Understanding Health Literacy: How to Communicate Complex Wellness Information Effectively

Health literacy (HL) is the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. Despite being a foundational determinant of health outcomes, low health literacy remains a widespread and often invisible crisis, contributing to poor adherence, increased mortality, and profound health inequities. In the modern wellness landscape, this challenge extends beyond understanding a prescription label; it involves comprehending complex, interconnected concepts like circadian biology, chronic inflammation, and the HPA axis. Effective communication, particularly in coaching and educational settings, requires a fundamental shift in responsibility—from viewing the client as deficient to recognizing the system and the communicator as inadequate. This article explores the neurocognitive barriers to understanding and details five core, evidence-based communication pillars, including Plain Language, Teach-Back, and strategic Chunking, to ensure complex wellness information is delivered effectively, fostering true client empowerment and sustained behavioral change.

Check out SNATIKA and ENAE Business School’s prestigious online MSc in Health and Wellness Coaching and Diploma in Health and Wellness Coaching before you leave.

1. The Health Literacy Crisis in the Age of Information

The twenty-first century is characterized by an abundance of complex wellness information, driven by advancements in personalized medicine and neurobiology. While this knowledge promises optimal health, it also widens the gap between the health-literate and the health-illiterate.

The U.S. Department of Health and Human Services estimates that nearly 9 out of 10 adults struggle to understand and use routine health information. This issue is not limited to functional literacy (the ability to read words); it encompasses communicative literacy (the ability to extract and interpret information) and critical literacy (the ability to analyze information and use it to control one’s life circumstances) <small>1</small>.

In the context of wellness coaching, a client may flawlessly read the words "Hypothalamic-Pituitary-Adrenal axis," but completely fail to grasp the core concept that chronic work stress physically damages the endocrine system. The challenge for wellness communicators is therefore twofold:

1. To convey complex scientific concepts (e.g., mitochondria, insulin sensitivity) accurately.
2. To translate these concepts into personally relevant, actionable steps (e.g., "Take a 10-minute walk after your big meal to improve insulin sensitivity").

Ignoring the principles of health literacy means that the best-designed program or the most accurate advice will fail simply because the client cannot process the instructions, leading to frustration, non-adherence, and a persistent belief that they are personally "bad" at making health changes.

2. The Impact of Low Health Literacy on Wellness Outcomes

Low health literacy is a profound barrier to self-management, which is the cornerstone of modern chronic disease and wellness care.

The Vicious Cycle of Confusion and Disengagement

When clients cannot understand why a behavior is important, or what the specific instructions are, they experience a breakdown in the crucial link between knowledge and motivation.

• Poor Adherence: Confusing instructions lead to errors in implementing protocols (e.g., improper timing of supplements, misunderstanding dietary restrictions, or failing to differentiate between resistance training and cardio).
• Reduced Self-Efficacy: When a client tries a complex plan and fails to see results—not because the plan was wrong, but because they executed it incorrectly due to misunderstanding—they conclude the fault lies with them. This shatters self-efficacy, the belief in one's capacity to succeed, making future attempts far less likely <small>2</small>.
• Increased Allostatic Load: The stress of continuous confusion, repeated failure, and fear of making a mistake adds to the body’s allostatic load (chronic wear and tear on the stress systems). This directly undermines wellness goals, as psychological stress is itself a key driver of inflammation, poor sleep, and metabolic dysfunction <small>3</small>.

In short, confusing communication doesn't just waste time; it actively makes the client sicker and less capable of change.

3. Neurocognitive Barriers to Information Processing

Effective communication must respect the innate limitations of the human brain, particularly when the client is already stressed or fatigued.

Cognitive Load Theory

Learning complex new information places demands on working memory, the brain's temporary storage system. Working memory has a finite, small capacity—roughly 3 to 5 new chunks of information at a time. When a communicator uses excessive jargon, overly long sentences, or introduces too many concepts simultaneously, they induce cognitive overload.

