White Paper: The Importance of Health Education and the Nurse’s Role

Education can help patients manage their conditions and significantly improve their overall health. Nurses play a critical role in providing health education, which contributes to positive individual and public health outcomes. About 129 million people in the U.S. have at least one major chronic illness (Benavidez, 2024). Providing them with the tools to manage their own health will not only benefit them but also decrease healthcare costs.

In addition, healthcare disparities and deserts have highlighted the need for accessible health education. This white paper explores the impact and approaches of health education and the important role nurses play in empowering individuals across demographics.

What is Health Education?

DC Health defines health education as learning experiences that help individuals and communities improve their health. It often overlaps with health promotion, which seeks to improve public health. Health education and health literacy are components of health promotion and prevention.

This education can come in the form of in-person workshops, one-on-one counseling, webinars, videos, websites, and materials given to patients by their healthcare providers.

Why is Health Education Needed?

The need for health education stems from a number of factors including:

• Health-related decisions becoming more complex
• Rising healthcare costs
• Increasing prevalence of chronic diseases
• A shift toward consumer-driven care

Education has been proven to help patients better understand their conditions and improve their health.

According to a study in the journal of the American Osteopathic Association, 45 minutes of patient education can improve outcomes for people with chronic conditions like hypertension, diabetes, or COPD. In the study, patients met with a healthcare provider one-on-one and had several follow-up appointments. The result was an increase in the patients’ ability and willingness to manage their own care.

For another example, stroke is the leading cause of disabilities and fifth leading cause of death in U.S. adults, yet few can identify the signs that someone is having a stroke. The American Stroke Association created a stroke recognition and response intervention called F.A.S.T. to educate people about what to look for. F.A.S.T. stands for facial drooping, arm weakness, speech difficulty, and time to call 911. The organization has delivered its materials to millions of people.

Health education is a means to empower patients and their family or caregivers. Teaching methods that recognize the patient’s experiences and in which the instructor and patient form a bond can be effective. The ultimate goal is for the patient to be more autonomous and engaged in managing their own health (Oliveia et al., 2019).

The Nurse’s Role in Health Education

Nurses play a critical role in health education because they often have close contact with patients and a high interest in health promotion and prevention. Their technical knowledge, skills and philosophy make them suited for this role. This is true for nurses who interact with individual patients but also for public health nurses or those who work in community settings like schools, clinics, or prisons (Iriarte-Roteta et al., 2020).

For example, a nurse might educate a patient and/or the family about the dangers of certain chemicals in the home and how best to store them or educate them about vaccinations.

Nurses commonly perform the following:

• Assess the patient’s health status
• Address lifestyle by providing objectives for changing behaviors
• Provide education, counseling, and advice
• Offer emotional or spiritual support
• Advocate for the patient

They also can refer patients to other services, such as physical therapists, fall clinics, dietitians, lifestyle programs, smoking cessation services and addiction care (Iriarte-Roteta et al., 2020).

Nurse Influence on Breast Cancer Patients

In a study by Catherine Oakley and Emma Ream (2024), nurses played an important role in educating patients with advanced breast cancer. Cancer patients may have poor engagement due to fear, denial, a poor relationship with their clinicians, age and other reasons. This can impact emotional and physical outcomes.

Because many people are diagnosed with breast cancer when they are older, they often have age-related health challenges like cognitive decline, a chronic condition or hearing impairments. Meanwhile, cancer has complex treatments, so it is crucial patients care for themselves and communicate any symptoms or side effects. This is where nurses can facilitate education and communication.

The researchers found that nurses can help support patients by tailoring their approach and providing evidence-based interventions.
“Cancer nurses are crucial in supporting patients to self-manage physical and psychological consequences of cancer and its treatments. Effective patient education—that engages people optimally in monitoring and managing symptoms and side effects—is imperative for patient safety” (Oakley and Ream, 2024).

Nurses can engage patients by inviting them to share their stories and listening actively. It is recommended that nurses address emotional concerns before imparting information and evaluate whether a patient has the capability and support to manage their illness.

