Health literacy in the pharmacy setting: defining pharmacotherapy literacy.

Main Article Content

Sean R. King
David J. McCaffrey III
Alicia S. Bouldin



Objective: All currently available definitions of health literacy may be considered quite general. Given the complex nature of the patient-pharmacy encounter and the varying tasks required to properly and successfully consume or administer medication or to adhere to a pharmaceutical care regimen, these available definitions may describe inadequately a patient’s health literacy for the purpose of pharmacotherapy and pharmacist intervention. Therefore, the objective of this research was to conceptualize the Pharmacotherapy Literacy construct.

Methods: Licensed pharmacists (n=2,368) were mailed a questionnaire providing them with the Healthy People 2010 definition of health literacy and asked, “Given this definition, how would you define Pharmacotherapy Literacy?” A total of 420 usable surveys were returned of which 176 (42%) included responses to the open-ended question concerning pharmacotherapy literacy. Responses were reviewed independently and collectively by the authors. Common themes were identified, compared and discussed until consensus was reached. An initial definition was formulated and distributed to six doctoral-trained academicians and practicing pharmacists who were asked to offer their opinions of the definition as well as suggestions for its improvement. The definition was modified and subjected to further review from 15 additional doctoral-trained academicians and practicing pharmacists who provided feedback concerning its improvement.

Results: Based on the recommendations received from the academicians and pharmacists, the following, final definition was formulated by the authors: Pharmacotherapy Literacy – An individual’s capacity to obtain, evaluate, calculate, and comprehend basic information about pharmacotherapy and pharmacy related services necessary to make appropriate medication-related decisions, regardless of the mode of content delivery (e.g. written, oral, visual images and symbols).

Conclusions: As the ever-changing pharmacy environment continues to advance and become more complex in nature, a definition of health literacy specific to the pharmacy setting—thereby providing a name and a focus—may improve medication consumption, medication safety, and the patient-pharmacist relationship.


Keywords: Health Literacy. Drug Therapy. Medication Errors. Consensus.

Abstract 1083 | PDF Downloads 603


1. American Heritage Dictionary. Third Edition. New York, NY: Bantam Doubleday Dell Publishing Group, Inc. 1994.

2. Kirsch I, Jungeblunt A, Jenkins L, Koldtad A. Adult literacy in America: a first look at the findings of the national adult literacy survey. Washington, DC: National Center for Education Statistics, U.S. Department of Education. 1993.

3. Simonds SK. Health education as a social policy. Health Education Monograph. 1974; 2: 1-25.

4. Ad Hoc Committee on Health Literacy for the American Council on Scientific Affairs, American Medical Association. Health literacy: report of the council on scientific affairs. JAMA. 1999;281(6):552-557.

5. Nutbeam D. Health promotion glossary. Health Promot. 1986;1(1):113-127.

6. Ratzan SC and Parker RM. Introduction In: Selden CR, Zorn, M, Ratzan SC, Parker, RM, eds. National Library of Medicine Current Bibliographies in Medicine: Health Literacy. Vol. NML, Pub. No CBM 2000-1. 2000. Bethesda, MD. National Institutes of Health, U.S. Department of Health and Human Services. Available at: (Accessed April 2, 2007).

7. Parker RM, Baker DW, Williams MV, Nurss JR. The test of functional health literacy in adults: a new instrument for measuring patient’s literacy skills. J Gen Intern Med. 1995;10(10):537-541.

8. Williams MV, Baker DW, Parker RM, Nurss JR. Relationship of functional health literacy to patients’ knowledge of their chronic disease: a study of patients with hypertension or diabetes. Arch Intern Med. 1998;158(2):166-172.

9. Williams MV, Baker DW, Honig EG, Lee TM, Nowlan A. Inadequate literacy is a barrier to asthma knowledge and self-care. Chest. 1998;114(4):1008-1015.

10. National Academy on an Aging Society/Center for Health Care Strategies Low health literacy skills increase health care expenditures by $73 billion. Center for Health Care Strategies Fact Sheet, Washington, DC. 1998.

11. Benson JG Forman WB. Comprehension of written health care information in an affluent geriatric retirement community: use of the test of functional health literacy. Gerontology. 2002;48(2):93-97.

12. Williams MV, Davis T, Parker RM, Weiss BD. The role of health literacy in Patient-physician communication. Fam Med. 2002;34(5):383-389.

13. Mika VS, Kelly PJ, Price MA, Franquiz M, Villarreal R. The ABCs of health literacy. Fam Community Health. 2005;28(4):351-357.

