Patient Education and Health Literacy

Wittink, H.; Oosterhaven, J.

doi:10.1016/j.msksp.2018.06.004

Cited by 267Health Literacy and Information AccessibilityPatient-Provider Communication in HealthcareCultural Competency in Health Care

Patient Education and Health Literacy

Wittink, H., Oosterhaven, J.·2018·Musculoskeletal Science and Practice

DOI 10.1016/j.msksp.2018.06.004

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Abstract

Introduction Patient education is a relatively new science within the field of health care. In the past it consisted mainly of the transfer of knowledge and mostly biomedically based advice. Research has shown this to not be effective and sometimes counterproductive. As health care has moved away from applying a traditional paternalistic approach of 'doctor knows best' to a patient-centred care approach, patient education must be tailored to meet persons' individual needs. Purpose The purpose of this master paper is to increase awareness of patients' health literacy levels. Health literacy is linked to literacy and entails people's knowledge, motivation and competences to access, understand, appraise and apply health information in order to make judgements and take decisions in everyday life concerning health care, disease prevention and health promotion to maintain or improve quality of life during the life course. Many patients have low health literacy skills, and have difficulty with reading, writing, numeracy, communication, and, increasingly, the use of electronic technology, which impede access to and understanding of health care information. Implications Multiple professional organizations recommend using universal health literacy precautions to provide understandable and accessible information to all patients, regardless of their literacy or education levels. This includes avoiding medical jargon, breaking down information or instructions into small concrete steps, li…

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Patient characteristics, such as health literacy and disease awareness, affect how individuals can articulate their symptoms and understand treatment instructions, which directly impacts the diagnostic process.
“patient characteristics, such as health literacy and disease awareness, affect how individuals can articulate their symptoms and understand treatment instructions, which directly impacts the diagnostic process [24,25].”
From Toward Safer Diagnoses: A SEIPS-Based Narrative Review of Diagnostic Errors (2026) · cites this paper as [24]

