Health Literacy Framework: A Definition of Terms

Healthcare is rapidly moving from its historical patriarchal culture where the doctor is the final authority and a “good patient” does as they are told, to a new world where an informed empowered patient expects to be fully involved in making their health care decisions and selections.

 Responding to this paradigm shift HIMSS is developed a Health Literacy Framework to support the role of technology in the improvement of health and health care.  The development of the Health Literacy Framework within this changing culture requires a careful analysis of terminology.  New terms are being developed and old terms are taking on new and expanded meaning.

The following terms and their definitions provides a foundation for understanding the goals and concepts inherent in the Health Literacy Framework.

Literacy is the ability to identify, understand, interpret, create, communicate and compute, using printed and written materials associated with varying contexts. Literacy involves a continuum of learning in enabling individuals to achieve their goals, to develop their knowledge and potential, and to participate fully in their community and wider society (UNESCO Educational Sector, 2004, p. 13).   

UNESCO Educational Sector. (2004) Plurality of literacy and its Implications for Policies and Programmes. p. 13 located at

Digital literacy includes the following knowledge and skills:

  • Competency with digital devices of all types, including cameras, eReaders, smart­ phones, computers, tablets, video games, and so forth. This does not mean that one can pick up a new device and use that device without an orientation. Rather, one can, using trial and error as well as a manufacturer’s manual, determine how to effectively use a device.
  • The technical skills to operate these devices as well as the conceptual knowledge to understand their functionality.
  • The ability to creatively and critically use these devices to access, manipulate, evalu­ ate, and apply data, information, knowledge and wisdom in activities of daily living.
  • The ability to apply basic emotional intelligence in collaborating and communicating with others.
  • The ethical values and sense of community responsibility to use digital devices for the enjoyment and benefit of society

Nelson, R. & Joos, I. (2013) An Introduction: Social media and the transforming roles and relationships in health care. Chapter 1 in  Nelson, R., Joos, I., Wolf.  Social Media for Nurses: Educating Practitioners and Patients in a Networked World. New York: Springer Publishing Company

Financial literacy is the ability to make informed judgments and to take effective actions regarding current and future use and management of money. Financial capability is  the individual’s capacity, based on knowledge, skills, and access, to manage financial resources effectively

U.S. Government Accountability Office (February 9, 2012) Financial Literacy: Strengthening Partnerships in Challenging Times: A Forum Convened by Comptroller General Gene L. Dodaro, GAO-12-299SP accessed at

Health Insurance Literacy measures the degree to which individuals have the knowledge, ability, and confidence to find and evaluate information about health plans, select the best plan for their financial and health circumstances, and use the plan once enrolled.

 Consumers Union, (February 2012).  Measuring Health Insurance Literacy: A Call to Action.  Accessed at

Health literacy is defined as the degree to which individuals have the capacity to obtain, process and understand basic health information needed to make appropriate health decisions and services needed to prevent or treat illness.

U.S. Department of Health and Human Services, Health Resources and Services Administration (N.D.) About Health Literacy. Accessed at

An organization that makes it easier for people to navigate, understand, and use information and services to take care of their health. Ten attributes of health literate health care organizations include:

  1. Has leadership that makes health literacy integral to its mission, structure, and operations.
  2. Integrates health literacy into planning, evaluation measures, patient safety, and quality improvement.
  3. Prepares the workforce to be health literate and monitors progress.
  4. Includes populations served in the design, implementation, and evaluation of health information and services.
  5. Meets the needs of populations with a range of health literacy skills while avoiding stigmatization.
  6. Uses health literacy strategies in interpersonal communications and confirms understanding at all points of contact.
  7. Provides easy access to health information and services and navigation assistance.
  8. Designs and distributes print, audiovisual, and social media content that is easy to understand and act on.
  9. Addresses health literacy in high-risk situations, including care transitions and communications about medicines.
    1. Communicates clearly what health plans cover and what individuals will have to pay for services.

IOM (2012) Ten attributes demonstrate the characteristics of a health literate organization: A discussion paper. Accessed at

Organizational health literacy are the approaches that organizations and professionals implement to help people find, process, understand, and decide on health information and services.

U.S. Department of Health and Human Services, Health Resources and Services Administration (N.D.) About Health Literacy. Accessed at

Digital health literacy is a specific type of health literacy involving the application of digital literacy knowledge and skills (as referenced above)  to improve or enable health and health care. 

Patient engagement is an organization's strategy to get patients involved in actively and knowledgeably managing their own health and wellness and that of family members and others for whom they have responsibility. This includes reviewing and managing care records, learning about conditions, adopting healthy behaviors, making informed healthcare purchases and interacting with care providers as a partner.

Patient experience is the sum of all interactions, shaped by an organizations culture, that influence patient perceptions across the continuum of care.  

The Beryl Institute (N.D) Defining Patient Experience. Accessed at

Patient literacy is not a specific type of knowledge and/or skill but rather refers to the combination and levels of each type of literacy as they are synthesized and expressed by an individual, family, group or community within their activities of daily living including the management of their health.  

Nelson, R. & Staggers, N. (in press). Theoretical Foundations of Health Informatics. Chapter 2 in Nelson & Staggers (Eds.) Health Informatics: An Interprofessional Approach. 2nd edition St Louis:  Elsevier/Mosby

Plain language (or clear writing) is a way of writing and presenting information so that readers can understand it quickly and easily.

Plain language documents are:

  • Relevant to the reader
  • Clear and concise
  •  Easy to follow
  • Conversational and direct> Designed to be inviting and help readers find important information

Plain Language Association International (N.D) About plain language. Accessed at

A patient story provides a chronological narrative of events as these events were experienced by the patient along with the patient’s interpretation of the events. It provides a context explain how the patient’s health problem(s) are understood and the patients While patient stories vary greatly in how detailed and cohesively they are expressed a patient story usually includes three parts these parts are not necessarily in the order presented in the following example.

The introduction will describe the unset of the event often within a certain setting. For example, I was home fixing dinner for house guests when I noticed a strange feeling in my chest. The body of the story will describe the progression of events and well as the interactions between other factors and people who are part of the story.

Nelson, R. & Staggers, N. (in press). Theoretical Foundations of Health Informatics. Chapter 2 in Nelson & Staggers (Eds.) Health Informatics: An Interprofessional Approach. 2nd edition St Louis:  Elsevier/Mosby


Health Literacy, digital literacy