14. Hardin LR. Counseling patients with low health literacy. Am J Health Syst Pharm. 2005;62(4):364-365.

15. Baker DW, Parker RM, Williams MV, Pitkin K, Parikh NS, Coates W Imara M. The health care experience of patients with low literacy. Arch Fam Med. 1996;5(6):329-334.

16. Kutner M, Greenberg E, JinY, Paulsen C. The Health Literacy of America’s Adults: Results From the 2003 National Assessment of Adult Literacy (NCES 2006–483). U.S. Department of Education. Washington, DC: National Center for Education Statistics, 2006.

17. Nichols-English G. Improving health literacy: a key to better patient outcomes. J Am Pharm Assoc. 2000;40(6):835-836.

18. Classen DC, Pestotnik SL, Evans RS, Lloyd JF, Burke JP. Adverse drug events in hospitalized patients: excess length of stay, extra costs, and attributable mortality. JAMA. 1997;277(4):301-306.

19. Schneitman-McIntire O, Farnen TA, Gordon N, Chan J, Toy WA. Medication misadventures resulting in emergency department patients at an HMO Medical Center. Am J Health Syst Pharm. 1996;53(12):1416-1422.

20. Dennehy CE, Kishi DT Louie C. Drug-related illness in emergency department patients. Am J Health Syst Pharm. 1996;53(12):1422-1426.

21. Schneider PJ, Gift MG, Lee YP, Rothermich EA, Sill BE. Cost of medication-related problems at a university hospital. Am J Health Syst Pharm. 1995;52(21):2415-2418.

22. Foulk D, Carrol P, Wood SN. Addressing health literacy: a description of the intersection of functional literacy and health care. American Journal of Health Studies. 2001;17(1):7-14.

23. Kim SP, Knight SJ, Tomori C, Colella KM, Schoor RA, Shih L, Kuzel TM, Nadler RB, Bennett CL. Health literacy and shared decision making for prostate cancer patients with low socioeconomic status. Cancer Invest. 2001;19(7):684-691.

24. National Academy on an Aging Society/Center for Health Care Strategies (1998). Low health literacy skills increase health care expenditures by $73 billion. Center for Health Care Strategies Fact Sheet, Washington, DC. Available at: (Accessed February 2, 2011).

25. Schloman BF. Health literacy: a key ingredient for managing personal health. Online J Issues Nurs. 2004;9(2):6.

26. Baker DW, Parker RM, Williams MV, Clark WS. Health literacy and the risk of hospital admission. J Gen Intern Med. 1998;13(12):791-798.

27. Baker DW, Gazmararian JA, Williams MV, Scott, T, Parker RM, Green D, Ren J, Peel J. Functional health literacy and the risk of hospital admission among medicare managed care enrollees. Am J Public Health. 2002;92(8):1278-1283.

28. Youmans SL, Schillinger D. Functional health literacy and medicine use: the pharmacist’s role. Ann Pharmacother. 2003;37(11):1726-1729.

29. Safeer RS, Keenan J. Health literacy: the gap between physicians and patients. Am Fam Physician. 2005;72(3):463-468.

30. Wolf MS, Davis TC, Tilson HH, Bass PF, Parker RM. Misunderstanding of prescription drug warning labels among patients with low literacy. Am J Health Syst Pharm. 2006;63(11):1048-1055.

31. Young D. Low health literacy is high among Americans, studies say. Am J Health Syst Pharm. 2004;61(10):986-987.

32. Wallace L. Patient’s health literacy skills: the missing demographic variable in primary care research. Annals of Family Medicine. Ann Fam Med. 2006;4(1):85-86.

33. U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. Healthy People 2010. Available at: (Accessed: February 12, 2008).

34. Jorm AF, Korten AE, Jacomb PA, Christensen H, Rodgers B, Pollitt P. Mental health literacy: a survey of the public’s ability to recognize mental disorders and their beliefs about the effectiveness of treatment. Med J Aust. 1997;166(4):182-186.

35. Jacobson KL, Gazmararian JA, Kripalani S, McMorris KJ, Blake SC, Brach C. Is Our Pharmacy Meeting Patients’ Needs? A Pharmacy Health Literacy Assessment Tool User’s Guide. (Prepared under contract No. 290-00-0011 T07.) AHRQ Publication No. 07-0051. Rockville, MD: Agency for Healthcare Research and Quality. October 2007.