Industry collaboration to implement health literacy strategies for patient counselling at pharmacy

Candida C. Halton, MSc11, Gregory Duncan, BPharm, MPH22, Emma N. Andrews, PharmD33


  • Health Literacy (HL) is an important component of safe and effective medicines use.
  • Low health literacy is highly prevalent456, presenting a significant public health burden. Shows rates of adults with limited in health literacy are: 56% (Australia), 48% (Europe) and 88% (US).
  • Low HL is a risk factor for poor understanding of treatment, lower adherence, higher rates of hospitalization after discharge, and poorer overall health.78
  • Pharmacists report higher drug errors with low HL patients.9
  • Low HL also creates barriers to engagement between patient and health care professional, and self-care.1011
  • A Universal Precautions (UP) strategy is a validated process to mitigate these risks. There are clear, evidence-based strategies for UP implementation.12
  • It is important for the pharmaceutical industry to communicate effectively to ensure safe and effective medicines use.
  • Pfizer Inc. has an established interest in Health Literacy strategies, including supporting the development of the of the Newest Vital Sign screener.13


To develop and test a Health Literacy education program for community pharmacists to enhance counselling and reduce medicines risk.


Using expert input and drawing on the HL evidence base and validated HL interventions a structured educational model was developed. The core elements aligned with those described in other work14. Specifically:

  • a meaningful and practical definition of HL
  • an overview of its importance and impact on health outcomes
  • the patient experience of low HL
  • an introduction to the concept of UP in HL
  • strategies to reduce risk in particular "what questions you have?" and "teach back"

The core resource was developed as a face-to-face training session with breakouts to role-play the techniques, reflecting research demonstrating the importance of practice and peer support. Supporting collateral materials were also prepared.

What is teach-back?


  • Ask your patient to say in their own words what they know or understand.
  • If they can’t do this, repeat the information and ask them again to explain.
  • This can initially seem awkward, but is very effective!
  • Teach-back shifts the responsibility for error from the patient to the healthcare professional.


“Just to make sure I haven’t missed any important points, could you explain back to me how you are going to use this medicine?”

Training Resources

A number of Health Literacy training resources were created:

  • A workshop slide set resource structured to deliver the following learning objectives:
    1. Describe health literacy and its impact
    2. Understand why it’s relevant for your pharmacy and your patients
    3. Feel confident in using the teach-back technique
    4. Have ideas and resources to enhance your store and services for patients with low health literacy
  • Detail aid and fact sheet based on this information and used as quick guides to Health Literacy.
  • A short animated video that gives an introduction to the issues around Health Literacy and how to address them

A still from the animated Health Literacy resource (contains no information).


  • Training was piloted with the Indian Pharmaceutical Association for 150 pharmacists, with further trainings scheduled in 2018.
  • Further training was undertaken at the Medical Information Learning and Educational Services (MILES) meeting for Partner4Better in Kalyan, India on 28 April 2018.
  • A version was adapted for Pfizer medical staff to enhance HL knowledge and establish a trainer network for wider implementation.
  • Pilot data shows that learning objectives were met, with the content being relevant and well-received.

Photograph of the group at the MILES meeting, Palm Water Resort, Kalyan, India.


A well described structured program for Universal Precautions in Health Literacy was identified, that lent itself to practical implementation for the education of pharmacists to improve patient counselling.

  1. Visiting Lecturer/Researcher, University of Westminster (and Studio Health Consultancy), London, UK ↩︎

  2. Senior Research Fellow, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia ↩︎

  3. Senior Director, US/Global Medical Affairs, PEH, Pfizer Inc., New York, United States ↩︎

  4. Australian Bureau of Statistics, 2006 ↩︎

  5. Sørensen et al., 2012 ↩︎

  6. Kutner et al., 2006 ↩︎

  7. Frisch et al., 2011 ↩︎

  8. Mitchell et al., 2012 ↩︎

  9. Koster et al., 2016 ↩︎

  10. Batterham et al., 2014 ↩︎

  11. von Wagner et al., 2009 ↩︎

  12. Paasche-Orlow & Wolf, 2007 ↩︎

  13. Weiss et al., 2005 ↩︎

  14. Mihalopoulos et al., 2013 ↩︎

  15. AHRQ, 2017 ↩︎