Nurse Practitioners Are Key to Improving Health Literacy
Learn how focusing on clarity, open communication and creating a mutual understanding with patients can improve health literacy and patient outcomes.
In 2025, the Gallup Poll announced nursing was again recognized as the most trusted profession — an honor that goes back decades. Being able to convey important information to patients in a culturally competent and holistic way is part of why patients trust their nurse practitioners (NPs) in particular, and overcoming any miscommunication between patient and provider in diagnosis and treatment is crucial to delivering high-quality health care. October is Health Literacy Month, an opportunity to consider how perceptions of health literacy have changed over the years and what NPs need to know.
Patients, Providers and Organizations
The definition of health literacy itself has been updated since Health Literacy Month was established over twenty years ago. In 2020, the initiative Healthy People 2030 was launched by the U.S. Department of Health and Human Services “to improve health and well-being over the next decade.” Building upon prior definitions of health literacy, Healthy People 2030 created a new framework including organizational responsibilities in addition to personal ones. As such, these new guidelines say that health literacy should:
- Emphasize people’s ability to use health information rather than just understand it.
- Focus on the ability to make “well-informed” decisions rather than “appropriate” ones.
- Incorporate a public health perspective.
- Acknowledge that organizations have a responsibility to address health literacy.
This welcome update is a step in recognizing the importance social determinants of health play in a patient’s overall wellness. While considering the big picture, NPs are also considering individual approaches to better meet the needs of the communities they serve.
Simplicity Over “SMOG”
Today, several obstacles face patients when it comes to understanding important information regarding health. In an article for the Journal for Nurse Practitioners (JNP) entitled Improving Patient Education to Meet Health Literacy Standards, the five authors focus on one stumbling block — difficult to understand patient education materials (PEMs) — but the recommendations of the authors are applicable to many other cases.
The authors begin by noting that, “National guidelines recommend that PEMs be written at a fifth to sixth grade reading level to ensure accessibility for the broadest range of patients, including those with limited literacy skills. However, institutional analysis reveals that many PEMs routinely exceed these thresholds, creating structural barriers to health engagement, particularly for individuals from diverse linguistic, educational and cultural backgrounds.” Furthermore, “Many individuals — regardless of education level —struggle with dense, jargon-laden text, passive sentence structures and poorly organized content that lacks clear headings or visual cues.”
The authors found that by using the Simple Measure of Gobbledygook (SMOG) Index and other tools, they were able to effectively locate “major barriers” like “complex terms, lack of visuals and limited cultural responsiveness” that stood in the way of patients’ understanding of PEMs. Every person has had some experience where spoken or written language becomes incomprehensible, turning into the “gobbledygook” that forms the “G” in SMOG. This can happen with any subject, so how can NPs avoid isolating patients when conveying often complex health care information?
In their article for JNP, the authors found several approaches that can help NPs reach patients — whether the medium is visual or verbal. One suggestion was to “use plain language,” like saying “high blood pressure” instead of “hypertension.” For more examples, they cite the Agency for Healthcare Research and Quality, which created a Health Literacy Universal Precautions Toolkit with an added list of plain language words (“helpful” instead of “beneficial,” etc.).
Culturally Competent Care
Another important consideration (or, in plain English, something to think about) is cultural relevance. On the episode Treating Patients with Diabetes: New Tools For NPs on NP Pulse: The Voice of the Nurse Practitioner®, guest Eligio David P. Soliman Jr., DNP, APRN, FNP-BC, CDCES, CMSRN, talks about how he relates to his specific patient population through both cultural sensitivity and using comparisons and analogies that make health care relatable.
“I serve a large Filipino community, a large Asian community, and we — in general — eat a lot of rice. To a lot of these patients, rice is life. If I tell this patient, ‘You can’t have rice,’ which is a common statement from providers…then it could be perceived as a death sentence,” he says. Soliman then frames the issue in a different way: “That’s a venue for me to introduce portions so [the patient] can continue to have rice…and then I use terms that are easily understandable to them.
“I would tell them, your body can survive on almost any nutrient, but now, your body can’t process carbohydrates. It’s like buying a new car that requires a new kind of fuel. So, if you drive something that was diesel before, and now you drive an unleaded car, try putting diesel in…what will happen? ‘Oh, it won’t start.’ That’s the same reason why when your blood sugar is so elevated, you feel sluggish.” For his patients, Soliman says this “lights a light bulb. Now, it’s not about restricting. It’s not about punishing myself. It’s about making my system work better because now I understand how it works.”
Using both relatable imagery and meeting his patients where they are, Soliman makes health care relevant and actionable. Health Literacy Month is a time to think about how all providers can work to make health care accessible, engaging and understandable to patients — and to continue that process all year long.
Clinical Resources Available for NPs
The American Association of Nurse Practitioners® (AANP) has a number of clinical resources organized by therapeutic and specialty area available to both members and nonmembers. These include continuing education courses, education resources for NPs, educational tools for your patients, evidence-based practice recommendations, the latest news, strategic partners and helpful external resources.