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Health Literacy-What is it? (revised)

Author: Alka Bhalla, PharmD, MPH Candidate ‘18

Our patients need to understand health information.

Health literacy is defined as “the ability to access, understand, evaluate and communicate information as a way to promote, maintain and improve health in a variety of settings across the life-course” (Rootman & Gordeon-El-Bihbety, 2008, p. 11).

Let’s look at an example.

On January 25, 2016, the Public Health Agency of Canada (PHAC) issued a public health notice to Canadians travelling to the affected areas, to take protective measures to prevent mosquito bites as prevention against Zika (PHAC, 2016).

But what is Zika virus?

Here’s the WHO fact sheet:

The readability score is at grade level 13.9. Grade 6-8 is the recommended level.

I edited the WHO fact sheet to try to make it have a health literacy level of Grade 8.

For example, this paragraph from the WHO fact sheet:


Mosquitoes and their breeding sites pose a significant risk factor for Zika virus infection. Prevention and control relies on reducing mosquitoes through source reduction (removal and modification of breeding sites) and reducing contact between mosquitoes and people.

This can be done by using insect repellent; wearing clothes (preferably light-coloured) that cover as much of the body as possible; using physical barriers such as screens, closed doors and windows; and sleeping under mosquito nets. It is also important to empty, clean or cover containers that can hold water such as buckets, flower pots or tyres, so that places where mosquitoes can breed are removed.

Special attention and help should be given to those who may not be able to protect themselves adequately, such as young children, the sick or elderly.

During outbreaks, health authorities may advise that spraying of insecticides be carried out. Insecticides recommended by the WHO Pesticide Evaluation Scheme may also be used as larvicides to treat relatively large water containers.

Travellers should take the basic precautions described above to protect themselves from mosquito bites.


Zika virus disease is usually relatively mild and requires no specific treatment. People sick with Zika virus should get plenty of rest, drink enough fluids, and treat pain and fever with common medicines. If symptoms worsen, they should seek medical care and advice. There is currently no vaccine available.



There is no vaccine to prevent infection with Zika. Reducing the number of mosquitoes and the contact between mosquitoes and people is important.

The Aedes mosquitoes are usually active during daylight hours. Mosquitoes need water to breed. Items such as buckets, flower pots and tires collect water.

To stop mosquito bites, take the following steps:

  • Use a mosquito repellent.
  • Use physical barriers such as screens, closed doors and windows to keep mosquitoes outside.
  • Sleep under a mosquito net.
  • Empty items that collect water at least once a week to prevent mosquito breeding.
  • Wear protective clothing such as long sleeved shirts, long pants, and socks.

Protect young children, the sick and/or elderly. They may find it hard to protect themselves.

Spray insecticides as advised by health authorities during outbreaks. Insecticides recommended by the WHO Pesticide Evaluation Scheme may also be used as larvicides to treat relatively large water containers.


 There is no cure for Zika infection. Treat the symptoms:

  • Get plenty of rest
  • Drink fluids to prevent dehydration
  • Use medications to reduce pain and fever. Ask your doctor.
  • If symptoms worsen, seek out medical care and advice.

The edited paragraphs are still not at a Grade 6 literacy level. It is Grade 8.

The implications that this exercise may have for future practice with different audiences are:

  • To think about organizing and presenting information in a way that makes sense and is easy to read for the intended audience and to put it in action.
  • To provide the intended audience with practical information where the focus is on what they want and need to know.
  • To ensure that the patients I see have been given relevant information regarding medications and medical procedures so that they understand the content and provide informed consent on this basis

I was excited to learn that there were online readability tools that can help me nudge me in the right direction in working towards particular reading Grade level on my future writing texts depending on the intended audience. I also learned that there are courses available through the Canadian Public Health Association designed to help you in working towards better health communication through clear verbal communication and plain language training

Health communication, through verbal or written formats, is very important to ensure my patients understand the content and agree or disagree with the recommendation based on this understanding.


Rootman, I., & Gordon-El-Bihbety, D. (2008). A vision for a health literate Canada: Reprot of the Expert Panel on Health Literacy. Ottawa: Canadian Public Health Association. Retrieved from

Hoffman-Goetz, L.., Donnell, L., and Ahmed, R. (2014). Health Literacy in Canada. A Primer for Students. Toronto: Canadian Scholars’ Press Inc.

Public Health Agency of Canada (2016). Public Health Notice – Zika Virus. Available at url: Accessed January 29, 2016.

Alka Bhalla, PharmD, MPH Candidate ‘18

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