Cognitive overload causes the client to stop processing the information and often resort to one of two detrimental behaviors:

1. Passive Agreement: The client nods and says, "Yes, I understand," simply to end the interaction and escape the mental discomfort.
2. Selective Recall: The client remembers only the first one or two pieces of information, potentially discarding the most crucial steps or safety instructions <small>4</small>.

Emotional Interference

Furthermore, a client seeking help for a chronic condition or profound wellness challenge (e.g., severe fatigue, depression) is often experiencing anxiety or fear. Research confirms that states of high arousal or anxiety significantly impair the function of the prefrontal cortex, which is responsible for executive functions, complex language processing, and planning <small>5</small>. Therefore, the communicator must prioritize emotional safety and clarity to reduce the cognitive burden imposed by the client's internal state.

4. Pillar 1: Plain Language and Simplified Syntax

The guiding principle of health-literate communication is to use the simplest words and sentence structures necessary to convey the concept accurately.

The "4th Grade Rule"

While not a literal mandate, the common advice is to aim for a reading level easily accessible by a fourth to sixth grader. This strategy ensures accessibility across diverse educational backgrounds and also helps those with higher literacy who may be distracted, tired, or anxious.

Key Linguistic Adjustments:

• Avoid Jargon: Replace complex terms with common synonyms (e.g., use "body clock" instead of "circadian rhythm"; use "blood sugar" instead of "glucose homeostasis"; use "gut bacteria" instead of "microbiome"). If a technical term must be used, define it immediately and consistently use the simpler synonym thereafter.
• Prefer Active Voice: Active voice is direct, clear, and action-oriented. Compare:
  • Passive: "The anti-inflammatory diet should be adhered to by all clients."
  • Active: "You must follow the anti-inflammatory diet."
• Short Sentences: Break complex concepts into multiple, concise sentences. Avoid subordinate clauses and parenthetical statements that force the reader/listener to hold multiple concepts in working memory simultaneously. One idea per sentence is the goal.

Effective communication is not about proving the communicator's intelligence; it is about guaranteeing the client's understanding.

5. Pillar 2: Teach-Back and Confirmation of Understanding

The Teach-Back method is the gold standard for confirming comprehension. It is often referred to as "closing the loop" in communication.

The Teach-Back Strategy

Instead of asking, "Do you understand?" (which almost always elicits a yes), the coach or communicator asks the client to explain the information back in their own words.

Steps for Effective Teach-Back:

1. Explain: Deliver the key instruction or concept clearly and concisely.
2. Request: Ask a non-shaming, open-ended question that shifts responsibility to the communicator (e.g., "To make sure I was clear, could you tell me in your own words what you’re going to do when you feel stressed?" or "I just gave you a lot of information about your morning routine. Can you walk me through the first three steps you’ll take tomorrow?").
3. Review and Adjust: If the client's explanation is inaccurate or incomplete, the communicator must assume they failed in the explanation, not the client in the listening. The information is then re-explained using different words, analogies, or visual aids, and the Teach-Back process is repeated until accuracy is achieved <small>6</small>.

Teach-Back is a powerful metric of communication quality and a vital tool for ensuring safety and adherence in any complex plan.

6. Pillar 3: Visual Communication and Chunking

Because working memory is limited, visual and organizational tools are essential for managing cognitive load.

Chunking Information for Retention

Chunking is the process of grouping related items of information into a smaller number of easily managed segments. When conveying a new protocol, always aim to deliver information in groups of 3 to 5 key steps or concepts <small>7</small>.

• Example (New Stress Protocol): Do not list ten stress reduction techniques. Instead, group them into three primary actions:
  1. Body Reset: 4-7-8 breathing (use for immediate anxiety).
  2. Digital Boundary: Phone off one hour before bed.
  3. Physical Release: Take a 15-minute walk daily.

The Power of Visuals and Analogy

Visual aids dramatically improve retention and understanding. Complex processes (like inflammation or the cortisol curve) are best explained with simple graphics.

