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Review
. 2025 Dec;28(6):e70479.
doi: 10.1111/hex.70479.

Understanding Health Literacy Through Patients' Interpretation of Health Education Leaflets: A Thematic Narrative Review

Yung-Hui Tang  1   2 , Chin Tsai Lin  3 , Li-Chu Wu  1
Affiliations
Review

Understanding Health Literacy Through Patients' Interpretation of Health Education Leaflets: A Thematic Narrative Review

Yung-Hui Tang et al. Health Expect. 2025 Dec.

Abstract

Background: Understanding how patients interpret health education leaflets is essential in promoting equitable and effective health communication. This narrative thematic review synthesises current evidence and introduces a conceptual model to inform patient-centred leaflet design.

Methods: Twenty-eight English- and Chinese-language studies (2010-2024) were identified via PubMed, CINAHL, ERIC, Airiti Library and Google Scholar. Boolean searches combined terms related to health literacy, patient education materials and information design. Eligible studies underwent open coding and thematic synthesis, guided by Nutbeam's three-tier health literacy model (functional, interactive and critical) and cognitive learning theories (Cognitive Load, Multimedia Learning and Dual Coding).

Results: Patients frequently encountered dense text, medical jargon and poor text-image integration. Thematic mapping aligned barriers with literacy levels, generating two strategy tables. The proposed 'Boiling Water Model' depicts the progression from information gathering to value integration and a 'boiling point' of insight, supported by reflective prompts, risk-benefit comparisons and clarifying aids.

Conclusions: Embedding cognitive learning principles within leaflet design can facilitate patients' progression towards critical health literacy. A theory-driven, user-centred approach-incorporating plain language, interactive cues and reflective elements-can transform leaflets into dynamic tools that enhance comprehension and foster informed, value-aligned health decisions.

Patient or public contribution: No patients or members of the public were directly involved in the design, conduct or analysis of this narrative review. The study focus and synthesis were guided by documented patient experiences and reported barriers to comprehension in the existing literature, informing patient-centred health education material design.

Clinical trial registration: Not applicable. This study is a narrative literature review and does not report results of a clinical trial.

Keywords: cognitive learning theories; health communication; health literacy; patient education materials; patient‐centred care; user‐centred design.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
PRISMA flow diagram of the study selection process.
Figure 2
Figure 2
Boiling water model of health literacy. Note: This conceptual model illustrates four cognitive stages in patients' engagement with health information: information gathering, value integration, initial processing and critical comprehension. The final stage represents the ‘boiling point’ of health literacy, where reflective insight and decision‐making converge. Design elements such as reflective prompts, risk–benefit comparisons and clarifying aids act as cognitive ‘heat sources’ that sustain engagement and support decisions aligned with personal values.
Figure 3
Figure 3
Philosophical extension of the boiling water model: Patient thresholds for quality of life and dignity in dying.
See this image and copyright information in PMC

References

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