Guide to Implementing the Health Literacy Universal Precautions Toolkit

Written Communication

 Tool 11: Assess, Select, and Create Easy-to-Understand Materials

The goal of this tool is to make sure that patients can easily complete forms and easily understand the written materials that your practice uses.

Tips for Assessing Written Materials

  • To ensure that your practice's written documents are easy to read and understand, you should assess both materials that your practice or health system has developed, as well as materials that you have received from outside organizations (e.g., professional associations, pharmaceutical companies, etc.).
  • Ask your staff for recommendations of materials to assess. It may be best to start with items that are widely used or those that often prompt patient questions.
  • Find out what materials are not being used by patients. Check garbage cans around your office building and parking lot to see if there are specific materials that are being thrown out. Target these materials for assessment and revision (Tool 11).
  • Implementation of this tool presents an excellent opportunity to engage your patients. After all, the gold standard for assessing written materials is testing them with users. Remember to obtain feedback on your practice's written materials from a representative group of your practice's patients (e.g., gender, age, race, ethnicity).

Tips for Reducing Redundancy in Forms

  • When revising forms, check that each item requested from patients is actively used. Sometimes questions remain on forms when they have outlived their usefulness.
  • Often times the same questions are asked on multiple forms. This may give patients the impression that no one is looking at the forms they have previously completed. If this happens in your practice, ask yourself:
    • Is it necessary to collect the same information on different forms?
    • Can redundancy be eliminated?
    • Could electronic forms be used by patients so that information is entered only once and can go directly into the EHR into multiple fields?

Tips for Practices Affiliated With Large Health Systems

  • Practices affiliated with large health systems may need to obtain permission from their system's administration to revise practice forms and materials. If this is your case, consider including on your health literacy team representatives from departments that bring additional resources and knowledge to the team to help you in your efforts (e.g., marketing and communications, patient education, interpreter services, and health information technology)
  • Enlarging your circle can also build awareness about health literacy and foster buy-in at a system-wide level. You can play an important role in advocating for easy-to-understand patient materials by getting involved in system-wide committees and voicing the importance of health literacy.
  • Be realistic in your timeline. Even with engagement and help from invited departments, getting formal permissions to revise forms and materials may still be a slow and time-consuming process.
Practice Experiences

"It is a bureaucratic organization, and so if you are dealing with a compliance document, we don't have final say on the content… same with marketing. Marketing has a very specific focus and that is to essentially sell our services to the public. They don't necessarily have health literacy as a primary consideration."

—Family Medicine Practice



Tips for Educating Your Practice About Using Materials That are Easy to Read and Understand

  • Don't forget to educate practice members about health literacy and why it is important, and about the steps you are taking to develop or revise materials so they are easy to read and understand for patients (Tool 3). Content for these trainings may include:
    • General introduction to health literacy and its importance.
    • Dispelling misconceptions that using written materials that are easy to understand = "dumbing down" of information.
    • Evidence from studies that have repeatedly shown that patients prefer simplified materials.
    • Materials you have created or revised, or plan to create or revise.
    • Why you have chosen these materials and why practice members should use them.
    • Where these materials will be located, including where in your EHR system, for easy access by practice members.
    • How to use the materials to promote better patient understanding.
  • Many patients have difficulty understanding numbers describing medical risks versus treatment benefits. The article Numeracy and Health: Helping Americans Do the Math (PDF File, 690.45 KB) provides insights for health care professionals on the numeracy challenges that patients face.
Making the Case for Easy-to-Understand Written Material

Studies have shown that patients forget 40-80% of the medical information they are told during office visits and that nearly half of the information they retain is incorrect. So, providing easy-to-understand written materials that reiterate your key points is important.

Colon Cancer Screening: This study shows how easy-to-read brochures can increase participation in colon cancer.



Tips for Tracking Assessment of Written Materials

  • Use a spreadsheet to track written materials that have been assessed and revised:
    • Date when materials were last assessed.
    • Assessment scores (e.g., reading level, understandability).
    • Date when materials were last reviewed by patients.
    • Date when materials were last revised.

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 Tool 12: Use Health Education Material Effectively

The goal of this tool is to offer strategies for using educational materials and explain information effectively to support better patient understanding.

Tips for Preparing your Practice

  • Consider working on parallel strategies to improve spoken communication skills in your practice (Tools 4, 5, and 8) at the same time that you implement Tool 12.
  • Map your practice's workflow for use of health education materials. If workflow inefficiencies exist, redesign your practice's workflow to optimize use of these materials.
  • Keep supplies of highlighters and pens in offices and exam rooms.

Tips for Training Patients to Use Patient Portals

  • Many people learn by doing, so making a presentation about your patient portal or giving patients a written guide may not be sufficient. Collaborate with a senior center, community colleges, or other community partner that can provide space and volunteers to conduct hands-on training for your patients. Other patients or adult educators may also be sources of volunteer instructors.
  • Ask patients what features of your portal they are most interested in and gear your training to spend the greatest amount of time on these features.
  • Let patients know where they can get further help to access and use the portal.

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 Tool 13: Welcome Patients

The goal of this tool is to offer your practice suggestions for creating a welcoming atmosphere by addressing your front desk, waiting room, and signage.

Tips for Implementing this Tool

  • It may appear obvious that your practice members should always be welcoming to patients. However, implementation of this tool requires that you learn to look past the familiar to understand what patients see and experience when they come to your practice.
  • Many of the recommendations made in this tool are aimed at members of your front desk staff. Create work group of these staff members to engage them in the planning and implementation of this tool. The health literacy team should work to support and empower these front desk champions to make changes to the practice.
  • Cultivate a customer service orientation. Use role playing to train staff to be:
    • Attentive, observant listeners.
    • Open, friendly, and compassionate.
    • Skilled at communicating clearly and confirming patients' understanding.
    • Patient and calm.
    • Non-judgmental.
    • Problem solvers.
    • Knowledgeable about office procedures and resources.
    • Willing to go the extra mile.
  • Practices planning to implement this tool should know that some Toolkit recommendations may not fully apply to them.
    • Extensive use and placement of signs to help direct patients from place to place may not be necessary in a practice that's small and easy to navigate. Small practices should use this tool flexibly to meet their specific needs.
    • Practices that are part of a larger health system (e.g., integrated delivery systems, or Federally Qualified Health Centers) may be limited in their ability to make changes to the signage, layout, or aesthetics of their practices.
    • These practices may also require permission from their administration to use materials developed outside of the practice, such as signs, videos, brochures, or posters.
    • Patient education materials developed by your marketing department may be visually appealing but may not conform to health literacy recommendations. You may be able to help improve these materials' understandability to patients. Go to Tool 11: Assess, Select, and Create Easy-to-Understand Materials for suggestions.

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Page last reviewed January 2015
Page originally created January 2015
Internet Citation: Written Communication. Content last reviewed January 2015. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/literacy-toolkit/impguide/impguide-written.html