title: 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.
authors.affiliation: a Department of Community and Behavioral Health , Colorado School of Public Health , Aurora , Colorado , USA.|b Department of Family Medicine , University of Colorado Anschutz Medical Campus , Aurora , Colorado , USA.
authors.forename: Angela G
authors.initials: AG
authors.lastname: Brega
authors.affiliation: a Department of Community and Behavioral Health , Colorado School of Public Health , Aurora , Colorado , USA.
authors.forename: Megan A G
authors.initials: MA
authors.lastname: Freedman
authors.affiliation: b Department of Family Medicine , University of Colorado Anschutz Medical Campus , Aurora , Colorado , USA.
authors.forename: William G
authors.initials: WG
authors.lastname: LeBlanc
authors.affiliation: c Adult and Child Center for Health Outcomes Research and Delivery Science , University of Colorado Anschutz Medical Campus , Aurora , Colorado , USA.
authors.forename: Juliana
authors.initials: J
authors.lastname: Barnard
authors.affiliation: d American Academy of Family Physicians , Kansas City , Kansas , USA.|e Department of Family Medicine , University of Kansas Medical Center , Kansas City , Kansas , USA.
authors.forename: Natabhona M
authors.initials: NM
authors.lastname: Mabachi
authors.affiliation: b Department of Family Medicine , University of Colorado Anschutz Medical Campus , Aurora , Colorado , USA.
authors.forename: Maribel
authors.initials: M
authors.lastname: Cifuentes
authors.affiliation: a Department of Community and Behavioral Health , Colorado School of Public Health , Aurora , Colorado , USA.|c Adult and Child Center for Health Outcomes Research and Delivery Science , University of Colorado Anschutz Medical Campus , Aurora , Colorado , USA.
authors.forename: Karen
authors.initials: K
authors.lastname: Albright
authors.affiliation: f Department of Family and Community Medicine , University of Arizona , Tucson , Arizona , USA.
authors.forename: Barry D
authors.initials: BD
authors.lastname: Weiss
authors.affiliation: g Center for Delivery, Organization, and Markets , Agency for Healthcare Research and Quality , Rockville , Maryland , USA.
authors.forename: Cindy
authors.initials: C
authors.lastname: Brach
authors.affiliation: b Department of Family Medicine , University of Colorado Anschutz Medical Campus , Aurora , Colorado , USA.|c Adult and Child Center for Health Outcomes Research and Delivery Science , University of Colorado Anschutz Medical Campus , Aurora , Colorado , USA.
authors.forename: David R
authors.initials: DR
authors.lastname: West
mesh_terms: D000368:Aged; D032882:Comprehension; D057220:Health Literacy / Q000706:statistics & numerical data; D006284:Health Plan Implementation; D006801:Humans; D010353:Patient Education as Topic; D036301:Qualitative Research; D013664:Teaching Materials / Q000592:standards*; D017749:Total Quality Management / Q000379:methods*