AHRQ 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.

What Are Health Literacy Universal Precautions?

Health literacy universal precautions are the steps that practices take when they assume that all patients may have difficulty comprehending health information and accessing health services. Health literacy universal precautions are aimed at—

Simplifying communication with and confirming comprehension for all patients, so that the risk of miscommunication is minimized.
Making the office environment and health care system easier to navigate.
Supporting patients' efforts to improve their health.

Why Should Practices Implement Health Literacy Universal Precautions?

Experts recommend assuming that everyone may have difficulty understanding and creating an environment where allpatients can thrive. Only 12 percent of U.S. adults have the health literacy skills needed to manage the demands of our complex health care system, and even these individuals' ability to absorb and use health information can be compromised by stress or illness. Like with blood safety, universal precautions should be taken to address health literacy because we can't know which patients are challenged by health care information and tasks at any given time.

How Can This Toolkit Help?

This toolkit provides evidence-based guidance to adult and pediatric practices to ensure that systems are in place to promote better understanding by all patients, not just those you think need extra assistance. The toolkit is divided into manageable chunks so that its implementation can fit into the busy day of a practice. It contains:

21 Tools (3-5 pages each) that address improving:
- Spoken communication.
- Written communication.
- Self-management and empowerment.
- Supportive systems.
Appendices (over 25 resources such as sample forms, PowerPoint presentations, and worksheets).
Quick Start Guide.

New in the Second Edition

The AHRQ Health Literacy Universal Precautions Toolkit, 2nd edition, includes such features as:

A new tool: Make Referrals Easy.
An enhanced assessment and quality improvement planning tool, including a link to a SurveyMonkey template for conducting practice assessments electronically.
New resources for assessing written materials.
A link to a crosswalk showing how implementing health literacy tools can help meet standards for patient-centered medical home certification or recognition. This crosswalk identifies tools from the AHRQ Health Literacy Universal Precautions Toolkit that can be used to meet specific NCQA, The Joint Commission, and URAC PCMH standards. [ PDF file, 301 KB].
Slide presentations:
- Health Literacy: Hidden Barriers and Practical Strategies [ PowerPoint file, 1.31 MB ]—This PowerPoint presentation includes 30 slides, with speaker's notes, that can be delivered in 30-45 minutes to a group or as a self-study program.
- Navigating the Health Care System [ PowerPoint file, 12 MB ]—This PowerPoint presentation describes the kinds of information you can obtain by shadowing a patient.

Select to download the 2nd edition of the toolkit [

PDF file, 2.36 MB]. Sample forms and worksheets from the appendix are also available as downloadable Word and individual PDF files.

Still like the original toolkit? Select to download a copy of the original toolkit [

PDF File - 5.51 MB].

Companion Implementation Guide

"Implementing the AHRQ Health Literacy Universal Precautions Toolkit: Practical Ideas for Primary Care Practices" is must-read for health literacy team leaders, practice facilitators, and quality improvement leaders. Based on the experience of diverse primary care practices, the guide supplements the toolkit by providing lessons learned in the course of implementing health literacy tools.

Select to download the implementation guide [

PDF file, 567.4 KB].

Additional Resources

To find additional AHRQ health literacy resources, select Health Literacy Topics.

Additional resources related to this toolkit are located at NC Program on Health Literacy

Select to access a video

of Dr. Darren DeWalt describing implementation of health literacy universal precautions using the toolkit.

For information about how the toolkit was developed, see the article, "Developing and testing the health literacy universal precautions toolkit." Select to access an abstract of the article.

Accreditation Canada, a not-for-profit organization that accredits more than 1,100 organizations across Canada, has mapped the requirements in the Accreditation Canada Primary Care Standards and Medicine Services Standards with corresponding tools from the AHRQ Health Literacy Universal Precautions Toolkit, Second Edition. To learn how the toolkit can help organizations meet Accreditation Canada standards, contact Program Development, Accreditation Canada at ProgramDevelopment@accreditation.ca for a copy of the crosswalk.

View abstracts of articles related to the AHRQ Health Literacy Universal Precautions Toolkit:

Related Impact Case Studies

AHRQ Health Literacy Toolkit Supports Better Health Communication in Tasmania

Johns Hopkins HealthCare Uses AHRQ Resources to Promote Health Literacy and Measure Patient Experience

University of Arkansas Medical Centers Improving Care with AHRQ's CUSP and Health Literacy Toolkit

Novant Health Boosts Patient Understanding and Outcomes with Health Literacy Toolkit

Kentucky Area Health Education Center

Mayo Clinic Transplant Center

AHRQ Health Literacy Tool Helps Pennsylvania's Learning Collaborative

Highmark Uses AHRQ Materials in Health Literacy Outreach Program

University of Missouri Uses AHRQ's Health Literacy Toolkit to Train and Coach Physicians

AHRQ Health Literacy Tool Helps University of Wisconsin School of Pharmacy Educate Students and Community Pharmacists

Massachusetts Community Health Center Improves Communication With Health Literacy Toolkit

American Academy of Physician Assistants Recommends AHRQ's Health Literacy Universal Precautions Toolkit

Saint Louis University School of Medicine Incorporates AHRQ's Health Literacy Toolkit Into Curriculum

Page last reviewed August 2016

Internet Citation: AHRQ Health Literacy Universal Precautions Toolkit. Content last reviewed August 2016. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/literacy-toolkit/index.html