Health Literacy Universal Precautions Toolkit, 2nd Edition

The AHRQ Health Literacy Universal Precautions Toolkit, 2nd edition, can help primary care practices reduce the complexity of health care, increase patient understanding of health information, and enhance support for patients of all health literacy levels.


Quick Start Guide
Tools to Start on the Path to Improvement
   Form a Team: Tool #1
   Create a Health Literacy Improvement Plan: Tool #2
   Raise Awareness: Tool #3
Tools to Improve Spoken Communication
   Communicate Clearly: Tool #4
   Use the Teach-Back Method: Tool #5
   Follow Up with Patients: Tool #6
   Improve Telephone Access: Tool #7
   Conduct Brown Bag Medicine Reviews: Tool #8
   Address Language Differences: Tool #9
   Consider Culture, Customs, and Beliefs: Tool #10
Tools to Improve Written Communication
   Assess, Select, and Create: Tool #11
   Use Health Education Material Effectively: Tool #12
   Welcome Patients:: Tool #13
Tools to Improve Self-Management and Empowerment
   Encourage Questions: Tool #14
   Make Action Plans: Tool #15
   Help Patients Remember How and When to Take Their Medicine: Tool #16
   Get Patient Feedback: Tool #17
Tools to Improve Supportive Systems
   Link Patients to Non-Medical Support: Tool #18
   Direct Patients to Medicine Resources: Tool #19
   Connect Patients with Literacy and Math Resources: Tool #20
   Make Referrals Easy: Tool #21
Appendix Items
List of Internet Resources

Prepared for:
Agency for Healthcare Research and Quality
Contract No: HHSA290200710008, TO#10

Prepared by:
Colorado Health Outcomes Program
University of Colorado Anschutz Medical Campus
Aurora, CO

Authors of the Second Edition:
Angela G. Brega, PhD1,2
Juliana Barnard, MA3
Natabhona M. Mabachi, PhD, MPH4
Barry D. Weiss, MD5
Darren A. DeWalt, MD, MPH6
Cindy Brach, MPP7
Maribel Cifuentes, RN2
Karen Albright, PhD3
David R. West, PhD2,3

Authors of the First Edition:
Darren A. DeWalt, MD, MPH6
Leigh F. Callahan, PhD6
Victoria H. Hawk, MPH, RD, CDE6
Kimberly A. Broucksou, MSW, MPA6
Ashley Hink, MPH6
Rima Rudd, ScD8
Cindy Brach, MPP7

We acknowledge the following primary care practices and clinics for participating in testing of the second edition of the Toolkit:

Annville Family Medicine, Annville, Pennsylvania
Chula Vista Medical Plaza, Chula Vista, California
Complete Family Medicine, Kirksville, Missouri
Fairview Clinics—Lakeville, Lakeville, Minnesota
Family Medical Care Center, Granite Falls, North Carolina
Georgetown University-Providence Hospital Family Medicine Residency Program, Fort Lincoln Family Medicine Center, Colmar Manor, Maryland
Legacy Medical Group—Emanuel, Internal Medicine, Portland, Oregon
Namaste Health Care, Ashland, Missouri
Omar Khan, MD & Javed Gilani, MD, Wilmington, Delaware
Providence Medical Center—South Lyon, South Lyon, Michigan
RST Medical Group Inc., Decatur, Georgia
Stony Brook Internal Medicine, Primary Care Center, East Setauket, New York

For convenience, we use the term "patient" throughout the toolkit, but recognize that health literacy improvement efforts often include caregivers, family members, and other consumers of health care.

This document is in the public domain and may be used and reprinted without permission except those copyrighted materials noted for which further reproduction is prohibited without the specific permission of copyright holders.

Author Affiliations:

1 Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
2 Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
3 Colorado Health Outcomes Program, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
4 American Academy of Family Physicians, Kansas City, Kansas.
5 Department of Family and Community Medicine, University of Arizona, Tucson, Arizona.
6 The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC.
7 Agency for Healthcare Research and Quality, Rockville, MD.
8 Harvard School of Public Health, Harvard University, Cambridge, MA.

Page last reviewed February 2015
Page originally created February 2015
Internet Citation: Health Literacy Universal Precautions Toolkit, 2nd Edition. Content last reviewed February 2015. Agency for Healthcare Research and Quality, Rockville, MD.