Health Literacy

Limited health literacy - the ability to obtain, process, and understand basic health information and services - affects a patient's entire health care experience. Patients with low health literacy are more likely to skip preventive measures and require hospitalization.

According to the Institute of Medicine, nearly half of all American adults - 90 million people - have difficulty understanding and using health information. Health literacy is the ability to read, understand, and effectively use basic health information. Low health literacy affects people of any age, ethnicity, background, or education level.

UnityPoint Health works with hospitals, outpatient clinics, and home health teams to develop communication tools and implement strategies that help increase understanding and provide a better experience for our patients and their families.

Ask Me 3

Through patient and provider education materials developed by leading health literacy experts, Ask Me 3 promotes simple, but essential, questions patients should ask their medical team in every health care interaction:


1. What is my main problem?

2. What do I need to do?

3. Why is it important for me to do this?

These questions also help build an effective partnership between patients and their health care team, and clarify misunderstandings about medical needs and treatment. Ask Me 3 materials help patients and providers initiate communication and improve understanding.

UnityPoint Health implemented use of the Ask Me 3 tools, including:

  • Introducing and explaining Ask Me 3 to patients during the admission process.
  • Distributing Ask Me 3 materials in patient rooms and waiting areas.
  • Educating providers about Ask Me 3 through e-learning modules and employee orientation.
  • Providing patients with Ask Me 3 notepads to write down questions and answers.
  • Displaying Ask Me 3 posters throughout patient areas.
  • Advertising Ask Me 3 during Health Literacy Month.
  • Receiving patient and provider feedback about Ask Me 3 materials and procedures.

Evaluation showed:

  • Patients were more likely to have questions and feel comfortable communicating with their physicians.
  • Hospitals and providers received noticeable improvements in patient satisfaction.
  • Ask Me 3 could be embedded into organizational strategies and routines with relative ease.

Resources and Information

Berkman N, Sheridan S, Donahue K, et al. Health Literacy Interventions and Outcomes: An Updated Systematic Review. Evidence Report/Technology Assessment No. 199. Executive Summary. Prepared by RTI International-University of North Carolina Evidence-based Practice Center under contract No. 290-2007-10056-I. AHRQ Publication Number 11-E006. Rockville, MD. Agency for Healthcare Research and Quality. March 2011. Available at:

Accessed: June 29, 2012.

DeWalt DA, Callahan LF, Hawk VH, et al. Health Literacy Universal Precautions Toolkit. AHRQ Publication No. 10-0046-EF. Rockville, MD. Agency for Healthcare Research and Quality. April 2010. Available at:

Accessed: June 29, 2012.

Doak CC, Doak LG, Root JH. Teaching Patients with Low Literacy Skills. Second Edition. Philadelphia, PA: J.B. Lippincott Company; 2007. Available at:

Accessed: June 29, 2012.

Institute of Medicine Committee on Health Literacy. Health Literacy: A Prescription to End Confusion. Nielsen-Bohlman L, Panzer AM, Kindig DA, eds. Washington, DC: The National Academies Press; 2004. Available at:

Accessed: June 29, 2012.

Koh HK, Berwick DM, Clancy CM, et al. New federal policy initiatives to boost health literacy can help the nation move beyond the cycle of costly 'crisis care'. Health Affairs. 2012;31(2). Available at:

Accessed: June 29, 2012.

Kutner M, Greenberg E, Jin Y, Paulsen C. The Health Literacy of America's Adults: Results from the 2003 National Assessment of Adult Literacy. National Center for Education Statistics. US Department of Education. 2006. NCES Publication No. 2006-483. Available at:

Accessed: June 29, 2012.

Rudd RE. Improving Americans' health literacy. N Engl J Med. 2010;363:2283-2285.

Schillinger D, Piette J, Grumbach K, et al. Closing the loop: physician communication with diabetic patients who have low health literacy. Arch Intern Med. 2003;163(1):83-90. Available at:

Accessed: June 29, 2012.

U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. (2010). National Action Plan to Improve Health Literacy. Washington, DC. Available at:

Accessed: June 29, 2012.