• Scholarly report

Literacy and health outcomes. Volume I. Final evidence report

Context: More than 90 million adults in the United States have poor literacy, which would cause them to have trouble finding pieces of information or numbers in a lengthy text, integrating multiple pieces of information in a document, or finding two or more numbers in a chart and performing a calculation. Those with poorer reading skills are believed to have greater difficulty navigating the health care system and to be at risk of experiencing poorer health outcomes.

Objectives: Research has examined the effect of low literacy on a wide variety of health outcomes, but we are unaware of any published systematic reviews that have analyzed these relationships or examined interventions to mitigate the health effects of low literacy. To evaluate the existing research, we performed a systematic review to address two four-part key questions based on questions initially posed by the American Medical Association and the Agency for Healthcare Research and Quality and put into final form in cooperation with our Technical Expert Advisory Group. The questions are as follows:
- Key Question 1: Are literacy skills related to: (a) Use of health care services? (b) Health outcomes? (c) Costs of health care? (d) Disparities in health outcomes or health care service use according to race, ethnicity, culture, or age?
- Key Question 2: For individuals with low literacy skills, what are effective interventions to: (a) Improve use of health care services? (b) Improve health outcomes? (c) Affect the costs of health care? (d) Improve health outcomes and/or health care service use among different racial, ethnic, cultural, or age groups?


Berkman, N., DeWalt, D. A., Pignone, M. P., Sheridan, S. L., Lohr, K., Lux, L., ... Bonito, A. (2003). Literacy and health outcomes. Volume I. Final evidence report. (Submitted to Agency for Healthcare Research and Quality). Research Triangle Park, NC: RTI International.