• outcome assessment
• health care

Poor health literacy is common occurring in a third of the adult population.1 Rates of low health literacy are higher in the elderly, those with limited education, lower income, chronic medical conditions and those who are non-native English speakers. Low health literacy is associated with limited knowledge of health conditions and increased likelihood of poor adherence, rehospitalisation, morbidity and mortality.2–4 Limited health literacy has also been associated with approximately double the risk of not achieving guideline blood pressure recommendations.5 Health literacy as defined by the American Heart Association is the degree to which individuals can access and process basic health information and services and thereby participate in health-related decisions.3

Improved health literacy may be achieved by various education tools. There are increasing amounts and increasing complexity of cardiac educational material provided to patients, including electronic patient portals and other internet-based tools. There is also increasing capture of the young by computer devices. Greater health literacy is required to navigate these. Health literacy requires multiple skills beyond reading, writing and numeracy and includes interpretation of images, oral communication and may include social networking. As many as 11 fundamental and inter-related skills have been reported to make up and define health literacy (table 1).3

The increasing health information that comes via the internet and social media will not reach the many older people without access to technology and will also exclude those without understanding of how to access and interpret the information. There is also the increasing challenge of sifting ‘false information’ from facts on these platforms.

In this issue of the journal,6 McIntyre and colleagues6 describe the results of a randomised single centre clinical trial with 330 participants …