What we can do about low health literacy

What we can do about low health literacy


There are five techniques advocated by the national health literacy action plan and outlined and explained in the Tools and Techniques pages of this site. You will find relevant evidence in relation to techniques such as Teach Back in the resource library section of the website.  


In 2014 a summary overview was produced providing information on health literacy interventions. This report focused on interventions designed to enhance workforce awareness and capabilities and interventions focused on health literacy approaches. This overview was developed as part of the production of the national action plan and provides information on a number of interventions which fall under the following two headings:

Interventions focused on health literacy tools and approaches

The evidence suggests that the most successful interventions to improve health literacy are multi-faceted including several approaches and techniques. For example, the use of teach back and other tools have been found to be most successful when they are an integral part of a wider holistic approach to improving health literacy. 

Interventions designed to enhance workforce awareness and capabilities

The evidence review found limited research on interventions to address the workforce contribution to health literacy. Findings suggest the importance of embedding health literacy within culture/organisational change processes and there is some limited literature which addresses the impacts of the education of health care staff on health literacy.

Optimising health literacy to improve health and equity (Ophelia)

The Scottish Health Literacy Action Plan Implementation Group have recently had a visit from the Australian Project Ophelia to provide a workshop on using the Ophelia process and tools to identify health literacy issues and interventions to address these with specific populations. Information on Ophelia including journal articles on the programme are accessible via the relevant resource below. 


There are a wide range of tools available to measure health literacy. Some of the main tools for measurement are outlined below with further information available below via the resources links and in the resources library. 

Test of Functional Health Literacy in Adults (TOFHLA)

The TOFHLA was developed using hospital and healthcare materials and consists of reading comprehension and numerical ability tests. The TOFHLA requires a level of literacy skills and if being used in Scotland people should take into consideration the transferability of the materials for use as they are written for use in the US.

Rapid Estimate of Literacy in Medicine (REALM)

The REALM is a tool to screen and assess adult patient ability to read common medical words. It is designed to assist medical professionals in identifying patients at risk of low health literacy. The tool uses a test for word recognition it is not based on reading comprehension. 

Newest Vital Sign

The Newest Vital Sign uses an ice cream nutrition label accompanied by some questions to measure health literacy and takes roughly three minutes for administration. This tool has been identified as a suitable test for limited literacy and has been proven to correlate with the TOFHLA.