Nurse Impact on Patients with Psoriatic Arthritis

Psoriatic arthritis (PsA) is a chronic autoimmune disease that causes joint pain and other issues. One to two people in every 1,000 have it. Education about this disease is essential to a patient’s satisfaction and quality of care. In the field of rheumatology, nurses often deliver patient education that typically covers medical treatment, exercises, joint protection and pain management (Candelas et al., 2016). In one study, participants had “significantly better global well-being,” self-efficacy and improved “disease activity” after four months of education. This includes less pain and fatigue. Patients who were counseled in a group adhered to practices and took medications more consistently than those educated individually (Candelas et al., 2016).

Candelas et al. outlines several recommendations and benefits:

• Nurses should take a fundamental role in developing education programs
• Patients should be given tools to develop in-depth knowledge of their condition and its management
• Nurses can liaise between the patient and other medical professionals
• Patients should be monitored through a systematic clinical evaluation process
• Nurses and other providers should be specifically trained to educate and help patients solve issues

Nurse-Led Smoking Cessation

According to the World Health Organization, smoking is a major contributor to chronic diseases. Smoking cessation can help prevent complications from coronary heart disease and diabetes. Clinical interventions involving nurses have been shown to be effective. In one study, education did have some effect on quitting, stage of change, and the reduction in cigarette consumption at three months and six months. The study also showed that patients who receive intensive nurse-led counseling are more likely to quit smoking (Lu et al., 2019).

Health Literacy Improves Wellness

Health literacy refers to the ability of individuals to find, understand and use medical information to make decisions and take action about their health. Whenever you are reading a nutrition label, managing your health condition, or even getting a flu shot, you are demonstrating health literacy.

U.S. Department of Education research found that only 12% of English-speaking adults in the U.S. had proficient health literacy skills. This limited health literacy disproportionately affected people in lower socioeconomic and minority groups (Department of Health and Human Services, 2010). Adults over the age of 65 tend to have limited health literacy.

Most adults who have below basic health literary schools are more likely to lack health insurance than those with proficient health literacy (Department of Education, 2003). They also are more likely to return incomplete medical forms, miss appointments, and neglect procedure follow-up steps (Milken Institute, 2022).

Limited health literacy has been linked to poor health in the following ways:

• Less use of preventive services like flu shots or mammograms
• Poor management of chronic conditions like asthma, diabetes, or high blood pressure
• Increase in preventable hospital visits
• Misunderstandings of prescription medication instructions
• Poor comprehension of nutrition labels
• Mortality

Low health literacy also leads to increased spending. “Patients with limited health literacy could expect to spend an additional $143 to $7,798 per year” (Milken Institute, 2022).

The U.S. Department of Health’s Healthy People 2030 initiative focused on health literacy and endeavored to “eliminate health disparities, achieve improved health for all, and attain health literacy to improve the health and well-being of all” (Office of Disease Prevention and Health Promotion, n.d.).

The agency’s 2010 National Action Plan also focused on health literacy. It stated two guiding principles:

• Everyone has the right to health information that helps them make informed decisions.
• Health services should be delivered in ways that are understandable and beneficial to health, longevity, and quality of life.

The plan notes several facts. Most adults have difficulty using health information available through healthcare facilities, retail outlets, and the media. If they do not have information that is clear to them, they are more likely to skip medical tests they need or visit the emergency room more often. It is difficult for them to manage their chronic diseases like diabetes or high blood pressure.

People gain health information through a variety of sources, from their healthcare provider, the internet, social media, and elsewhere. The challenge for nurses is that many people do not speak up if they are struggling to understand.

Nurses and Kidney Disease Literacy

Nurses and other healthcare providers have a duty to educate patients to improve health literacy. Positive outcomes have been achieved for those with kidney conditions by educating them about preventive strategies.

As chronic kidney disease (CKD) progresses, other health changes or challenges can make treating it more complex and harder for patients to manage.

Nurses and other healthcare workers like dieticians, pharmacists and social workers often spend more time with people who have CKD than physicians do. This is an opportunity to empower patients. Using strategies like the teach-back method to educate those with CKD has been shown to improve communication, knowledge and their ability to self-manage (Langham et al., 2022).

