The SHARE Approach—Health Literacy and Shared Decisionmaking: A Reference Guide for Health Care Providers

Workshop Curriculum: Tool 4

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

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:

*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:

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 (most in both English and Spanish), visit:

A limited number of copies are available at no cost through the AHRQ Clearinghouse. All AHRQ resources are freely available online.

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


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.

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Page last reviewed July 2014
Page originally created July 2014
Internet Citation: The SHARE Approach—Health Literacy and Shared Decisionmaking: A Reference Guide for Health Care Providers. Content last reviewed July 2014. Agency for Healthcare Research and Quality, Rockville, MD.