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Enjezab, B., Zarehosseinabadi, F., Tafti, A., & Zarehosseinabadi, M. (2021) · Iranian Journal of Nursing and Midwifery Research · doi:10.4103/ijnmr.ijnmr_104_20 · Cited by 7
“Many studies have highlighted the importance of the issue and its effective relevance.[21,22] However, in the present study, this relationship was found to be inverse; the result of our study is in line with a study reporting that although most of the subjects were highly educated, health literacy was reported to be i…”
Result
Assessing Parents' Communication of Weight and Weight Management from Clinic to Home
Cain, K. S., Cohen, G. M., Skelton, J., Crawford, L., & Brown, C. L. (2020) · Childhood Obesity · doi:10.1089/chi.2019.0207 · Cited by 7 · see citing works
“This comprehensive level of medical understanding is best achieved through tailored patient education rather than through generic materials(35) and through the cocreation of solutions rather than the transfer of information from provider to patient.(36) In our study, parents did not find printed materials, online reso…”
Background
Toward Safer Diagnoses: A SEIPS-Based Narrative Review of Diagnostic Errors
Yen, C., Epling, J. W., Rockwell, M., & Vaughn-Cooke, M. (2026) · Diagnostics · doi:10.3390/diagnostics16020347 · Cited by 6 · see citing works
“For example, patient characteristics, such as health literacy and disease awareness, affect how individuals can articulate their symptoms and understand treatment instructions, which directly impacts the diagnostic process [24,25].”
Characterizing health literacy in cardiac rehabilitation patients: a decade of multinational data (2014–2024)
Ghisi, G. L. D. M., Aultman, C., & Oh, P. (2024) · Health Literacy and Communication Open · doi:10.1080/28355245.2024.2446620 · Cited by 6
Same patient but different worlds: A state-of-the-art review translating best practice psychosocial care from musculoskeletal care to the orthopaedic context
March, M. K., & Roberts, K. E. (2024) · BMC Musculoskeletal Disorders · doi:10.1186/s12891-024-08107-4 · Cited by 6 · see citing works
Exploring Stakeholders’ Perceptions of Using Digital Health Technologies to Improve the Conservative Treatment of Adolescent Idiopathic Scoliosis: Qualitative Study
Sykorova, K., Mathew, A., Pavel, N., Gazerani, P., Saidi, T., Johnsen, M. B., Lystad, J. U., Bull, H., Kvammen, M. F., He, H.-G., et al. (2024) · Journal of Medical Internet Research · doi:10.2196/69089 · Cited by 6 · see citing works
“The importance of language and personalized information aligns with research suggesting that tailored patient education can improve treatment adherence [41].”
Evaluating cancer patient-reported experience measures against health literacy best practices
Giannopoulos, E., Moody, L., Mackinnon, R., Gill, B., Giuliani, M., & Papadakos, J. (2024) · Supportive Care in Cancer · doi:10.1007/s00520-024-08838-z · Cited by 6 · see citing works
“To illustrate this point, patients with limited health literacy may find it challenging to read and understand items on a PREM questionnaire if they include unfamiliar medical jargon, risking inaccurate responses, thus impacting the instrument’s validity [22].”
An Analysis of the Readability of Online Sarcoidosis Resources
Irshad, S., Asif, N., Ashraf, U., & Ashraf, H. (2024) · Cureus · doi:10.7759/cureus.58559 · Cited by 6
“Health literacy is defined as "the personal, cognitive, and social skills that determine the ability of individuals to gain access to, understand, and use information to promote and maintain good health" [11].”
Background
Hospital health literacy conceptual explanation: A qualitative content analysis based on experts and population perspectives
Bahrambeygi, F., Rakhshanderou, S., Ramezankhani, A., & Ghaffari, M. (2023) · Journal of Education and Health Promotion · doi:10.4103/jehp.jehp_494_22 · Cited by 7 · see citing works
“[35,36] Patients need to apply a basic level of reading, writing, and numeracy skills to health‐related materials such as prescriptions and medicine labels.[37]”
Background
Regional Inequalities and Influencing Factors of Residents’ Health in China: Analysis from the Perspective of Opening-Up
Gao, G.-C., Hu, J., Wang, Y., & Wang, G. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph191912069 · Cited by 6
“Thirdly, the coefficient of Education is significantly positive, which is mainly since the improvement of education level can promote residents to form a correct life and behavior style, enhance awareness of personal health and disease prevention, so as to improve their health level [25].”
Background
Implementation of health literacy training for clinicians in a federally qualified health center
Naperola-Johnson, J., Gutiérrez, J., Doyle, K., Thompson, J., & Hendrix, C. (2022) · PEC Innovation · doi:10.1016/j.pecinn.2022.100083 · Cited by 6
“One way to address this is to exchange the universal screening of health literacy, highlighted during this training, for the “universal precautions” approach [4,11,29,33-34].”
