According to the most comprehensive national assessment of literacy among U.S. adults, only 12% have proficient health literacy – meaning nearly nine of out of 10 may lack the skills needed to manage their health and prevent disease.1 This issue of health literacy is of national importance; in fact, the U.S. Department of Health and Human Services has declared it an overarching goal of their Healthy People 2030 initiative to improve health over the next decade.2
Among injured workers, health literacy is an SDoH as well as a determinant of recovery. When patients do not understand their condition, treatment plan, or the workers’ compensation process, they are less likely to actively participate in their recovery. This impacts their treatment adherence and leads to longer claim durations and increased costs – materially worsening claim outcomes. As one former claims examiner aptly describes, “Engagement is the engine of recovery, and health literacy is the key that starts it.”3
Fortunately, claims teams have the opportunity to promote better health literacy for injured workers. Using targeted screening and communication strategies, they can help patients make informed decisions and achieve more optimal recovery outcomes.
According to the Centers for Disease Control and Prevention, health literacy is “the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.”4
Experts increasingly recognize that health literacy is not just an individual skill –organizations also play a role. The World Health Organization mentions that all information providers – including government, civil society, and health services – should enable access to trustworthy information in a form that is understandable and actionable for all people.5
Could interpret a table about blood pressure, age, and physical activity
Could consult reference materials to determine which foods contain a particular vitamin
Reading and understanding information in simple documents
Could search a short, simple text to find out what a patient is allowed to drink before a medical test
Source: National Assessment of Adult Literacy6,7
Women have higher average health literacy than men8
Adults aged 65 and older have lower average health literacy than adults in younger age groups8
Urban populations have higher health literacy than rural populations9
Those most at risk for limited health literacy have an annual income of less than $50,00010
In workers’ comp, health literacy may also be compounded by “system literacy” – as injured workers often have difficulty understanding the workers’ compensation system. This includes understanding claims reporting and processing, benefits, resolution of disputes, and the return-to-work process.
This lack of knowledge doesn’t just make filing for workers’ comp difficult – it can become an impediment to recovery. In Healthesystems’ 2026 survey of over 500 workers’ comp stakeholders, just over half of respondents (51%) ranked injured worker disengagement/unfamiliarity with the workers’ comp system as the biggest barrier to recovery.11
Workers who do not understand both their medical care and the workers' compensation process may be less likely to engage in treatment, attend appointments, comply with recommendations, or participate in return-to-work planning. That’s why it’s more important than ever for workers’ comp stakeholders to promote good health literacy and system literacy.
Among the general population, low health literacy is linked to worse health outcomes and poorer use of healthcare services. A systematic review of more than 100 articles reveals that it is consistently associated with:
More hospitalizations
Greater use of emergency care
Poorer ability to demonstrate taking medications appropriately
Poorer ability to interpret labels and health messages
Poorer overall health status and higher mortality rates among elderly people12
A 2022 study concluded that only half of patients admitted to general internal medicine units had adequate health literacy – and those with inadequate or marginal health literacy scores were more likely to revisit the emergency room (ER) within 90 days following their discharge from the hospital.13
Poor health literacy is also linked with the number of chronic conditions a patient suffers from. In one study of older adults in Switzerland, respondents who reported one, two, and three or more chronic conditions were more likely to have lower health literacy scores compared to respondents who did not report any chronic condition.14
Another study examined the associations between health literacy and health outcomes among individuals with traumatic brain injury at least a year post-injury. It concluded that inadequate health literacy was associated with worse perceived physical health and greater depressive symptoms.15
Even mortality rates are affected by health literacy. According to an American Heart Association study, patients hospitalized for heart failure who had a lower level of health literacy had an increased risk of all‐cause death – and this risk rose with decreasing health literacy.16
In addition to negative health outcomes, there’s also a financial toll to low health literacy, as it has been found to be negatively associated with a range of healthcare costs.17 In the United States, low health literacy is estimated to cost $105 to $238 billion each year in direct healthcare costs.18
Claims teams and nurse case managers can help promote health literacy among injured workers by embedding it in every step of the claims process, from intake to management to return-to-work preparation. Research has shown that health literacy interventions can improve patient understanding and support better health outcomes.19
Strategies for promoting health literacy include:
Screening. Before educating patients about their injury, care plan, and recovery, it’s important to assess their SDoH, including health literacy. One assessment tool is PRAPARE® (Protocol for Responding to & Assessing Patients’ Assets, Risks & Experiences), available in more than 25 languages.20
Tailoring communication. Once any disparities are identified, claims teams should aim to bridge the gaps. One review found that effective health literacy intervention approaches were more likely to use face-to-face components and information matched to participants’ language skills and cultural backgrounds.21
Using teach-back. Improving literacy requires providing plain communication and clear, unbiased information as well as checking for understanding via the “teach-back” method (i.e., asking injured workers to repeat back instructions). A systematic review found that teach-back was effective in 19 of 20 studies.22
Building trust. Empathetic communication and clear explanations can help alleviate the fear and anxiety many injured workers feel and empower them to make more informed decisions. According to one source, “A coach, supervisor, or case manager who listens, encourages, and answers questions is often the single most important factor in keeping an injured worker engaged.”23
