Table 4.

AHRQ Health Literacy Universal Precautions Toolkit¹⁸ Components and Modification for Integrating Health Literacy Into Cardiovascular Care

Tool	Title	Applications for Cardiovascular Prevention and Management
1	Form a Team	Develop a team of multidisciplinary stakeholders (eg, primary care, geriatric, and cardiology representatives) to promote best practices for HL
2	Create a Health Literacy Improvement Plan	Construct a plan with explicit short-and long-term goals for addressing HL challenges in the care of CVD
3	Raise Awareness	Educate staff about HL and challenges of HL relevant to CVD
4	Communicate Clearly	Use plain language, avoiding jargon; review consents for reading level; adopt the patient’s words; integrate pictures to teach about testing, disease states
5	Use the Teach-Back Method	Document teach-back and use to demonstrate quality improvement in patient engagement and education
6	Follow-Up With Patients	Involve patient in monitoring (eg, symptoms and adherence tracking)
7	Improve Telephone Access	Implement universal precautions to facilitate patient-centered communications
8	Conduct Brown Bag Medicine Reviews	Review all medications as a standard for quality patient care; develop logs to assess adherence routinely with patients; implement pharmacist collaborators
9	Address Language Differences	Conduct education, assessments, and testing with a trained interpreter
10	Consider Culture, Customs, and Beliefs	Receive training in cultural competence; remember the patient’s expertise in the intersection of culture and beliefs with CVD and other medical care
11	Assess, Select, and Create Easy-to-Understand Materials	Evaluate forms, informed consents, procedural brochures for readability
12	Use Health Education Material Effectively	Create information order sets or collected materials on CVD treatment options
13	Welcome Patients: Helpful Attitude, Signs, and More	Use the environment to promote questions and medication review
14	Encourage Questions	Invite questions routinely on CVD, patients’ experience with disease and treatments
15	Make Action Plans	Have patients choose realizable goals (eg, medication adherence, or addressing risk factors for AF, such as smoking, physical activity, blood pressure control)
16	Help Patients Remember How and When to Take Their Medicine	Facilitate tools to support medication use; educate patients on systems for tracking medication; anticipate errors; provide tools such as pill boxes
17	Get Patient Feedback	Use patient expertise on being a patient through surveys and suggestions
18	Link Patients to Non-Medical Support	Use community-based resources
19	Direct Patients to Medicine Resources	Review insurance coverage and verify eligibility; integrate case management
20	Connect Patients With Literacy and Math Resources	Discern how HL affects patients’ lives and experience; identify and integrate community resources
21	Make Referrals Easy	Make sure the patient understands the referral rationale; provide timely and relevant feedback when consulting

AF indicates atrial fibrillation; AHRQ, Agency for Healthcare Research and Quality; CVD, cardiovascular disease; and HL, health literacy.