• Infographics and Diagrams: Use simple, annotated diagrams to illustrate anatomical or physiological concepts. For instance, explaining the function of the HPA axis with a diagram showing the brain sending a signal (like a car's accelerator) and the adrenal gland releasing cortisol (like fuel).
• Action-Oriented Materials: Materials given to the client should prioritize checklists, flowcharts, and simple calendars over dense blocks of text. The design should signal the next step clearly.

7. Pillar 4: Cultural Competence and Contextualization

Health literacy is not just about reading; it's about the ability to act within one's own environment and culture. Effective communication must be contextualized and respectful of the client's reality.

Beyond Reading Scores

A client may have a high reading level but low health literacy if the information provided is irrelevant, inaccessible, or conflicts with their deeply held beliefs, culture, or daily life realities <small>8</small>.

• Relatable Analogies: Use analogies drawn from the client’s known life (e.g., explaining energy management by comparing the body to a phone battery, or metabolic balance to balancing a checkbook).
• Addressing Structural Barriers: Acknowledge and plan around the client's real-world constraints. If a client works two jobs and uses public transit, a recommendation for a daily 60-minute gym session is not only unhelpful but demoralizing. The coach should instead suggest accessible, time-efficient options (e.g., resistance band exercises at home, using a 10-minute break for a walk).

Culturally competent communication ensures that the path to wellness is seen as feasible and congruent with the client’s life, not an imposed foreign standard.

8. Pillar 5: Motivational Interviewing and Confidence Building

The success of communicating complex information is tied directly to the client's readiness for change and their belief in their ability to execute the plan. Motivational Interviewing (MI) techniques enhance this readiness.

The "Elicit-Provide-Elicit" (EPE) Framework

When providing new, complex information, the EPE framework ensures the client is receptive and engaged, preventing the passive agreement caused by overload <small>9</small>.

1. Elicit: Start by asking what the client already knows about the topic and what they want to know. This identifies the knowledge gaps and gauges their baseline understanding (e.g., "What have you heard about sleep and stress?").
2. Provide: Deliver the new information in small, manageable chunks, using Plain Language and visuals.
3. Elicit: Use the Teach-Back method to check for understanding, focusing on the client's confidence in applying the information (e.g., "On a scale of 1 to 10, how confident do you feel that you could do the 4-7-8 breathing tonight?").

By focusing the conversation on the client's existing knowledge and confidence, the coach turns the delivery of complex information into a collaborative, empowering process.

9. Organizational and Systemic Strategies

While individual communication is critical, effective health literacy requires systemic support within wellness organizations and the broader healthcare ecosystem.

Creating a Health Literate Environment

Organizations should systematically review all client-facing materials and processes through the lens of health literacy:

• Universal Precautions: Assume everyone is operating under conditions of low health literacy, stress, and fatigue. All materials, from website forms to waiting room signage, should follow Plain Language standards.
• Form Simplification: Ensure intake forms, consent documents, and patient-reported outcome measures are designed for clarity, with minimal jargon and clear instructions. Use fill-in-the-blank or multiple-choice formats over open-ended essays.
• Technology for Simplification: Leverage technology to reduce the cognitive burden. This includes sending follow-up instructions via simple text message reminders, using personalized dashboards that visualize progress rather than raw data, and utilizing voice-to-text features for those with low functional literacy <small>10</small>.

The goal is to design an environment where the client has to exert minimal mental effort to navigate their care and understand their instructions.

10. Conclusion: Fostering Empowerment Through Clarity

Effective communication is the ethical backbone of wellness coaching and the single most powerful strategy for combating the negative consequences of low health literacy. It requires communicators to embrace a shift in paradigm: failure to understand is not a client flaw, but a system flaw.

