cost of emergency services may be attributed to the top 13% of homeless users". in this way, low health literacy produces financial outcomes as well as those of health. risk identification identifying a patient as having low health literacy is essential for a healthcare professional to conform their health intervention in a way that the patient will understand. when patients with low health literacy receive care that is tailored to their more limited medical knowledge base, results have shown that health behaviors drastically improve. this has been seen with: correct medication use and dosage, utilizing health screenings, as well as increased exercise and smoking cessation. effective visual aids have shown to help supplement the information communicated by the doctor in the office. in particular, easily readable brochures and videos have shown to be very effective. healthcare professionals can use many methods to attain patients' health literacy. a multitude of tests used during research studies and three minute assessments commonly used in doctors offices are examples of the variety of tests healthcare professionals can use to better understand their patients' health literacy. the american medical association showed that asking simple single-item questions, such as "how confident are you in filling out medical forms by yourself?", is a very effective and direct way to understand from a patient's point of view how they feel about interacting with their healthcare provider and understanding their health condition. homelessness individuals facing homelessness constitute a population that holds intersectional identities, is highly mobile, and is often out of the public eye. thus the difficulty of conducting research on this group has resulted in little information regarding homelessness as a condition that has increased risk of low health literacy levels among individuals. nonetheless, studies that do exist indicate that homeless individuals experience increased prevalence of low health literacy and poor health—both physical and mental—due to vulnerabilities brought on by the insecurity of basic needs among homeless individuals. the combination of poor health and homelessness has been found to increase the risk for further decline in health status and increased housing insecurity, all of which is highly affected—and in many cases perpetuated—by low levels of health literacy. intervention in order to be understood by patients with insufficient health literacy, health professionals must intervene to provide clear and concise information that can be more easily understood. avoidance of medical jargon, illustrations of important concepts, and confirming information by a "teach back" method have shown to be effective tools to communicating essential health topics with health illiterate patients. a program called "ask me 3" is designed to bring public and physician attention to this issue, by letting patients know that they should ask three questions each time they talk to a doctor, nurse, or pharmacist: what is my main problem? what do i need to do? why is it important for me to do this? there have also been large-scale efforts to improve health literacy. for example, a public information program by the us department of health and human services encourages patients to improve healthcare quality and avoid errors by asking questions about health conditions and treatment. additionally, the irohla (intervention research on health literacy of the ageing population) project, funded by the european union (eu), seeks to develop evidence-based guidelines for policy and practice to improve health literacy of the ageing population in eu member states. the project has developed a framework and identified and validated interventions which together constitute a comprehensive approach of addressing health literacy needs of the elderly. the uk's national institute for health and care research (nihr) has published review of research on health literacy, focusing on how to help people understand health information, and which groups of the population may need extra support. it covers research on using plain language, finding the focus, online information, and using alternative formats (e.g. visuals). health illiterate-related diabetes prevalence in vietnamese-american populations diabetes is a rapidly growing health problem among immigrants—affecting approximately 10 percent of asian-americans. it is the fifth-leading cause of death in asian-americans between the ages of 45 and 64. in addition, type 2 diabetes is the most common form of the disease. those who are diagnosed with type 2 diabetes have high levels of blood glucose because the body does not effectively respond to insulin. it is a lifelong disease with no known cure. diabetes is a chronic, debilitating, and costly social burden—costing healthcare systems about $100 billion annually. diabetes disproportionately affects underserved and ethnically diverse populations, such as vietnamese-american communities. the relationship between the disease and health literacy level is in part because of an individual's ability to read english, evaluate blood glucose levels, and communicate with medical professionals. other studies also suggest lack in knowledge of diabetes symptoms and complications. according to an observational cross-sectional study conducted, many vietnamese-american diabetic patients show signs of poor blood glucose control and adherence due to inadequate self-management knowledge and experience. diabetes health literacy research is needed to fully understand the burden of the chronic disease in vietnamese-american communities, with respect to language and culture, health literacy, and immigrant status. ethnic minority groups and immigrant communities have less knowledge of health promoting behavior, face considerable obstacles to health services, and experience poor communication with medical professionals. according to a recent review, studies have supported an independent relationship between literacy and knowledge of diabetes management and glucose control, but its impact on patients has not been sufficiently described. with the demand of chronic disease self-management (e.g., diabetic diet, glucose monitoring, etc.), a call for cultural-specific patient education is needed to achieve the control of diabetes and its adverse health outcomes in low- to middle-income vietnamese-american immigrant communities. oral health literacy in school teachers of mangalore, india the problem of low oral health literacy (ohl) is often neglected which may lead to poor oral health outcomes and under utilization of oral care services. a cross-sectional survey of school teachers working in schools in mangalore, india, was undertaken. details regarding demographics, medical, and dental history, oral hygiene practices and habits, diet