Literacy Efforts and Teen Health

Many adolescents in the U.S. have limited health literacy, which is linked to negative behaviors. Programs supported by the National Library of Medicine educated teenagers at low-income schools using peer tutoring while another taught students how to engage in outreach. The programs helped increase participant health literacy, sense of empowerment and skills (Keselman et al., 2019).

The Need for Literacy in Rural Hospitals

A patient with adequate health literacy can access, understand and use health information to make informed decisions about their health.

In a rural hospital setting, obtaining information can be challenging. Nurses often are the ones who provide health education on critical topics as they perform their core duties. The danger is that patients can receive information hastily through one-way communication, meaning there is not enough opportunity to ask questions (Williams et al., 2024). And healthcare organizations are not mandated to address health literacy, nor is there a standard assessment tool. Early detection of low health literacy and intervention can help improve outcomes for the patient and the community (Williams et al., 2024).

Mental Health Literacy

Mental health literacy is one area where education could have a great impact on patients. Research has shown that university students in the U.S. experience high rates of depression, anxiety, and sleep disturbances. Targeted education to improve their mental health literacy could teach them self-compassion and self-care and show how to access services (Gorczynski and Sims-Schouten, 2024).

Mental health literacy includes the following:

• Knowledge and ability to identify symptoms of poor mental health
• Knowledge and beliefs of causes of poor mental health
• Knowledge and beliefs of self-compassion and self-care practices
• Knowledge of mental health services
• Attitudes toward poor mental health and services
• Intentions to access services

“Research has shown that different elements of mental health literacy are associated with better mental health, improved knowledge of and attitudes toward poor mental health, and greater intentions to seek support from mental health services” (Gorczynski and Sims-Schouten, 2024).

Lower mental health literacy can prevent people from seeking help. Barriers include concerns about stigma and negative feelings about mental health services (Elshaikh et al., 2023). Lower mental health literacy is also found among older adults with lower levels of educational attainment, a lack of prior contact with mental health professionals and a lack of perceived need for treatment services for emotional distress (Elshaikh et al., 2023).

Health Literacy and Poverty

Health education is especially needed for underserved populations and patients in poverty. For example, free clinic patients typically have lower levels of health literacy. There might also be barriers to attending education programs, such as personal beliefs, or perceived lack of benefit, etc.

Poverty is significantly correlated with a poor diet and physical inactivity, which lead to increased risks of chronic health conditions, such as cardiovascular disease, obesity, diabetes and other conditions (Sabanayagam and Shankar, 2012). Conversely, lifestyle interventions have shown to be effective in improving health status, health behaviors and self-efficacy, which consequently improve long-term health behaviors. (Kamimura et al., 2016).

Lifestyle interventions have been shown to help prevent chronic health conditions.

To promote healthy lifestyles among underserved populations, it is important for health educators to engage a number of physical activity motives to increase the likelihood that clients will experience enjoyment and sustained adoption of exercise into their lifestyle (Kamimura et al., 2014). Clinic or community-based lifestyle or nutrition intervention programs generally have a positive effect on health behaviors among underserved populations.

Health Education and Promotion Approaches

Approaches to education need to be adjusted to the audience to account for cultural, language, and socioeconomic differences. (Kamimura et al., 2016). Studies have shown that using targeted and tailored communication can help improve patients’ ability to manage their own conditions. (Department of Health, 2010).

“Proficiency in health literacy improves health status, reduces health-service use and costs and extends lives” (Milken Institute, 2022).

The challenge is to “activate” patients and increase their engagement. Activation refers to a patient’s willingness to participate in managing their own health.

A health policy brief by the Robert Wood Johnson Foundation studied patient engagement and outlines what patient engagement looks like. First, patients receive information about a condition from their provider and can ask questions.