By meticulously applying the principles of Plain Language, utilizing the Teach-Back method to ensure comprehension, breaking down information through Chunking, and adopting a culturally competent approach driven by the principles of Motivational Interviewing, communicators can transform complex wellness concepts into actionable, understandable steps. This proactive commitment to clarity not only improves adherence and health outcomes but fosters genuine empowerment, allowing clients to confidently transition from passively receiving information to actively managing and owning their journey toward optimal health.

Check out SNATIKA and ENAE Business School’s prestigious online MSc in Health and Wellness Coaching and Diploma in Health and Wellness Coaching before you leave.

Citation List

1. U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. (2004). National Assessment of Adult Literacy (NAAL): Health Literacy. (Foundational statistics and definitions).
2. Bandura, A. (1997). Self-efficacy: The exercise of control. W. H. Freeman and Company. (Self-efficacy as a core change mechanism).
3. McEwen, B. S. (2000). The neurobiology of stress: from serendipity to clinical relevance. Brain Research, 886(1-2), 172-189. (Allostatic load concept).
4. Sweller, J. (1988). Cognitive load theory, learning difficulty, and instructional design. Learning and Instruction, 12, 251-267. (Cognitive Load Theory).
5. Arnsten, A. F. T. (2015). The neurobiological basis of stress-induced cognitive impairment: the prefrontal cortex under fire. Annual Review of Neuroscience, 38, 21-44. (Anxiety and PFC function).
6. The Joint Commission. (2007). "What Did the Doctor Say?" Improving Health Literacy to Protect Patient Safety. The Joint Commission. (Teach-Back method in clinical settings).
7. Miller, G. A. (1956). The Magical Number Seven, Plus or Minus Two: Some Limits on Our Capacity for Processing Information. Psychological Review, 63(2), 81–97. (Chunking principle).
8. Nutbeam, D. (2000). Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century. Health Promotion International, 15(3), 259–267. (Definitions of functional, communicative, and critical health literacy).
9. Rollnick, S., Miller, W. R., & Butler, C. (2008). Motivational Interviewing in Health Care: Helping Patients Change Behavior. Guilford Press. (Elicit-Provide-Elicit framework).
10. Rimer, B. K., & Viswanath, K. (2013). Advancing the Science of Health Communication. Journal of the National Cancer Institute Monographs, 2013(47), 2-10. (Technology in health communication).
11. Safeer, R. S., & Keenan, J. (2005). Health literacy: The gap between physicians and patients. American Family Physician, 72(3), 463-465.
12. Berkman, N. D., et al. (2011). Health Literacy Interventions and Outcomes: An Updated Systematic Review. Agency for Healthcare Research and Quality (AHRQ) Publication No. 11-E006.
13. Viswanath, K. (2006). The communications revolution and differential access to health information. Journal of Communication, 56(1), S20-S34. (Health disparities and information access).
14. Kripalani, S., & Weiss, B. D. (2006). Teaching the illiterate patient. American Family Physician, 74(1), 17-18. (Practical communication techniques).
15. Paasche-Orlow, M. K., & Wolf, M. S. (2007). The correlation of health literacy with chronic disease outcomes. Journal of Internal Medicine, 262(3), 335-344.
16. Adepoju, V. O., et al. (2017). Influence of Health Literacy on Patient Engagement and Outcomes in Chronic Disease Management. Patient Education and Counseling, 100(4), 624-630.
17. Dube, N., et al. (2020). Visual Communication Strategies to Improve Comprehension of Health Information: A Systematic Review. Health Communication, 35(12), 1540-1550.
18. Institute of Medicine (IOM). (2004). Health Literacy: A Prescription to End Confusion. The National Academies Press. (Landmark report on the societal impact of low HL).
19. Coulter, A., & Ellins, J. (2007). Effectiveness of strategies for informing and involving patients in their health care: an overview of the research evidence. BMJ, 335(7609), 24-27.
20. Houts, P. S., et al. (2006). The role of pictures in improving health communication: a review of research and recommendations for practice. Patient Education and Counseling, 61(2), 180-192.