Using the Health Literacy Universal Precautions Toolkit to Improve the Quality of Patient Materials

Abstract

Patient materials are often written above the reading level of most adults. Tool 11 of the Health Literacy Universal Precautions Toolkit ("Design Easy-to-Read Material") provides guidance on ensuring that written patient materials are easy to understand. As part of a pragmatic demonstration of the Toolkit, we examined how four primary care practices implemented Tool 11 and whether written materials improved as a result. We conducted interviews to learn about practices' implementation activities and assessed the readability, understandability, and actionability of patient education materials collected during pre-and postimplementation site visits. Interview data indicated that practices followed many action steps recommended in Tool 11, including training staff, assessing readability, and developing or revising materials, typically focusing on brief documents such as patient letters and information sheets. Many of the revised and newly developed documents had reading levels appropriate for most patients and-in the case of revised documents-better readability than the original materials. In contrast, the readability, understandability, and actionability of lengthier patient education materials were poor and did not improve over the 6-month implementation period. Findings guided revisions to Tool 11 and highlighted the importance of engaging multiple stakeholders in improving the quality of patient materials.Address correspondence to Angela G. Brega, Department of Community and Behavioral Health, Colorado School of Public Health, 13055 East 17th Avenue, Mail Stop F800, Aurora, CO 80045, USA. angela.brega@ucdenver.edu. HHS Public AccessAuthor manuscript J Health Commun. Author manuscript; available in PMC 2016 October 28. Author Manuscript Author ManuscriptAuthor Manuscript Author ManuscriptHealth literacy plays a critical role in comprehension of written health-related materials. And yet numerous studies show that the reading level of patient materials often exceeds the reading skills of many adults. It is estimated that the average U.S. adult can comprehend text written at the eighthto ninth-grade level (Doak, Doak, & Root, 1996; Institute of Medicine Committee on Health Literacy, 2004; National Work Group on Literacy and Health, 1998), although literacy skills are substantially lower among older and low-income adults (Doak et al., 1996;Kutner, Greenberg, Jin, & Paulsen, 2006;Weiss et al., 1994). In contrast, patient materials are often written at or above the 10th-grade level (Aliu & Chung, 2010;Helitzer, Hollis, Cotner, & Oestreicher, 2009;Kaphingst, Zanfini, & Emmons, 2006;Vallance, Taylor, & Lavallee, 2008;Wallace, Turner, Ballard, Keenum, & Weiss, 2005). These high reading levels, in addition to other features that can make documents difficult to understand (e.g., the use of medical terms), render many patient materials unusable for millions of Americans.The Agency for Healthcare Research and Quality developed the Health Literacy Universal Precautions Toolkit to support primary care practices in thei...

The impact of health literacy, patient-centered communication and shared decision-making on patients’ satisfaction with care received in German primary care practices

“…To support patients with limited health literacy, health care organizations can engage in the implementation of specific interventions that target the improvement of patient’s health literacy skills or help to respond to the health literacy needs of patients. Several scholars and organizations such as the WHO and IOM already propose organizational techniques deemed helpful to identify and support patients with particular health literacy needs [5, 43, 44]. Further, a recent review on purposeful interventions to address the issue of limited patient health literacy conducted by the Commonwealth Fund, also recommends specific measures for primary care [45].…”

“…Further, a recent review on purposeful interventions to address the issue of limited patient health literacy conducted by the Commonwealth Fund, also recommends specific measures for primary care [45]. The existing action plans and manuals for health care organizations encompass recommendations on oral and written communication as well as supportive actions to help patients organize their care [44]. Effective interventions on patient-physician communication involve the implementation of trainings for health care staff equipping them with competencies to use standardized communication tools, such as the teach back (checking patient understanding by letting the patient explain medical issues in his own words) and chunk and choke method (breacking down information into manageable sections and checking patient understanding) and the use of plain language without medical jargon [46, 47].…”

“…Interventions involving written information encompass the use of audio/visual health information and pictorials as well as educational materials adjusted to the reading level of low literate patients (e.g. fact boxes, decision aids) [44, 48, 49]. Supportive measures to help patients organize their care and navigate through the health care system involve the coordination of medical appointments by health care staff, application of follow up services to check the therapy adherence of patients, use of medication reviews to check medication adherence, application of therapy plans with easy understandable written information for patients [46].…”

Using Teach-Back to Understand Participant Behavioral Self-Monitoring Skills Across Health Literacy Level and Behavioral Condition

“…Specifically, the positive perceptions of the call by both LHL and HHL participants indicate that teach-back strategies can be an acceptable means to incorporate universal health literacy precautions within interventions targeting LHL and HHL participants. 39 …”

Development and Evaluation of Cardiovascular Disease Prevention Education Materials for Middle-aged Korean-Chinese Female Workers: Applying Patient Education Materials Assessment Tool for Printable Materials (PEMAT-P)

“…또한, 체계적인 의료 서비스에 대한 접근이 어렵고 주로 민간단체와 교회 등에서 운영하는 무료 진료소를 이용하기 때문에 [3] (actionability)가 강조되고 있다 [8]. 따라서, 교육자료의 적합 성 평가는 가독력(readability)과 이해도(understandability) 뿐만 아니라 실행도(actionability)가 포함되어야 할 것이다 [9].…”