Improving health literacy levels in Sri Lanka: a shared responsibility
Author: Laxsini Murugesu (PhD), senior consultant at Pharos - the Dutch centre of expertise
on health disparities
Making well-informed health decisions requires more than simply understanding
information. It also involves being able to find, evaluate and apply information in
everyday life. Improving patients’ health literacy is therefore a shared responsibility.
Patients, healthcare professionals and organisations in Sri Lanka should work
together to ensure that everyone can make informed decisions and achieve better
health outcomes.
What are health literacy skills?
According to the World Health Organisation (WHO), health literacy includes the knowledge
and competencies people need to access, understand, appraise, and use information to
make decisions about healthcare, disease prevention and health promotion.
Globally, limited health literacy is associated with poorer health outcomes, lower use of
preventive services such as vaccines or screening, higher hospitalisation rates, and
increased healthcare costs. Health literacy is also closely linked to education, income,
language, and access to healthcare services. People from vulnerable backgrounds are more
likely to face challenges due to lower health literacy levels. Importantly, any patient can
become low health literate, especially during times of stress, illness, or when facing
unfamiliar medical situations.
This means healthcare professionals should adopt a “universal precautions” approach,
which assumes that any patient may have difficulty understanding health information.
Healthcare systems should, therefore, be designed to be accessible, understandable and
inclusive for all patients.
Health literacy levels in Sri Lanka
Sri Lanka has a general literacy rate above 90%. However, general literacy does not
automatically translate into adequate health literacy levels. Wijesinghe and colleagues
(2025) surveyed 532 adults aged 18–49 across five districts: Colombo, Hambantota,
Kurunegala, Monaragala, and Mullaitivu (figure 1).
Key findings were:
● 85% had sufficient health literacy
● 15% (about 1 in 6 adults) had limited health literacy
● 27% lacked access to health information
● 17% faced language-related comprehension challenges
Regular interactions with public health workers and access to trusted media sources were
associated with higher health literacy levels. Language proficiency also played a critical
role. Participants who did not experience language barriers were less likely to have limited
health literacy.

Figure 1.

Five districts selected for the study by Wijesinghe et al. (2025)
These findings highlight the need to improve multilingual communication, expand digital
and media access, and invest in community-based interventions through frontline
healthcare workers.
Improving health literacy is a shared responsibility

The WHO emphasises that improving health literacy is not solely up to patients. Healthcare
organisations and professionals can apply strategies to make health information and
services more accessible and understandable for all patients.
Recommendations for healthcare organisations
1. Improve navigation of health services
Organisations can use clear signage inside facilities, simplify appointment procedures and
administrative procedures and provide patient navigators.
2. Train all staff in clear communication
Training should extend to all patient-facing personnel, because communication barriers are
not limited to doctor–patient interactions. Receptionists, nurses, pharmacists, and
administrative staff all influence patient understanding and healthcare navigation.
3. Provide information in patients’ first language
In Sri Lanka’s multilingual context, providing information in Tamil, Sinhala, and English is
essential. Culturally appropriate communication enhances understanding, reduces errors,
and increases patient confidence.
4. Support digital health literacy
With eHealth platforms, online appointment systems, and SMS reminders becoming
common, digital literacy does not automatically equate to health literacy. Organisations
should provide clear instructions and support to patients by staff for using digital tools.
Recommendations for healthcare professionals
1. Create a shame-free environment
○ Encourage questions, for example ask: “What questions do you have for
me?”. Instead of asking: “Do you have any questions?”
○ Normalise that many people have difficulties with reading and writing. For
example, ask: “We know that many people find it difficult to fill in forms. How
is that for you?”

2. Use simple language and avoid medical jargon.
3. Use visual aids and demonstrations to further support comprehension, especially
for people who may have difficulties with reading.
4. Apply the teach-back method during consultations.
The teach-back method involves asking patients to repeat information in their own
words to confirm understanding. This technique has shown to reduce
misunderstandings and improve adherence.
● Ask: “I want to make sure I’ve explained this well. Can you tell me how you
will take this medication at home?”
● Instead of asking: “Do you understand?”, because it often results in a “yes”
even if patients do not understand

References
Department of Census and Statistics, Sri Lanka. (2021). Labour Force Survey 2021: Literacy
rate of population (age 10 years and above) by district and sex. http://www.statistics.gov.lk
Murugesu, L., et al. (2022). Challenges and solutions in communication with patients with
low health literacy: Perspectives of healthcare providers. PLoS ONE, 17(3), e0264567.
https://doi.org/10.1371/journal.pone.0267782

Wijesinghe, M. S. D., et al. (2025). Health literacy among adults in five Sri Lankan districts.
BMC Public Health, 25, 112. https://doi.org/10.1186/s12889-025-23641-z
World Health Organization. (2025). Health literacy fact sheet. https://www.who.int/news-
room/fact-sheets/detail/health-literacy