• Health Literacy Universal Precautions Toolkit

    Study Description and Methods

    Health literacy represents the ability to understand and use health-related information and includes a person’s ability to read, write, and understand verbal communications related to health. Research suggests that difficulty understanding health information is linked to limited health knowledge, poor self-care behavior (e.g., managing medications), and negative clinical outcomes (e.g., higher mortality rates and greater use of emergency department care).

    Although some patients are more likely to have limited health literacy skills – for example, elderly patients – nearly everyone struggles with health information and navigating the healthcare system. The good news is that providers can do a great deal to make things easier for their patients. The Health Literacy Universal Precautions Toolkit was developed to guide primary care practices in making simple changes to their office environments and strategies for communicating with patients that can improve comprehension of health information among patients of all health literacy levels.

    As part of this demonstration project, 12 primary care practices were selected to implement a subset of the tools included in the Toolkit. Practices implemented four tools over a 6-month period, collecting data about their office environments and healthcare processes during the month prior to and the month following implementation. The research team made two site visits to each participating practice, during which qualitative interviews addressing the implementation process were conducted. The data practices collected and the information they provided as part of the qualitative interviews allowed the research team to refine and improve the Toolkit at the conclusion of the project.

    Specific Aims and Objectives

    The specific aims of this project were to:

    1. To learn about the experiences of practices implementing the Toolkit, including what changes they are able to make and what challenges they face.
    2. To revise the Toolkit based on the experience of and input provided by participating practices.


    This study is complete.

    Key Findings and Publications

    Primary care practices can take action to decrease the complexity of the healthcare environment. Making health information and instructions easier to understand will increase the likelihood of them being acted on.

    Because limited health literacy is common and limitations are hard to recognize, experts recommend the use of health literacy universal precautions to simplify communications and confirming understanding for all patients.

    The AHRQ Health Literacy Universal Precautions Toolkit has been revised, based on recommendations from the AAFP National Research Network’s demonstration project, and provides evidence-based guidance to practices for implementing systems to better promote understanding by all patients.

    Access the Health Literacy Universal Precautions Study Impact Summary

    Access the AHRQ Health Literacy Universal Precautions Toolkit

    Patient materials are often written above the reading level of most adults. Tool 11 of the Health Literacy Universal Precautions Toolkit 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.

    The analysis of the research project provides insight into the use of the Health Literacy Universal Precautions Toolkit for the improvement of written patient materials. In this real-world demonstration, practices followed many of the action steps recommended in Tool 11. However, their efforts focused mainly on small documents under their local control, leaving larger and externally produced patient materials largely unaddressed. Study results highlight the importance of engaging all developers of patient-focused documents in the effort to improve the quality of these materials. Findings from this study guided revisions to Tool 11, which is included in the second edition of the Agency for Healthcare Research and Quality Health Literacy Universal Precautions Toolkit.

    Improving the Effectiveness of Medicine Review: Guidance from the Health Literacy Universal Precautions Toolkit. Weiss BD, Brega AG, LeBlanc WG, Mabachi NM, Barnard J, Albright K, Cifuentes M, Brach C, West DR. J Am Board Fam Med. January-February 2016; 29(1): 18-23.

    Demonstration of Health Literacy Universal Precautions Toolkit - Lessons for Quality Improvement. Mabachi NM, Cifuentes M, Barnard J, Brega AG, Albright K, Weiss BD, Brach C, West D. Journal of Ambulatory Care Management. July/Sept 2016; 39(3): 199-208.

    Using the Health Literacy Universal Precautions Toolkit to Improve the Quality of Patient Materials. Brega AG, Freedman MA, LeBlanc WG, Barnard J, Mabachi NM, Cifuentes M, Albright K, Weiss BD, Brach C, West DR. Journal of Health Communication. 2015. 20:69-76.

    Collaborating Institutions

    The AAFP National Research Network is collaborating with the University of Colorado, School of Medicine, and the State Networks of Colorado Ambulatory Practices & Partners USA (SNOCAP-USA) to conduct this study.

    Contact Information

    For additional information about this study, please contact:

    AAFP National Research Network
    1-800-274-2237 x3180

    This project was funded by a grant from the Agency for Healthcare Research and Quality.