title: Developing and testing the health literacy universal precautions toolkit.
abstract: The health literacy demands of the healthcare system often exceed the health literacy skills of Americans. This article reviews the development of the Health Literacy Universal Precautions (HLUP) Toolkit, commissioned by the Agency for Healthcare Research and Quality and designed to help primary care practices structure the delivery of care as if every patient may have limited health literacy. The development of the toolkit spanned 2 years and consisted of 3 major tasks: (1) developing individual tools (modules explaining how to use or implement a strategy to minimize the effects of low health literacy), using existing health literacy resources when possible, (2) testing individual tools in clinical practice and assembling them into a prototype toolkit, and (3) testing the prototype toolkit in clinical practice. Testing revealed that practices will use tools that are concise and actionable and are not perceived as being resource intensive. Conducting practice self-assessments and generating enthusiasm among staff were key elements for successful implementation. Implementing practice changes required more time than anticipated and some knowledge of quality improvement techniques. In sum, the HLUP Toolkit holds promise as a means of improving primary care for people with limited health literacy, but further testing is needed.
authors.affiliation: Cecil G. Sheps Center for Health Services Research, Division of General Internal Medicine, University of North Carolina, Chapel Hill, NC 27599, USA. dewaltd@med.unc.edu
authors.forename: Darren A
authors.initials: DA
authors.lastname: DeWalt
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Broucksou
authors.forename: Victoria
authors.initials: V
authors.lastname: Hawk
authors.forename: Cindy
authors.initials: C
authors.lastname: Brach
authors.forename: Ashley
authors.initials: A
authors.lastname: Hink
authors.forename: Rima
authors.initials: R
authors.lastname: Rudd
authors.forename: Leigh
authors.initials: L
authors.lastname: Callahan
mesh_terms: D000328:Adult; D002648:Child; D057220:Health Literacy; D006284:Health Plan Implementation / Q000379:methods*; D006801:Humans; D009657:North Carolina; D017749:Total Quality Management / Q000379:methods*; D014481:United States