history, and decay promoting the potential of school teachers were obtained using face-to-face interview method. the rapid estimate of adult literacy in dentistry-99 (reald-99) was used to assess their ohl. the ohl was high in the school teachers with the reald-99 scores ranging from 45 to 95 with a mean score of 75.83 ± 9.94. th this study found that there was a statistically significant difference between ohl and education, frequency of brushing and the filled teeth. although this study indicated high ohl levels among school teachers in mangalore, india, the magnitude of dental caries in this population was also relatively high and very few had a healthy periodontium. ehealth literacy ehealth literacy describes an individual's ability to search for, access, comprehend, and appraise desired health information from electronic sources and to then use such information to attempt to address a particular health problem. it has become an important topic of research due to the increasing use of the internet for health information seeking and health information distribution. stellefson (2011) states, "8 out of 10 internet users report that they have at least once looked online for health information, making it the third most popular web activity next to checking email and using search engines in terms of activities that almost everybody has done." though in recent years, individuals may have gained access to a multitude of health information via the internet, access alone does not ensure that proper search skills and techniques are being used to find the most relevant online and electronic resources. as the line between a reputable medical source and an amateur opinion can often be blurred, the ability to differentiate between the two is important. health literacy requires a combination of several different literacy skills in order to facilitate ehealth promotion and care. six core skills are delineated by an ehealth literacy model referred to as the lily model. the lily model's six literacies are organized into two central types: analytic and context-specific. analytic type literacies are those skills that can be applied to a broad range of sources, regardless of topic or content (i.e., skills that can also be applied to shopping or researching a term paper in addition to health) whereas context-specific skills are those that are contextualized within a specific problem domain (can solely be applied to health). the six literacies are listed below, the first three of the analytic type and the latter three of the context-specific: traditional literacy media literacy information literacy computer literacy scientific literacy health literacy according to norman (2006), both analytical and context-specific literacy skills are "required to fully engage with electronic health resources." as the world wide web and technological innovations are more and more becoming a part of the healthcare environment, it is important for information technology to be properly utilized to promote health and deliver health care effectively. furthermore, it was argued by hayat brainin & neter (2017) that digital media fosters the creation of interpersonal ties, that can supplement ehealth literacy. according to hayat brainin & neter (2017), individuals with low ehealth literacy who were able to recruit help when performing online activities demonstrated higher health outcomes compared to similar individuals who did not find help. also relating to the proliferation of digital media is the fact that many individuals now can create their own 'media content' (user-generated content). it has also been suggested that the move towards patient-centered care and the greater use of technology for self-care and self-management requires higher health literacy on the part of the patient. this has been noted in several research studies, for example among adolescent patients with obesity. improvement incorporate information through the university level the united states department of health and human services created a national action plan to improve health literacy. one of the goals of the national action plan is to incorporate health and science information in childcare and education through the university level. the target is to educate people at an early stage; that way individuals are raised with health literacy and will have a better quality of life. the earlier an individual is exposed to health literacy skills the better for the person and the community. programs such as head start and women, infants, and children (wic) have impacted society, especially the low-income population. head start provides low-income children and their families early childhood education, nutrition, and health screenings. health literacy is integrated in the program for both children and parents through the education given to the individuals. wic serves low-income pregnant women and new mothers by supplying them with food, health care referrals, and nutrition education. programs like these help improve the health literacy of both the parent and the child, creating a more knowledgeable community with health education. although programs like head start and wic have been working with the health literacy of a specific population, much more can be done with the education of children and young adults. now, more and more adolescents are getting involved with their health care. it is crucial to educate these individuals in order for them to make informed decisions. many schools in the country incorporate a health class in their curriculum. these classes provided an excellent opportunity to facilitate and develop health literacy in today's children and adolescents. the skills of how to read food labels, the meaning of common medical terms, the structure of the human body, and education on the most prevalent diseases in the united states should be taught in both private and public schools. this way new generations will grow with health literacy and would hopefully make knowledgeable health decisions. framework and potential intervention points the national library of medicine defines health literacy as: "the degree to which individuals have the capacity to obtain, process, and understand basic health literacy information and services needed to make appropriate health decisions." based on this clinical definition, health literacy gives individuals the skills that they need to both understand and effectively communicate information and concerns. bridging that gap between literacy skills and the ability of the individual in health contexts, the health literacy framework highlights the health outcomes and costs associated with health contexts including cognitive abilities, social skills, emotional state, and physical conditions such as visual and auditory contributions. potential intervention points are illustrated in reflection of