With shared decision-making, the provider can share the treatment options, medical evidence, benefits and risks and discuss them with the patient to come up with a treatment plan together (Robert Wood Johnson Foundation, 2013). Vehicles for information can include pamphlets, books, videos, websites, etc. According to a study, patients who received “enhanced decision-making support” saw a decrease in medical costs by more than 5% (Robert Wood Johnson Foundation, 2013).

Nurses and other healthcare professionals can use a variety of tactics to educate their patients, including:

• Different types of communication and tools like models or materials with graphics
• Direct and age-appropriate communication with children
• Check for patient understanding, such as using the teach-back method
• Use patient-centered technologies
• Participate in ongoing health literacy training
• Refer patients to resources

Nurses and other healthcare providers can utilize resources like the Health Literacy Tool Shed, which includes information about evaluation tools like the 6-Item Cancer Health Literacy Test. Materials used to educate patients should keep to a sixth-grade reading level.

They can also use the teach-back method, in which providers ask patients to explain what they learned, their understanding of their condition, the options available to them, and their intention to act on the information (Robert Wood Johnson Foundation, 2013).

Educating Parents and Guardians of Children

Nurses need to be aware of the important role parents and guardians play in children’s health. Educating parents and caregivers leads to their making informed decisions for their children and ultimately better health for them. A study by Pereira et al. (2023) showed that nurses build trust through dialogue, enabling them to identify problems, interrupt negative development trajectories, and promote healthy choices and lifestyles.

Parents felt nurses had the time to spend with them, which provided better access to healthcare. The fact that nurses knew of the patient’s problems contributed to the success of interventions. For example, several studies show that the relationship between parents and health professionals is crucial for long-term weight maintenance in obese children.

Nurses should continue their own professional development to stay current on techniques of health education.

Educating parents and caregivers of children in preschool and children with chronic illnesses were found to improve their health.

In a study of a train-the-trainer program that included parents with children in Head Start preschool programs, researchers examined parents’ knowledge and attitudes regarding stress and depression before and after training. Most Head Start children reside in homes with a single parent and experience food insecurity and other hardships.

As part of the study, staff took webinars then taught the parents the material and held monthly activities for three months. At the end, the number of parents who felt stressed most of the time fell to 18.6% from 37.2% after education. Parents who felt depressed most of the time also decreased (Guerrero, 2021).

A European study, meanwhile, looked at the impact of health literacy on parents and caregivers of children with chronic health conditions like asthma, epilepsy, etc. Children with these diseases use healthcare services more often than other children, and caring for them is complex. The study found that health literacy interventions likely were more effective if they were tailored to the audience, used a variety of modalities, engaged a health provider, and contained multiple sessions (Nevill et al., 2024). Individual health outcomes were improved.

Mental Health Education

A systematic review published in 2016 indicates that online mental health information delivered via the Internet can increase mental health literacy. Interactive experiences were effective in that case. Using games or entertainment to deliver messaging also was effective.

Older adults can be especially impacted by low mental health literacy. Interventions can include:

• Integration of mental health assessment and treatment into healthcare programs, increasing older adults’ ability to access and understand online information about mental health.
• Using “education-entertainment” strategies and developing “serious games” focused on increasing mental health literacy.

Use Listening Skills

Storytelling is a tool nurses and other healthcare providers can use to engage with patients and discover critical information they might not learn by traditional methods. The practitioner actively listens to the story the patient is telling and refrains from assuming specific answers or making hypotheses (Stone and Faughnan, 2022). Paul Ranelli, a professor at the University of Minnesota, said, “That patient is an expert in their life and an expert in how they take their medicines or what experiences that they’ve had” (as cited in Stone and Faughnan, 2022).

Conclusion

Health education is a cornerstone of preventive care, chronic disease management and overall public health. Nurses are uniquely positioned to lead in delivering this education due to their proximity to patients and holistic care philosophy. As the healthcare landscape grows more complex, it is essential to equip patients with the knowledge and skills to make informed decisions about their health. Improving health literacy across demographics, especially in underserved and vulnerable populations, enhances individual well-being. By continuing to prioritize education, leverage evidence-based strategies and advocate for systemic support, nurses can transform lives and communities.

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