Health literacy demonstrator site - Headline report four

Posted by Dr Phyllis Easton on 27-03-2017
Health literacy demonstrator site - Headline report four

Raising awareness and promoting health literacy among healthcare staff


The issue: The language and processes of healthcare services can be hard to understand, undermining people’s ability to participate in healthcare and compromising their ability to maintain and sustain their health and well-being.1  One of the aims of the Scottish Demonstrator Programme is to enable staff to recognise and cater for the health literacy needs of those in their clinical population. Because low literacy and health literacy needs are often hidden, clinical staff can make false assumptions about what information has been heard and understood and thus, underestimate health literacy needs.2 Having an enhanced awareness of health literacy and using specific tools like Teach-Back to improve communication require educational input and support.  

What we did: We developed and delivered multiprofessional education sessions that raise awareness of the prevalence of low literacy and its relationship with low health literacy. These sessions were delivered to a variety of healthcare staff, including nurses and pharmacists. Sessions were also provided for student nurses from the University of Dundee. Students were from both adult and mental health fields, education was delivered as interactive sessions and as simulated skills practice sessions. Both were incorporated into the third year curriculum. Those attending sessions were encouraged to review the health literacy demands made of people within their specific clinical context, including how information is given and how understanding of that information is determined. Use of specific learning activities enabled staff to appreciate the ambiguous and often difficult nature of giving and receiving information/instructions. Encouraging staff to interact throughout the sessions promoted the sharing of stories from practice; this helped to contextualise the subject matter, making it live, reflective and interesting. Over 300 practitioners within NHS Tayside have attended a session. 

What we learned:

  • Healthcare staff are largely unaware of the extent of low health literacy among the populations in contact with their services.

  • Staff do not routinely use the Teach-Back technique to ensure people understand the information given to them.

  • When introduced to the evidence, practitioners are able to relate this to their own experiences, realising that some engagement or self-care issues may well be associated with low health literacy.

  • Participant reported knowledge of health literacy and confidence in using Teach-Back increased after education.

  • The majority of participants stated intention to change practice.

  • It can be difficult for frontline staff to be released for education and training.

  • Incorporating the use of Teach-Back into the nursing curriculum raises awareness of the issues of poor health literacy and may encourage early adoption and utilisation of techniques to improve communication.

  • Follow up evaluation revealed that the Teach-Back technique takes time to learn and is not always straightforward to use but, when implemented, it enables professionals to better meet the needs of the people in contact with their service:

“Sometimes it’s difficult to get into the Teach-Back conversation”

“I think it [Teach-Back] worked quite well when I had explained something to a couple and then I asked the woman to make sure I feel confident that I have explained that well”

[Teach-Back] also allows you to provide useful information to colleagues who are also involved in the patient’s care so that they may reiterate and reinforce information the patient may be having some difficulty with”


Staff release for education remains a significant challenge; Health literacy must be high on the organisational agenda in order to ensure that staff education is prioritised and sustained. Incorporating health literacy education into the undergraduate nursing curriculum will make certain that nurses are aware of the issue of low health literacy and can practise using Teach-Back in a safe and supported environment.


  1. Easton P, Entwistle VA, Williams B. Health in the ‘hidden population’ of people with low literacy. A systematic review of the literature. BMC Public Health. 2010;5(10):459.

  2. Making it Easy: A Health Literacy Action Plan for Scotland. The Scottish Government 2014 


Written by Dr Phyllis Easton

Health Intelligence Manager

NHS Tayside