Table 1.

Health Literacy Principles Checklist

Planning
Objective	∙ Define the communication objectives
Target audience	∙ Know audience need, interests, and behaviors
	∙ Identify ways to engage the target audience
	∙ Involve the target audience in development and testing
Content
Purpose	∙ Focus and limit the objectives
	∙ State objectives in the title, cover illustration, and introduction
Evidence	∙ Ensure content is accurate and evidence based
	∙ State what is known and when relevant, what is not known
Scope	∙ Limit to essential information; include the “need to know,” but not the “nice to know”
	∙ Include only information that is relevant and meaningful to the intended audience
	∙ Focus on behaviors, skills, and instructions
	∙ Go beyond the facts to include action-oriented material
	∙ Stress, repeat, and summarize the main points
Language and culture	∙ Ensure high-quality translation and interpretation of content
Demographics	∙ Ensure content reflects age, education, income, gender, occupation, and residence of intended audience
Clarity	∙ State the information as clearly and simply as possible
Tone and appeal	∙ Include positive, truthful, and helpful content
	∙ Edit content for bias and prejudice
References	∙ Note key sources
	∙ Provide sources for more information
Date/authorship	∙ Include author(s) and date of publication or revision
Literacy demands
Reading level	∙ Ensure as many people as possible can read and understand the materials
	∙ Consider using a readability calculator, but be sure you understand its limitations
Choice of words	∙ Use common, everyday, specific words that are two syllables or less
	∙ Avoid using jargon, abstract words, technical terms, statistics, abbreviations, and acronyms
	∙ Include the pronunciation of words that may not be familiar
	∙ Explain words, expressions, and phrases through simple definitions; consider using word/picture association or examples
	∙ Use positive statements. Limit sentences that begin with “don’t” or “never”
Sentences/paragraphs	∙ Write in a conversational style, using active voice
	∙ Use short, simple, and direct sentences (8–15 words)
	∙ Use short paragraphs and avoid large blocks of text
Use of numbers	∙ Do the math for the reader, do not require addition, subtraction, multiplication, or division
	∙ Consider using visual presentations of numbers
	∙ Use whole numbers when possible (1 in 1,000 instead of 0.001)
	∙ Express risk information in frequencies (1 out of 10 instead of 10%)
Organization
Content	∙ Present context before new information
Sequence	∙ Present information that is logical and easy to follow
	∙ Position important information at the beginning and end for emphasis
Groupings	∙ Divide information into small, logical sections
Headings	∙ Use short, simple, and explanatory headings to organize
Layout and typography
Font	∙ Use a clear typeface like Times New Roman or Arial
	∙ Use upper and lowercase letters; avoid using all uppercase
	∙ Limit the variations of typefaces used
	∙ Use a type size that is easy to read and as large as possible (at least 12-point; 14-point; or 16-point text is preferred)
Headlines and titles	∙ Use headlines and titles to orient and engage the reader
White space	∙ Provide breaks for the eye with white space
	∙ Balance the use of white space with content and graphics
	∙ Separate paragraphs and topics by one or two lines
Justification	∙ Avoid full justification of text; format edges flush left with right ragged instead
Highlights and color	∙ Use bulleted lists, underlining, and bold for emphasis
	∙ Introduce color to highlight, add clarity, differentiate, or focus the eye
	∙ Use shading, boxes, and arrows to direct attention to key content
Graphics
Engagement	∙ Use graphics to grab attention
	∙ Spotlight the objectives with the cover graphic
	∙ Reinforce the objectives with graphics
	∙ Choose graphics that are friendly, attractive, and recognizable
Relevancy	∙ Use action-oriented graphics
	∙ Show key desired behaviors, rather than behaviors to avoid
	∙ Choose graphics that reflect the age, gender, ethnic, and cultural background of the audience
	∙ Design graphics that support and reinforce important points
Clarity	∙ Use simple design, free from clutter and distractions
	∙ Avoid diagrams, graphs, charts, and data tables that require multiple steps for use

Doak et al. [23]