Background
Factors affecting the parental knowledge, beliefs, and attitudes towards pediatric dental X-rays
Kose, T., Gunacar, D., Arslan, I., & Peker, K. (2022) · Clinical Oral Investigations · doi:10.1007/s00784-022-04603-w · Cited by 6 · see citing works
“As a component of health literacy efforts, providing understandable and accessible information to patients is crucial element for promoting patient involvement in treatment decisions as well as their decision-making for treatment choices [30, 31].”
Background
"Doing our best for patient safety": An international and interprofessional qualitative study with spinal manipulative therapy providers in community-based settings.
Funabashi, M., Holmes, M., Pohlman, K. A., Salsbury, S., O'Beirne, M., Vohra, S., & Mior, S. (2021) · Musculoskeletal Science and Practice · doi:10.1016/j.msksp.2021.102470 · Cited by 6
Effectiveness of Online Oral Health Education During the Covid-19 Pandemic
Kasuma, N., Biomed, M., Murniwati, Sumantri, D., Nofika, R., Nelis, S., Susi, & Fransiska, A. (2020) · Indian Journal of Forensic Medicine & Toxicology · doi:10.37506/ijfmt.v14i4.12306 · Cited by 6 · see citing works
A Linguistic Model of Communication Types in Palliative Medicine: Effects of Multidrug-Resistant Organisms Colonization or Infection and Isolation Measures in End of Life on Family Caregivers' Knowledge, Attitude, and Practices
Peters, J., Dykes, N., Heckel, M., & Ostgathe, C. (2019) · Journal of Palliative Medicine · doi:10.1089/jpm.2019.0027 · Cited by 6
Informing transplant candidate and donor education in living kidney donation: mapping educational needs through a rapid review
Truhan, T. E., McMahon, J., Courtney, A. E., Gill, P., Mansell, H., Noble, H. R., Reid, J., Rosaasen, N., Wood, A., & McKeaveney, C. (2025) · BMC Nephrology · doi:10.1186/s12882-025-04116-0 · Cited by 5 · see citing works
“Some transplant candidates and donors may face difficulties with these forms of education, due to low general or health literacy and/or language barriers [12, 13].”
Interventions to improve patient health education competence among nursing personnel: a scoping review protocol
Wang, G.-H., Wang, S., Liu, K., Tang, S., Qi, Y.-X., & Chen, Q.-R. (2024) · BMJ Open · doi:10.1136/bmjopen-2024-087015 · Cited by 5 · see citing works
Peningkatan Kemampuan Literasi Pemanfaatan Simplisia Tanaman Obat Herbal untuk Kesehatan Keluarga
Purba, A., Sakina, S., Hasanatuludhhiyah, N., Fatimah, N., Paramitha, N., Mukhoirotin, M., & Toyib, M. (2024) · PengabdianMu: Jurnal Ilmiah Pengabdian kepada Masyarakat · doi:10.33084/pengabdianmu.v9i9.6971 · Cited by 5
“Dengan literasi kesehatan yang baik, masyarakat dapat mengakses informasi kesehatan dengan baik dan membuat keputusan yang tepat terkait kesehatan (Wittink & Oosterhaven, 2018).”
Background
How do young women approaching screening age interpret the NHS cervical screening leaflet? A mixed methods study of identifying interpretation difficulties, barriers, facilitators, and leaflet interpretation, engagement and future screening behaviour
Charlton, C., & Rodrigues, A. (2024) · Health Psychology and Behavioral Medicine · doi:10.1080/21642850.2024.2361005 · Cited by 5 · see citing works
The association between health literacy and pedestrian safety behavior among adults: a cross-sectional study
Zahedi, H., Mohammadinia, L., Dehghani, S., Habibzadeh, S., & Kheibar, N. (2024) · BMC Public Health · doi:10.1186/s12889-024-18441-w · Cited by 5
“Increasing the awareness of families with accident-involved patients plays a significant role in improvement and preventing disease recurrence [7].”
Background
Collaborating with patients and caregivers to create web-based educational resources for people affected by cirrhosis
Johnson, E., Hyde, A., Drager, D., Carbonneau, M., Bain, V. G., Kowalczewski, J., & Tandon, P. (2023) · PEC Innovation · doi:10.1016/j.pecinn.2023.100201 · Cited by 5
“As others [37,38] discovered, this objective was not without its challenges.”
Background
A comprehensive review of the components of nurse-coordinated care which are most effective in preventing coronary heart diseases
Fan, W., Guo, C., Zhao, Q., & Ma, H. (2023) · African Health Sciences · doi:10.4314/ahs.v23i1.55 · Cited by 4 · see citing works
The effects of modifying elements of written informed consent forms for elective surgical or invasive procedures: A systematic review.
Bühn, S., Huppertz, E., Weise, A., Lühnen, J., Steckelberg, A., Büchter, R., Hess, S., Choi, K., & Mathes, T. (2022) · Patient Education and Counseling · doi:10.1016/j.pec.2022.107576 · Cited by 5 · see citing works
Can Artificial Intelligence Educate Patients? Comparative Analysis of ChatGPT and DeepSeek Models in Meniscus Injuries
Bozgeyik, B., & Öğümsöğütlü, E. (2025) · Healthcare · doi:10.3390/healthcare13222980 · Cited by 2 · see citing works
“The importance of using clear, simple, and easily understandable language—particularly in patient education and public information materials—has been frequently highlighted in previous studies [27].”
