Health literacy for healthcare providers

Key points about health literacy

  • The way health systems and services are designed and delivered places high health literacy demands on people, families and whānau.
  • There is a need for a stronger focus on how health systems, healthcare providers and practitioners can support people to access care, manage and maintain their own health and wellbeing.
  • A health literate organisation makes health literacy a priority and integral to quality service improvement. It makes health literacy part of all aspects of its service planning, design, delivery and performance evaluation. 
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Health literacy is about knowing how to:

  • find your way around the many different parts of the health system
  • understand your health condition(s), including what makes it better or worse
  • use your medicines safely
  • give informed consent to medical procedures
  • prevent illness and your health getting worse
  • manage long-term health conditions well.

The health literacy you need changes over time as your health changes and health services change.

Historically, the language used to describe the difference between the health knowledge people had and the knowledge they needed implied the problem was with the consumer. People were described as having ‘low health literacy’. This consumer-deficit view of health literacy is unfair as it ignores the role of the health system in creating health literacy demands and how these impact on people’s health literacy.

We now recognise that high literacy demands are created by the way health conditions are explained, managed and resourced by the health system, health services and providers.

The provision of adequate health care includes providing people with the information they need, in a way that works for them, so they can make informed decisions and manage their health. This role is described as meeting health literacy needs. This is reflected in the Ministry of Health’s Framework for health literacy(external link) published in 2015. 

The framework for health literacy(external link) aims to address some of the systemic issues creating barriers to health literacy. 

“Because of the way health systems are organised, individuals and whānau can often face a series of demands on their health literacy ... A health-literate health system reduces these demands on people and builds the health literacy skills of its workforce, and the individuals and whānau who use its services. It provides high quality services that are easy to access and navigate and gives clear and relevant health messages so that everyone living in New Zealand can effectively manage their own health, keep well and live well.”

The Ministry of Health developed the framework because it is committed to a health system that enables everyone living in Aotearoa New Zealand to live well and keep well. Building health literacy is an important part of this, and the framework outlines expectations for the health system, health organisations and all the health workforce to take action that:

  • supports a culture shift so that health literacy is core business at all levels of the health system
  • reduces health literacy demands
  • recognises that good health literacy practice contributes to improved health outcomes and reduced health costs.

The framework also identifies some success indicators that individuals and whānau can expect to see from every point of contact with the health system.

The complexity and accessibility of health information (spoken and written), care and services affects all aspects of health: prevention, acute care, long-term conditions and public health. This complexity leads to more negative health outcomes than if spoken and written information was provided in a way that was clear and easy to access and understand.

This complexity is also an equity issue because Māori and Pasifika are more likely to not have their health information needs met. This is also the case for consumer groups whose first language is not English, have a disability, use NZ Sign Language or are blind or visually impaired. In addition, care and services need to be culturally safe to meet the needs of everyone.

Healthcare providers have a responsibility to provide spoken and written information, care and services in ways that meet the needs of health consumers. Providers also need to help people understand what they need to know to live healthy lives.

In terms of spoken and written information, they need to:

  • use plain language where possible (written and spoken)
  • explain clinical language and sector terms
  • identify what people know or don’t know before providing information, so new information connects to prior knowledge
  • talk people through referrals to unfamiliar health services to ensure they know what to expect
  • thoroughly check that people have been given the important information they need, in a way that makes sense to them, before leaving a health service
  • provide information in different formats, such as videos, apps and tools and support people to use these formats
  • use photos, illustrations, diagrams and other non-written aids to support written content
  • translate information into multiple languages
  • make NZ Sign Language videos.

Video: Health literacy among Māori

Querida Whatuira-Strickland describes her work helping whānau with health literacy in her role as kaitakawaenga.

(Health Quality & Safety Commission NZ, 2014)

Video: Health Literacy: Three steps to effective communication to support self-management

(Healthify He Puna Waiora, 2017)

(Healthify & Health Literacy, NZ, 2019)

Ask, Build, Check

Use techniques such as Ask, Build, Check to improve how we communicate as health providers. The health literacy focus needs to extend beyond personal communication. Health literacy involves changing the healthcare environment and how knowledge is shared.

