them into health messages.

• Explore creative approaches to communicate health information using printed and electronic materials and media in appropriate and clear language. Messages must be appropriately translated and interpreted for diverse audiences.

• Establish methods for creating health information content in appropriate and clear language using relevant translations of health information.

• Include cultural and linguistic competency as an essential measure of quality of care.

Recommendation 6-2 HHS should fund research to define the needed health-literacy tasks and skills for each of the priority areas for improvement in health-care quality. Funding priorities should include participatory research that engages the intended populations.

Recommendation 6-3 Health literacy assessment should be a part of healthcare information systems and quality data collection. Public and private accreditation bodies, including Medicare, NCQA, and JCAHO, should clearly incorporate health literacy into their accreditation standards.

Recommendation 6-4 HHS should take the lead in developing uniform standards for addressing health literacy in research, service, and training applications. This includes addressing the appropriateness of research design and methods and the match among the readability of instruments, the literacy level, and the cultural and linguistic needs of study participants. In order to achieve meaningful research outcomes in all fields: