Priyanka Sharma explains how making systems and information more accessible can improve healthcare for everyone.

Priyanka Sharma is a Director at World Education (a JSI Initiative), an organization working at the intersection of health and education to improve systems, expand opportunity, and support individuals and communities to thrive. With more than 18 years of experience in nonprofit leadership across adult education and social impact, Priyanka examines how policies, professional practices, and health systems shift, and how outcomes improve, when literacy is treated not as a side issue, but as a practical lever for better health.

We invited Priyanka for a conversation to better understand the greatest barriers — and opportunities — to improving health outcomes for the millions of adults that lack functional literacy.

What do we actually know about the relationship between literacy and health outcomes?

We know enough to be concerned — and to motivate bold intervention. But we still need to understand more to identify and scale the most impactful solutions.

We know that literacy barriers are consistently linked to worse health outcomes and higher healthcare costs. It can result in missed preventive care and lower follow-through on referrals, confusion about medications and greater difficulty managing chronic conditions. They also often result in avoidable emergency visits. Approximately 59 million adults in the U.S. lack functional literacy, resulting in an estimated $237 billion in excess annual healthcare costs.

What we don’t yet understand is what it takes to solve this problem. Said differently, we have evidence that literacy matters but we need more agreement and more evidence on what interventions work, for whom, and in which settings.

When people hear a phrase like “literacy gaps,” their first instinct is often to focus on teaching adults to read better. Can you walk us through the limitations of that framing?

Totally. Teaching adults to strengthen reading skills is important, but it’s only one piece of the puzzle, and it can’t be the only strategy.

Healthcare (and increasingly, telehealth and digital care) is a literacy-intensive environment by design. Even people who are strong readers can struggle when they’re sick, stressed, in pain, or trying to interpret medical jargon quickly. And the system frequently assumes that everyone can navigate online portals, read dense discharge instructions, decode insurance letters, follow a telehealth link, and understand what to do next without help.

I think we need to take a wider view. Literacy is partly about individual skills, and partly about how systems are designed. In our work, we see again and again that people are often capable and motivated — but the “last mile” falls apart when information is unclear, steps are too complex, or support isn’t available at the moment decisions are made. That’s why shifting the framing matters. We need to provide target support to individuals while at the same time making systems and interfaces more readable and navigable. This systems-level approach can improve outcomes more quickly than long-term skill-building alone. If we make health systems more readable and navigable and provide targeted support, we can improve outcomes faster than if we focus only on long-term skill gains.

Can you give us some examples of how different kinds of literacy barriers show up in healthcare settings, and why they matter for both patients and providers?

I’ll share some examples that we see across healthcare settings, from both the patient’s and the provider’s perspective. These examples span several interrelated categories of literacy — health, digital, and financial — that together shape whether someone can actually navigate the system to receive care and act on the care they receive.

The first set of examples that come to mind are related to health literacy, what I’d describe as the “I can read, but I don’t know what this means” problem. A patient leaves a visit with instructions like “take twice daily,” “monitor symptoms,” or “follow up in five to seven days,” but doesn’t actually know what counts as a warning sign, who to call, or what “follow up” really requires. For patients, that confusion leads to missed follow-up, medication errors, and mismanaged conditions. For providers, it looks like nonadherence, but it’s often a communication and systems problem — one that drives repeat visits and avoidable escalation, especially in high-volume settings like community health centers.

We also think about digital literacy and system navigation barriers, which show up everywhere from telehealth to online patient portals. When seeking telehealth, too often a patient can’t join a video visit because the link opens in the wrong browser, the app needs an update, or two-factor authentication blocks them from logging in. These challenges aren’t limited to telehealth though; Lab results posted only online, complex password resets, and unreadable portal messages create the same dynamic. Patients lose access to their own care information, and the system feels the impact in the form of no-shows, rescheduling burdens, gaps in continuity, and front desk staff becoming the backup portal, pulling time away from care and straining already thin administrative capacity.

The third example that comes to mind relates to financial and insurance literacy, or what I’d summarize as “this bill makes no sense, so I avoid care.” Denials, Explanation of Benefits (EOB), prior authorizations, network rules, and billing language are confusing even for professionals. For patients with limited literacy, the result is fear and delay: People skip care, avoid medications, or disengage entirely. For systems, staff spend time repairing trust and reworking financial counseling, eligibility, and enrollment. This is especially common in safety-net settings, but it affects all healthcare organizations.

On top of all of this, misinformation is making it harder for everyone. Patients are sorting health claims from social media, family networks, and online searches, often without tools to evaluate credibility. That means clinicians and nurses spend precious time myth-busting in already short visits — and telehealth can make it even harder, because nuance gets lost and rapport is slower to build.

If the solution isn’t simply “teach more people to read,” what would actually move the needle here? Where do you see the most promising opportunities for intervention?

If we want real movement, we need to combine system redesign with targeted support — and we need to finance it in a way that makes these interventions sustainable.

The first priority should be making literacy-aware care and health navigation support part of routine practice, not as an add-on, but as a core health intervention. In many cases, this does not require a formal screen at all. A universal precautions approach can be more effective: Assume health information is complex for everyone and simplify by default, using plain language, teach-back methods, visual supports, and proactive navigation follow-up. When literacy awareness is embedded into existing social determinants of health (SDOH) workflows in this way, support becomes routine rather than reactive. 

The second priority should be building an evidence and quality framework that payers can use. The practical move is to align pilot programs addressing adult literacy to outcomes payers already track, like avoidable utilization, preventive care uptake, chronic disease measures, adherence, appointment and telehealth visit completion, and patient experience, then evaluate interventions with consistent metrics. That evidence base is what makes the case for broader adoption.

The third priority is unlocking sustainable financing and contracting pathways for new innovations. If navigation, coaching, and literacy-aware supports are permanently grant-funded, they won’t scale. We need models where health plans and systems can pay for these services as part of care coordination, community-based services, and value-based arrangements.

Finally, telehealth and digital touchpoints need to be designed like they’re part of care — because they are. Telehealth can improve access, but only if the “digital front door” works for real users. That means plain-language reminders, fewer steps, accessible design, and a human fallback when tech fails. If we treat the digital experience as an intervention surface rather than an administrative add-on, we can prevent a lot of missed care.

What kinds of cross-sector partnerships will it take?

No single sector can carry this. Health plans and systems need to define outcomes, enable responsible data-sharing, and create reimbursement and contracting routes that make interventions sustainable. Community-based organizations and adult education providers, including libraries, deliver trusted support where people are and help build skills and confidence over time. Community health centers are especially well-positioned to pilot and operationalize models quickly, because they already integrate medical care with enabling services, but they need funding and practical implementation support. And technology and product partners need to reduce friction in portals and telehealth, build plain-language journeys, and design for accessibility from the start.

What ties all of this together is not just a shared table, but shared accountability. Imagine a regional health plan partnering with public libraries to fund “literacy navigators” who help members enroll in coverage, understand care plans, and use telehealth portals confidently. Or a Medicaid plan reimbursing adult education programs for delivering structured literacy interventions tied to measurable health outcomes: improved medication adherence, better chronic disease management, reduced no-show rates. These models recognize literacy as a preventive health intervention. The goal isn’t a perfect theory of change. It’s a coordinated set of pilots in real settings with shared metrics, responsible data-sharing, and clear pathways to scale if outcomes improve. In this context, literacy is not peripheral to healthcare delivery — it is foundational to quality, safety, and long-term system performance.