The SHARE Approach—Health Literacy and Shared Decisionmaking: A Reference Guide for Health Care Providers
Cover Note: The SHARE Approach is a 1-day training program developed by the Agency for Healthcare Research and Quality (AHRQ) to help health care professionals work with patients to make the best possible health care decisions. It supports shared decisionmaking through the use of patient-centered outcomes research (PCOR).
Most patients want the best information available to make treatment decisions.1 Yet, people with limited health literacy may be less likely to make the choices and take the actions needed to stay well.2 This handout can help you learn about health literacy challenges in the United States and find ways to better communicate with your patients during shared decisionmaking.
Limited health literacy can impact effective shared decisionmaking
Eighty-seven percent of American adults lack full health literacy; that is approximately 9 out of 10 adults.3 Limited health literacy makes it hard to read, listen to, talk about, and evaluate health information.
Limited health literacy can make it harder for patients to:4,5
- Comply with their treatment plan.
- Fill out complex forms.
- Find providers and services.
- Share their health history.
- Understand risk and probability.
Limited health literacy leads to poor health outcomes
People with limited health literacy are more likely to:4,5
- Be hospitalized or visit the emergency room.
- Have trouble managing a chronic illness.
- Skip needed tests.
- Underuse preventive health care.
Some groups are at higher risk of limited health literacy
People with limited health literacy are more likely to:6
- Be older adults.
- Have a chronic illness.
- Have a low income level.
- Identify as a racial or ethnic minority.
- Lack a high school degree or GED.
- Speak English as a second language.
However, people from all walks of life can have limited health literacy.
How to communicate better with your patients
Use these techniques with all your patients—not just those who you think have limited health literacy. Any patient—especially when sick, frightened, or tired—can have trouble understanding health information. When it comes to shared decisionmaking, clearer is better.
Check off the strategies you will try when presenting decision aids
- Check that the decision aids are understandable and actionable using the Patient Education Materials Assessment Tool (PEMAT).
- Speak slowly in a caring voice.
- Use plain language and avoid medical jargon.
- Personalize print decision aids by circling or highlighting key information and asking your patient to write his or her name on the educational tool.
- Make sure to explain health numbers presented in decision aids in a way that is meaningful to your patient. Refer to Communicating Numbers to Your Patients: A Reference Guide for Health Care Providers (Tool 5).
- Make sure you present the information in a way your patient understands. Have your patient explain to you, in his or her own words, what you said to them. Refer to Using the Teach-Back Technique: A Reference Guide for Health Care Providers (Tool 6).
- Offer a qualified medical interpreter to patients who have language or hearing barriers. Refer to Overcoming Communication Barriers With Your Patients: A Guide for Health Care Providers (Tool 3).
Clear communication is key to shared decisionmaking
Communicating well with your patients opens the door to shared decisionmaking. That's because patients need information they understand in order to make an informed choice. Shared decisionmaking helps patients take charge of their care.
Learn more about health literacy
For health literacy information from the Agency for Healthcare Research and Quality (AHRQ) visit:
- Health Literacy Universal Precautions Toolkit AHRQ Pub. No. 10-0046-EF
- The Patient Education Materials Assessment Tool (PEMAT)* and User's Guide
*PEMAT is an instrument used to assess the understandability and actionability of print and audiovisual patient education materials.
For additional fact sheets on health literacy, visit:
- IOM (Institute of Medicine). 2012. Ten Attributes of Health Literate Health Care Organizations. Washington, DC: The National Academies Press.
Learn more about resources for patients
For culturally appropriate interactive decision aids from AHRQ, visit:
For consumer research summaries that compare treatment options for a variety of health conditions (in both English and Spanish), visit:
This tool is to be used in conjunction with the Agency for Healthcare Research and Quality's SHARE Approach workshop. To learn more about the workshop, visit www.ahrq.gov/shareddecisionmaking.
1. AARP, Building a Sustainable Future: A Framework for Health Security, Washington, D.C. (Annual Report 2008); and Moulton B., King J.S. Aligning ethics with medical decision-making: the quest for informed patient choice. J Law Med Ethics 2010 Spring;38(1):85-97. PMID: 20446987.
2. The Calgary Charter on Health Literacy: Rationale and Core Principles for the Development of Health Literacy Curricula; 2008.
3. National Assessment of Adult Literacy. National Center for Education Statistics; 2003.
4. Rudd R.E., Anderson J.E., Oppenheimer S., et al. Health literacy: An update of public health and medical literature. In Comings J.P., Garner B., Smith C. (Eds). Review of adult learning and literacy (vol. 7) (pp 175–204). Mahwa H., NJ: Lawrence Erlbaum Associates; 2007.
5. Berkman N.D., Sheridan S.L., Donahue K.E., et al. Health Literacy Interventions and Outcomes: An Updated Systematic Review. Prepared by RTI International, under Contract No. 290-2007-10056-I. AHRQ Publication No. 11-E006. Rockville, MD: Agency for Healthcare Research and Quality; March 2011.
6. Neilsen-Bohlman L., Panzer A.M., Kindig D.A. Health Literacy: A Prescription to End Confusion. Washington, DC: National Academies Press; 2004.