Health Literacy Universal Precautions Are Still a Distant Dream: Analysis of U.S. Data on Health Literate Practices

Health Lit Res Pract. 2017 Oct;1(4):e216-e230. doi: 10.3928/24748307-20170929-01. Epub 2017 Nov 9.


Background: Experts have recommended the adoption of health literacy universal precautions, whereby health care providers make all health information easier to understand, confirm everyone's comprehension, and reduce the difficulty of health-related tasks. The U.S. Department of Health and Human Services selected three health literate practices to track progress in the adoption of health literacy universal precautions.

Objectives: This study sought to examine whether there has been an increase in the delivery of health literate care and whether recommendations for health literacy universal precautions are being followed.

Methods: This study used trend and multiple regression analyses of data from 2011 to 2014 from the Medical Expenditure Panel Survey, a national household survey.

Key results: The proportion of adults in the U.S. who reported receiving health literate care increased from 2011 to 2014, but fell far short of health literacy universal precautions recommendations of delivering health literate care to everyone. In 2014, 70% of the population reported their providers always gave them instructions that were easy to understand, but only 29% were asked to Teach-Back the instructions and only 17% were offered help with forms. Older, less educated, and racial and ethnic minority group members were more likely to report receiving health literate care than more advantaged groups. People who perceived their health and mental health as fair or poor were less likely to report receiving health literate care.

Conclusions: Failure to adopt health literacy universal precautions in the face of the high prevalence of limited health literacy in the general population may perpetuate adverse health outcomes that are costly to society. Greater efforts should be made to increase providers' health literacy skills, particularly those who serve populations that are more likely to have limited health literacy, including those with poor health.

Plain language summary: This study shows that some health care providers did not always check that their instructions were clear enough for patients to understand. Even fewer providers always offered help in filling out forms. People who were older, less educated, or members of racial or ethnic minority groups were more likely to be asked to confirm their understanding or be offered help with forms. More patients said that their provider was easy to understand, checked their understanding, or offered help with forms in 2014 than in 2011.