View these three videos for examples and then start practicing this approach. 

Video: Using Ask, Build, Check: with a person with high blood pressure

(Healthify He Puna Waiora, NZ, 2021)

Video: Using Ask, Build, Check with a person with high blood pressure

(Healthify He Puna Waiora, NZ, 2021)

Video: Using Ask, Build, Check with a person as part of their diabetes annual review

(Healthify He Puna Waiora, NZ, 2021)

Video: Dr Rima Rudd talks about Teachback

Dr Rima Rudd discusses health literacy and introduces the concept of 'Teach back' (also known as 'closing the loop' and 'checking understanding') at the NZ health literacy conference.

(Workbase NZ, 2012)

Video: Health Coaching (Closing the Loop): Techniques to Deliver Patient Centered Care

Teach back is also known as Closing the Loop. In this video, we see a health coach applying this approach with a client poorly and then properly. 

(N. Montgomery, 2012)

High health literacy demands and failing to meet health literacy needs contributes to premature morbidity and mortality, poorer access to health care, inequity, treatment/medicine safety concerns, informed consent and quality of care issues.

Video: Health literacy among Māori

Querida Whatuira-Strickland describes her work helping whānau with health literacy in her role as kaitakawaenga.

(Health Quality & Safety Commission, NZ, 2014) 

Video: Counties Manukau – lifelong engagement with oral health services

Counties Manukau Health reviewed oral health services and were concerned about life-long consumer engagement with services. In this video they describe the reasons why they undertook a review.

(Ministry of Health, NZ, 2015)

Video: Capital & Coast DHB – non-attendance at children’s outpatient clinics

Capital & Coast DHB reviewed a service issue – non-attendance at children’s outpatient clinics. This was an issue they were already investigating and the review contributed a health literacy perspective. What CCDHB found is described in this video.

(Ministry of Health, NZ, 2015)

Video: Northland DHB – diabetes services in primary care

Northland DHB worked with Te Tai Tokerau Primary Healthcare Organisation to review diabetes services in primary care. The quality of diabetes care is of great importance in the North because of the growing numbers of consumers with diabetes. The reasons for Northland’s review are described in this video.

(Ministry of Health, NZ, 2015)

Video: Raising organisational awareness – a health literacy approach to service delivery

(Ministry of Health, NZ, 2015)

About health literacy(external link) Health Literacy NZ
Health Literacy NZ(external link) 
Ask, Build, Check training module(external link) Self-Management Support Toolkit website
Health literacy review – a guide(external link) Ministry of Health, NZ, 2015​
A framework for health literacy(external link) Ministry of Health, NZ, 2015​
Equity of health care for Maori(external link) – a framework Ministry of Health, NZ, 2014
Kōrero mārama – health literacy and Māori(external link)  Ministry of Health, NZ, 2010

For more information about care planning, visit our dedicated Self-Management Support (SMS) Toolkit website(external link) for health providers and healthcare staff. 

Resources for health services

Health TV(external link) is an independent television network for medical centre waiting rooms. It provides health information to help Kiwis and their whānau get the most out of their medical appointments.

On this page you will find a selection of resources on health literacy, including some training options.




Health Literacy NZ(external link) 

Key health literacy website in Aotearoa that offers:

  • information
  • resources
  • training
  • support.

Three steps to better health literacy – a guide for health professionals [PDF, 1.8 MB] 
Health Quality & Safety Commission, NZ, 2014

The phrase “people with low health literacy” only tells one side of the story(external link) 
NZMJ Digest, NZ, 2020

Health Literacy Review 2015(external link)

Health literacy review – a guide(external link) 
Ministry of Health, NZ, 2015 

Individuals and whānau face a series of demands on their health literacy when navigating the health system. These demands impact on consumers’ ability to access health information, care and services. Support is growing for a stronger focus on how health systems, healthcare providers and practitioners can support people to access care, manage and maintain their own health and wellbeing. This guide, developed by the Ministry of Health and Workbase NZ, takes healthcare providers through a review process and shows you how to develop a health literacy action plan.

