Nutrition counseling tips for patients with low health literacy

Understanding health information, navigating health care systems and services to make the best choices, and getting the care needed to stay healthy can be overwhelming for most people, but especially for those with low health literacy.  

Health literacy may have reduced emergency department visits and hospital readmissions. Dietitians and other health care providers educate patients to promote the best outcomes based on the goals for the individual patient. A patient’s understanding of a concept may lead to better dietary choices and health decisions.  

Since the mid-1970s, low health literacy has been a recognized topic in health care. The cost of low health literacy in direct health care in the United States is estimated between $105 to $238 billion (about $730 per person in the US) per year.  

Providing counseling for patients with low health literacy at the correct literacy level may result in fewer medication dosing errors, increased medication adherence, and increased patient follow-up with their doctors to request a refill on a prescription or a referral for services. 

Health, nutrition, and food literacy: What’s the difference? 

Nutrition and food literacy are different but complementary concepts that fall under the umbrella of health literacy. Individuals with food and nutrition literacy may be able to modify their diet to reduce their risk of developing complications from their health conditions. 

Nutrition literacy refers to the ability to understand basic nutrition information. It forms the foundation for the broader set of skills that make up food literacy. At its core, nutrition literacy reflects how well people can obtain, process, and comprehend essential nutrition information and services to make appropriate dietary decisions. 

Food literacy goes a step further. It extends beyond knowing facts or reading food labels and includes practical skills such as identifying foods, preparing them, and applying healthy eating behaviors in daily life. It encompasses the knowledge, confidence, and abilities needed to make informed, responsible food choices. 

How is health literacy assessed? 

Health literacy assessments are used by institutions, including hospitals, community health centers, the Department of Health, and others, including dialysis centers, nursing homes, and long-term care facilities.  

A health literacy score may be found in the patient’s medical record as part of the patient’s assessment or in other sections under the problem list or social history, etc. There are tools to assess the patient’s health literacy, such as the Brief Health Literacy Screening Tool or Rapid Estimate of Adult Literacy in Medicine.  

Educating the patient and involving the health care team 

Dietitians focus primarily on educating the patient and anyone involved in their care, whether the patient lives at home or in an assisted‑living setting. Education also extends to health care workers, including doctors, nurses, nursing assistants, and social workers. In many settings, improving health literacy can be incorporated into a Quality Assurance and Performance Improvement (QAPI) plan developed with the interdisciplinary team in a nursing home, dialysis facility, hospital, or similar environment. Dietitians may also collaborate with social workers to select effective, culturally sensitive tools for improving health literacy and to ensure interpreter services are used when language barriers exist.  

Considerations and counseling tips for patients with low health literacy 

Dietitians spend much of their time providing counseling and pairing verbal instruction with educational materials. During each meeting with a patient, clinicians also gather information and assess what the patient already understands about their diagnosis and use that insight to shape how to introduce nutrition‑related topics. 

Should education or counseling depend strictly on the reason for the consultation or referral?  

The education should begin with the reason for the consultation or referral, but it shouldn’t end there. The dietitian’s assessment during the visit, which may include labs, weight, medical history, medications, food access, health literacy, and the patient’s own questions, helps determine what else the patient needs to understand to manage their condition safely and effectively.  

What is the patient trying to communicate? 

A patient might say, “I’m diabetic on insulin and a blood pressure medication, but no one has ever talked to me about diet before.”  

They may be referring to conversations with their doctor or another health care provider, who may not have extensive nutrition training. A statement like this opens the door for meaningful discussion.  

The patient is expressing that they have a significant diagnosis and have been prescribed medications, yet they feel they haven’t received guidance on how their eating habits affect their condition. This indicates that they may feel confused, underserved, or unsure about how to manage their health. It also signals a gap in their understanding and an opportunity to begin meaningful nutrition education. 

Asking open-ended questions 

Though there may be “yes” or “no” questions in the assessment, try to ask open-ended questions as well. Ask the patient to verbalize what they would like to focus on during the counseling session. In other words, what have they been working on, and where to meet them on their journey to better health?  

Does this patient use reading glasses? What is the reading level of the patient? Answers may be found in the social work assessment.  

Educational materials 

Educational materials should be easy to read and culturally appropriate so patients can clearly understand and use the information. The Joint Commission and the American Medical Association recommend patient education materials be written at or below a fifth or sixth-grade reading level, respectively.  

