Health Literacy in the Pharmacy


By: Swana Thomas, PharmD, MPH 2018
Published in the Pharmacy Times

A patient walks into your pharmacy to pick up a new medication. You ask whether she has any questions, and she timidly shakes her head to say no. She thanks you and walks away, but right before turning the corner, she reads the prescription and runs back because she realizes she doesn’t know anything about the medication.

Being the medication expert, you provide her with counseling points, and since she’s interested in supplemental reading, you print out further information before sending her on her way. You hope the literature will help her, encourage compliance, and ultimately improve her health status. However, you must have wondered at some point: do all patients understand what you hand out to them? The truth is, most don’t.

The US Department of Health and Human Services defines health literacy as “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.” Basically, it’s the ability to understand health literature provided by medical professionals in order to make educated, confident health decisions.

Let’s put your health literacy to the test! Below, there are 3 lines, each with 3 words. Read the first word aloud, then determine which of the next 2 words is either the “distractor” or the “key” to the first word. The “key” is the word most likely to be associated with the first word. The “distractor” is the word least likely to be associated with the first word.

Here’s an example:
· Diabetes: sugar/salt

“Diabetes” is the word to read aloud, “sugar” is the key, and “salt” is the distractor.

Now, you try! The answers are listed at the bottom of the article:
· Medications: instrument/treatment
· Constipation: blocked/loose
· Syphilis: condom/contraception

For most of you, this association exercise wasn’t difficult. For more than 35% of Americans, however, it would take more than mere minutes to complete.

Health literacy is broken into 4 categories: below basic, basic, intermediate, and proficient. About 35% of Americans fall into the below basic to basic category (eg, a K- to 6th-grade reading level), which means they can only read and follow a set of directions from their prescriber or read a brochure on Zostavax and then iterate what the vaccination is indicated for.

About 53% of Americans are intermediately health literate (eg, a 7th- to 8th-grade reading level). They can read a prescription label for a medication to be taken twice daily and deduce when to take the drug without being told it’s taken approximately 12 hours apart. The remaining Americans are considered proficient (eg, a reading level of high school and above), which means they can do more algebraic calculations and comprehend the use of common medical jargon.

What makes medical pamphlets more difficult is the verbiage used could be categorized as requiring intermediate to proficient health literacy, meaning they could be “difficult” or “extremely challenging” to comprehend.

Why Pharmacists Should Be Aware of Health Literacy

  1. To reduce medication error morbidity/mortality rates. Low health literacy is linked to a higher risk of morality and emergency visits and has led to increased health disparities.
  2. To help patients become more active in their medication management. Knowing about their medication and that their role at home is so vital to their health makes patients want to achieve compliance and envision optimal health.
  3. To build trust. Taking the time to counsel patients, answer their questions, and find information that’s easy for them to understand builds the bridge of trust from the patient to the health care professional.

How Pharmacists Can Help

  1. Improve health literacy in the pharmacy with the Agency of Healthcare Research and Quality’s “Literacy Toolkit for the Pharmacy and its Staff,” which analyzes  staff’s understanding of health literacy and familiarity with their facility’s literature (eg, posters, advertisements, brochures).
  2. Provide health literacy assessments to patients to understand what type of information they need. Recommended assessments include the Rapid Estimate of Adult Literacy in Medicine and the Short Assessment of Health Literacy in English. 
  3. Encourage using the National Patient Safety Foundation’s “Ask Me 3 Campaign,” which initiates conversation on their medications by asking:

a. “What is my main problem?”
b. “What do I need to do?”
c. “Why is this important for me to do?”
Former Surgeon General C. Everett Koop once said, “There are all kinds of things [we] can do to marry literacy with health.” Many initiatives underway acknowledge the need for improved health literacy in the pharmacy. How will you join in the efforts?


The purpose of this article is to address the umbrella issue of pharmaceutical literacy which is the literacy proficiency, or lack of, amongst patients. As provided there is a sample assessment that can be used to acknowledge if an individual can successfully comprehend a prescription label. Based upon the results, statistics have shown that 53% of Americans are at an intermediate level of proficiency which encompasses an understanding to take medicine twice daily and when to take the next dosage. As concluded, what makes such existent labels difficult to understand is the use of verbiage and medical jargon that one of a higher level of proficiency may understand. Suggested steps to help improve ALL Americans understanding is simplifying the listed instructions for a lower literacy rate and also ensure patients are able to receive direct communication to acknowledge what they are taking and open such channel for questions that may rise during such conversations.


  1. Josh, this article had many good facts and I really enjoyed the small exercise it made the reader do to assess themselves. As I delve into my research, I realize that a lot of patients don’t understand the medical jargon on their prescriptions or keep a record of their previous prescriptions. I think that considering the idea of creating something where a patient can record the name of the medication and write a translation of how to take it (from how the pharmacist told them to), might be a cool idea to solve this problem. Of course, the pharmacist would need to sign-off on these directions that were written by the patient, but this is just an idea. I know that remembering the names of past medication is something that is very important, and it can be something that is life-threatening. I remember a few years back I’d gotten an infection twice, and both times I went to the local urgent care to seek help…and the doctor prescribed me the same thing, the second time I took the antibiotic I had an allergic reaction. The sad fact is that I do not know the name of that medication…I only know that it was not amoxicillin, because I remembered that name from when my dermatologist prescribed it to me for months to help me with acne – and I was fine. Whenever I go to the doctor, the only thing they can give me is amoxicillin because it’s the only antibiotic that I know is safe for me. If I get that mystery antibiotic I could have a worse reaction than before. I really need to track down the medication that caused me to have an allergic reaction all those years ago, but I’m not even sure if I can anymore. With that being said, I think remembering the names of medications is so important too. What was interesting is in one of my articles if you and the doctor talk about the medication prior to leaving and receive a pamphlet about it, around 80% of all patients remembered how to take it and the name of it some months later. This was the case with my amoxicillin vs. unknown antibiotic problem. At the dermatologist, they talked to me about amoxicillin prior to leaving.