It provides:

  • advice from 3 DHBs that have trialled the guide
  • videos and documents to help you conduct a review and design the action plan.
Ten attritutes of Health Literate Health Care Organizations

Ten attributes of health literate organisations 
Institute of Medicine, US, 2012

A health literate healthcare organisation:

  • has leadership that makes health literacy integral to its mission, structure, and operations
  • integrates health literacy into planning, evaluation measures, patient safety and quality improvement
  • prepares the workforce to be health literate and monitors progress
  • includes populations served in the design, implementation, and evaluation of health information and services
  • meets the needs of populations with a range of health literacy skills while avoiding stigmatisation
  • uses health literacy strategies in interpersonal communications and confirms understanding at all points of contact
  • provides easy access to health information and services and navigation assistance
  • designs and distributes print, audiovisual, and social media content that is easy to understand and act on
  • addresses health literacy in high-risk situations, including care transitions and communications about medicines
  • communicates clearly what health plans cover and what individuals will have to pay for services.
Korero Marama: Health Literacy and Maori

Kōrero mārama – health literacy and Māori(external link) 

Ministry of Health, NZ, 2010

Medline Plus Easy to read topics

A–Z index of easy to read patient information(external link) 
Medline Plus, US

Three steps to better health literacy

Health literacy resources for community pharmacists 
Health Quality & Safety Commission, NZ, 2012 

Health literacy information leaflet(external link)
Three steps to meeting health literacy needs(external link)
10 questions about health literacy
 and answers 
10 more questions about health literacy and answers

Some excellent resources and programmes have been developed to help improve the health literacy demands of the health system. (Note: Most are from outside New Zealand).



Rauemi Atawhai

Rauemi atawhai – a guide to developing health education resources in New Zealand(external link) 
Ministry of Health, NZ, 2012

This guide was developed to help the Ministry of Health and its contractors produce effective and appropriate health education resources that meet the needs of the intended audience, are easy to understand and support improved health literacy.


Simply put(external link) 
Centers for Disease Control, US

A useful plain language guide from the Centers for Disease Control, US, offering dozens of tips for clear communication. Check how well you do against the 4 most important steps:

  1. Know your audience and the purpose of your information.
  2. Organise the information from your readers’ or listeners’ perspective.
  3. Choose your words carefully: use active voice, short sentences, everyday words and personal pronouns.
  4. Use presentation elements, such as bulleted lists and graphics that match and reinforce text.


Ask me 3(external link) 
Institute for Healthcare Improvement, US

An excellent health communication programme by the Partnership for Clear Health Communication at the National Patient Safety Foundation.

3 questions(external link) for patients to ask their doctor, pharmacist or nurse at every encounter to better understand their health:

  1. What is my main problem?
  2. What do I need to do?
  3. Why is it important for me to do this?

Health literacy(external link) 

Department of Health & Health Services, US

A set of training modules have been developed covering a range of health literacy and self-management support topics. These modules will help clinicians address some of the health literacy barriers and communicate more effectively.

While designed for primary care teams, they will also be useful for secondary care providers and community organisations. 

Ask Build Check training module image

  • Each module has a training plan for the facilitator and a handout for all participants who attend the training session.
  • Each participant needs a copy of the handout.
  • Each session takes about one hour and follows a similar format – finding out what people already know, building on that knowledge and, at the end, an evaluation and reflection activity about the session.

Topics include: 

Visit the Self Management Support Toolkit website(external link) for more information and to access these modules.

  1. Rudd RE. Health literacy considerations for a new cancer prevention initiative(external link) The Gerontologist, 2019 Jun; 59(1):S7–S16.
  2. Brega AG, Hamer MK, Albright K. Organizational health literacy: Quality improvement measures with expert consensus(external link) Health Lit Res Pract. 2019 Apr; 3(2): e127–e146.


three steps to meeting health literacy needs hqscnz

Three steps to meeting health literacy needs

Health Quality & Safety Commission, NZ, 2022

Credits: Healthify editorial team. Healthify is brought to you by Health Navigator Charitable Trust.

Reviewed by: Health Literacy NZ

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