Health Literacy as a Modifiable Clinical Risk Factor: Operationalizing an Underrecognized Determinant of Outcomes

Health literacy has been considered a social determinant of health and has never been extensively incorporated in the general practice of clinical care. Systematic reviews and cohort studies show consistent evidence of low health literacy as a correlate of worse outcomes of chronic disease, enhanced use of health care, and greater mortality. Even with this evidence, health literacy is not often screened for, documented, or even included in clinical risk stratification. This article contends that health literacy ought to be re-conceptualized as a clinical risk factor, which can be modified just like other routinely managed issues, like smoking or blood pressure. Universal communication precautions and teach-back, as literacy-sensitive strategies implementable in clinical workflow, would enhance adherence, reduce complications, and allow achieving more equitable care. The acknowledgment of health literacy as a quantifiable and alterable risk factor can be used to endorse the educational interventions as a core element of efficient chronic disease management.