Provide color visuals with images demonstrating the written information, including test results, to help interpret the information and identify the need for change in behaviors and food choices.  

Introducing key concepts 

Present two to three key concepts for each topic during a counseling session. For example, when discussing sodium, dietitians may choose to focus on how sodium affects blood pressure, the recommended daily sodium limit, and how to read food labels to identify high‑sodium items. 

Let the patient help guide the conversation. They may share what foods they keep in their kitchen or pantry, mention condiments they use, or talk about items visitors bring to them. These details offer natural entry points for education. 

Patients living in health care facilities 

Staff in a facility can also provide helpful context, such as noting when patients make special requests or order outside food. During the holidays, patients often receive food gifts and homemade meals, providing another opportunity to continue the discussion and reinforce key concepts.  

Medication adherence 

A patient may not share that they didn’t understand the doctor or the reason why they are taking a particular medication. Some patients have their medications delivered in blister packs with instructions, but may not be able to identify them.  

Use plain language and explain medical terms. Providing directions in easy-to-understand terms and visuals, including clear color images of the medication, may improve medication adherence. 

Assessing readiness for implementation 

Ask the patient to share what they plan to do after reviewing the information. Are they ready for change? For those familiar with the motivational interviewing tool known as the “Readiness Ruler,” it can be a helpful way to gauge a person’s readiness for change during the conversation.  

Ask the patient what changes they plan to make and why. How will this help them reach a goal to improve a lab result, lose or gain weight, meet blood pressure goals, alleviate constipation, or remember to take a specific medication at the right time and the right dose as prescribed?  

Other helpful tips 

Teach-back method 

Some patients prefer to solely discuss the topic and skip handouts. The teach-back method works best in these situations. After reviewing a new topic, ask the patient to explain the new information.  

Identification of the patient’s support system 

Who is involved in the patient’s care at home and providing other support in their community? Examples may include family, friends, community center, church, and services (e.g., elder services). Aside from the patient, a social worker or case worker may be the best resource. 

Overcoming language barriers 

It would be ideal to be able to speak with the patient in their language, but if that is not possible, an interpreter is required. If the facility doesn’t have an interpreter or multilingual staff on site, then an interpreter service may be available over the phone.  

Though a patient’s family member may be handy as well, keep in mind that they are likely not trained in medical interpretive services and may not get the full message across. Be sure to follow any facility policies regarding the need for interpreter services. Be ready to answer and ask questions during these exchanges of information.  

Conclusion 

Going beyond counseling patients with low health literacy, the dietitian and the health care team can work together to develop a strong care plan that supports positive changes in the patient’s health behaviors. This collaborative approach helps the patient make full use of available services, manage their health more effectively, and reduce the risk of developing additional chronic conditions. 

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References:  

Hudson S, Rikard RV, Staiculescu I, Edison K. Improving Health and the Bottom Line: The Case for Health Literacy. Nih.gov. Published July 26, 2018. Accessed January 26, 2026. https://www.ncbi.nlm.nih.gov/books/NBK518850/ 

Silva P, Araújo R, Lopes F, Ray S. Nutrition and food literacy: Framing the challenges to health communication. Nutrients. 2023;15(22):4708. https://doi.org/10.3390/nu15224708  

National Institutes of Health. Clear & Simple. National Institutes of Health (NIH). Published May 8, 2015. Accessed January 26, 2026. https://www.nih.gov/institutes-nih/nih-office-director/office-communications-public-liaison/clear-communication/clear-simple 

Zikmund-Fisher BJ, Scherer AM, Witteman HO, et al. Graphics help patients distinguish between urgent and non-urgent deviations in laboratory test results. J Am Med Inform Assoc. 2016;3:ocw169. https://doi.org/10.1093/jamia/ocw169  

Case Western Reserve University. Readiness Ruler. Center for Evidence-Based Practices | Case Western Reserve University. Published August 18, 2021. Accessed January 26, 2026. https://case.edu/socialwork/centerforebp/resources/readiness-ruler 

Center for Health Care Strategies. Identifying Limited Health Literacy. Center for Health Care Strategies website. Published March 2024. Accessed February 24, 2026. https://www.chcs.org/resource/identifying-limited-health-literacy/  

Tucker CA. Promoting Personal Health Literacy Through Readability, Understandability, and Actionability of Online Patient Education Materials. J Am Heart Assoc. 2024;13:e033916. https://doi.org/10.1161/JAHA.124.033916