Digital Assistants for Diabetes Treatment: Designing a User Interface to Support Chronic Disease Self-Management
Mirbabaie, M., Marx, J., Möllmann, N., & Matt, S. (2025) · ACM SIGMIS Database the DATABASE for Advances in Information Systems · doi:10.1145/3757308.3757312 · Cited by 2 · see citing works
“Patients can only take responsibility for their illness and collaborate effectively with the responsible health specialists if they possess an appropriate level of health literacy to understand basic medical information and specific treatment goals (Wittink & Oosterhaven, 2018).”
Integrating theoretical and practical constructs in patient education: A comprehensive scoping review
Yousefiazar, A., Ghahramanian, A., Rahmani, A., Feizollahzadeh, H., Sadeghi, M. R., Ghaffarifar, S., & Parizad, R. (2025) · Patient Education and Counseling · doi:10.1016/j.pec.2025.109226 · Cited by 5 · see citing works
Communication styles and reader preferences of LLM- and human-authored COVID-19 information explanations: a case study
Zhou, J., Venkatachalam, K., Choi, M., Saha, K., & de Choudhury, M. (2025) · BMC Artificial Intelligence · doi:10.1186/s44398-026-00030-z · Cited by 4 · see citing works
Eyes on the Text: Assessing Readability of Artificial Intelligence and Ophthalmologist Responses to Patient Surgery Queries
Kurapati, S., Barnett, D. J., Yaghy, A., Sabet, C., Younessi, D. N., Nguyen, D., Lin, J. C., & Scott, I. U. (2025) · Ophthalmologica · doi:10.1159/000544917 · Cited by 4 · see citing works
Integrating evidence from lived experience of Aboriginal people and clinical practice guidelines to develop arthritis educational resources: a mixed-methods study.
Conley, B., Linton, J., Bullen, J., Lin, I., Toovey, R., Persaud, J. G., O'Brien, P., Prehn, R., Bromley, J., Gregory, N., et al. (2024) · The Lancet Rheumatology · doi:10.1016/s2665-9913(24)00233-9 · Cited by 4 · see citing works
Patient at community clinics: Recommendations for advancing health literacy.
Palmborg, M., Fernandez-Branson, C., & Pessoa-Brandao, L. (2024) · Patient Education and Counseling · doi:10.1016/j.pec.2024.108618 · Cited by 4
Impact of a transformative health literacy model for Thai older adults with hypertension
Sukcharoen, P., Sakunpong, N., Polruk, J., & Chumdaeng, S. (2024) · BMC Research Notes · doi:10.1186/s13104-024-06782-z · Cited by 4
Changes in Health Education Literacy After Structured Web-Based Education Versus Self-Directed Online Information Seeking in Patients Undergoing Carpal Tunnel Release Surgery: Nonrandomized, Controlled Study
Seel, M., Mihalic, J., Froschauer, S., Holzner, B., Meier, J., Gotterbarm, T., & Holzbauer, M. (2024) · JMIR Formative Research · doi:10.2196/65114 · Cited by 4 · see citing works
“This approach should provide patients with the health-related knowledge and skills to manage their medical conditions effectively [8].”
Psychometric Testing of the Filipino Version of the Clients' Perceptions of Providers' Cultural Competency (CPOPCC) Instrument Among LGBTQ+ Population in the Philippines.
Torres, R. Q. D., Pacquiao, D., Zha, P.-J., Katz, J. R., & Sattler, V. P. (2023) · Journal of Nursing Measurement · doi:10.1891/jnm-2022-0084 · Cited by 4 · see citing works
Massage Therapy: A Person-Centred Approach to Chronic Pain
Lebert, R., Noy, M., Purves, E., & Tibbett, J. (2022) · International Journal of Therapeutic Massage & Bodywork · doi:10.3822/ijtmb.v15i3.713 · Cited by 4 · see citing works
Disparities in Opioid Prescribing for Long-Term Chronic and Short-Term Acute Pain: Findings from the 2019 National Health Interview Survey
Weissman, J. D., Russell, D., & Taylor, J. (2022) · Journal of Behavioral Health Services & Research · doi:10.1007/s11414-022-09790-8 · Cited by 4
Knowledge translation resources to support the use of quality of life assessment tools for the care of older adults living at home and their family caregivers
Schick-Makaroff, K., Sawatzky, R., Cuthbertson, L., Öhlén, J., Beemer, A., Duquette, D., Karimi-Dehkordi, M., Stajduhar, K., Suryaprakash, N., Terblanche, L., et al. (2021) · Quality of Life Research · doi:10.1007/s11136-021-03011-z · Cited by 4 · see citing works
Medication Non-adherence Prevalence and Determinants in Children and Adolescents with Chronic Liver Diseases
Dehghani, S., Shamsaeefar, A., Kazemi, A., Kazemi, K., Mashhadiagha, A., Moosavi, S. A., Motazedian, N., Nikeghbalian, S., & Malek-hosseini, S. (2021) · Iranian Journal of Pediatrics · doi:10.5812/ijp.112323 · Cited by 4
Readability and lexical sophistication of colon cancer websites – a corpus-assisted assessment of online educational materials for patients
Bączkowska, A. (2020) · Forum filologiczne Ateneum · doi:10.36575/2353-2912/1(7)2019.009 · Cited by 4
“11 of Americans, nearly 50% of Europeans, and about 60% of Canadians and Australians have inadequate health literacy (Wittlink and Oosterhaven 2018) and thus their understanding of patient materials published on the web is unsatisfactory.”
Background

