​Health literacy refers to a person's ability to access, understand, and use information related to health(care). This includes the ability to read and understand health information, to navigate healthcare systems, to communicate effectively with healthcare providers, and to apply the information to make decisions about one's own health. Appropriate health literacy allows a patient to make informed decisions and to take appropriate actions. Therefore, health literacy is an important aspect in patient empowerment and self-management, as it allows people to take control of their own health.

It goes without saying that health literacy levels can greatly impact pain management. For example, research shows that lower levels of health literacy may contribute to opioid misuse and a higher pain experience in individuals who experience chronic pain¹. Therefore, authors conclude, interventions targeting health literacy may help to address the pain problem and consequently the opioid public health crisis¹. Moreover, people with adequate health literacy are known to show less kinesiophobia², a psychosocial factor that – when present – impacts pain intensity, quality of life and may prevent effective treatment.

One way to target pain-related health literacy is to use pain neuroscience education (PNE). PNE is used to help individuals understand the biological, psychological, and social factors that contribute to pain and is based on the idea that knowledge and understanding can be powerful tools in managing pain, and that improving health literacy is an essential part of this process. By providing education about the underlying mechanisms of pain, PNE can help individuals develop a better understanding of their pain, and provide them with tools to better manage it. PNE can also help individuals to better communicate with their healthcare providers, and to make informed decisions about their treatment options. Hence, PNE could lead to higher levels of pain-related health literacy.

However, one could argue that low health literacy could make it difficult for individuals to understand the language and concepts used in PNE and to grasp its key concepts, which can limit the effectiveness of the intervention. Yet, in this context, the patient-centred approach that should be inherent to delivering PNE becomes cardinal to overcome these challenges: it is important to take a patient-centred approach to PNE and to tailor the education to the individual's level of health literacy. This may involve using plain language, visual aids, and other tools to simplify complex concepts and make the information more accessible. It may also involve providing additional support and resources to help individuals navigate the healthcare system and access appropriate care.

As take-home message, a small summary of aspects to consider when providing healthcare education or information to people with low health literacy levels³:

1. Use plain language: Avoid using medical jargon or technical terms that may be unfamiliar to individuals with low health literacy. Use simple language that is easy to understand, and explain any unfamiliar terms or concepts.
2. Use visuals: Visual aids such as diagrams, pictures, or videos can help individuals with low health literacy to better understand complex information.
3. Break information into smaller chunks: Provide information in smaller, more manageable pieces. This can help individuals to process and retain the information more effectively.
4. Use teach-back or show-me techniques: Encourage individuals to repeat or demonstrate what they have learned to confirm their understanding of the information.
5. Address cultural and social factors: Consider cultural and social factors that may impact how information is received and understood. For example, language barriers, limited access to healthcare, and differences in beliefs and values may all impact how healthcare information is perceived and understood.
6. Engage family members or caregivers: Family members or caregivers can play an important role in helping individuals with low health literacy to understand and navigate healthcare information.

By taking these aspects into consideration, healthcare providers can improve the effectiveness of healthcare education and information for individuals with low health literacy levels. This can ultimately lead to better health outcomes and improved quality of life.

Anneleen Malfliet

2023Pain in Motion

References and further reading:

¹ Rogers et al. Health Literacy, Opioid Misuse, and Pain Experience Among Adults with Chronic Pain. Pain Medicine. 2020;21(4):670-676. https://pubmed.ncbi.nlm.nih.gov/30938818/

² Bittencourt et al. Health literacy, pain-related interference and pain-related distress of patients with musculoskeletal pain. Health Promot Int. 2021 Oct 31;daab183. https://pubmed.ncbi.nlm.nih.gov/34718561/

³ Kountz. Strategies for improving low health literacy. Postgrad Med. 2009;121(5):171-177.