Hospital pharmacists understanding of available health literacy assessment tools and their perceived barriers for incorporation in patient education – a survey study


By: Sara Chan, Sean P. Spina, Dalyce M. Zuk, & Karen Dahri
Published in BMC Health Services Research, Article number: 401 (2020)
11 May 2020


Patients with low health literacy experience difficulty in understanding their medications leading to worse health outcomes. Pharmacists need to use formal assessment tools to be able to identify these patients, so they can better tailor their patient education. The objective of the study was to characterize hospital pharmacists understanding of health literacy and their use of screening and counselling strategies before and after completion of an educational module and to identify barriers that hospital pharmacists perceive to exist that prevent them from using health literacy tools.


Pharmacists in three health authorities were administered a pre-survey and then given access to an online 11 min educational video. The post-survey was distributed 1 month later. Descriptive statistics were used to quantify survey responses with comparisons made between pre and post responses. The main outcome measure was pharmacists’ understanding of health literacy and their current practice related to health literacy.


There were 131 respondents for the pre-survey and 39 for the post-survey. In the pre-module survey, 84% of pharmacists felt they understood what health literacy was, but only 53% currently assessed patients for their health literacy status and 40% were aware of what strategies to use in low health literacy patients. Lack of time (74%) was the biggest barrier in assessing patients’ health literacy. In the post-module survey, 87% felt they understood what health literacy was and 64% incorporated health literacy status evaluation into their clinical practice. The educational module was helpful to the clinical practice of 74% of respondents.


As health literacy can affect a patient’s ability to adhere to their medications it is important for pharmacists to assess this in their patients. While pharmacists self-reported a high degree of understanding of health literacy, they are not regularly assessing their patients’ health literacy status and are unaware of what strategies to use for low literacy patients.


The purpose of this article was to provide further context on the present miscommunication between pharmacists and patients receiving medications. As outlined above, a study was conducted to not only inform patients of their understanding but also allow pharmacists to become more aware of their practice and self-reflect upon their methods of distributing information to their patients regarding medication knowledge. The conclusion that was identified not only addressed a similar theme which is the level of literacy amongst patients but acknowledging the responsibility pharmacists have when also knowing how much their patients are understanding when given a medication. Not only is it important for the patient to know what they are taking and why, but to also ensure pharmacists are routinely assessing their patients.


  1. This article is really good in pointing out that pharmacists have to be able to assess how much the patient is understanding. I think we should keep in mind that there is a give and take with both patient and pharmacist in pharmaceutical literacy.