Authors: Wittink, H., & Oosterhaven, J.
Affiliations: University of Applied Sciences Utrecht (NL)
Corresponding author: Wittink, H.
ORCID: Wittink, H.
Oosterhaven, J.
Venue: Musculoskeletal Science and Practice
Publisher: Elsevier BV
Published: 2018-12
Volume: 38
Pages: 120-127
ISSN: 2468-7812 (ISSN-L)
DOI: 10.1016/j.msksp.2018.06.004
OpenAlex: W2810661566
Cited by: 267
References: 0
Citations by year: 2026: 35 · 2025: 38 · 2024: 57 · 2023: 50 · 2022: 35 · 2021: 24 · 2020: 17 · 2019: 6 · 2018: 1 · 2015: 1 · 2012: 2
FWCI: 18.40
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Musculoskeletal Science and Practice (publishedVersion)
PubMed (publishedVersion)
Data Archiving and Networked Services (DANS) (submittedVersion)
Topics: Health Sciences › Health Professions › General Health Professions › Health Literacy and Information Accessibility
Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
Social Sciences › Sociology and Political Science › Cultural Competency in Health Care
Keywords: patient education, health literacy, patient-centered care, teach-back, health information understanding, health promotion, disease prevention, patient decision-making, health information access, visual aids, numeracy
MeSH terms: Adult, Aged, Aged, 80 and over, Female, Humans, Health Knowledge, Attitudes, Practice, Male, Middle Aged, Patient Education as Topic, Patient-Centered Care, Health Literacy

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