Using universal solutions to target universal problems

Many factors that can facilitate Mr Bell in gaining access to care are generally in the control of healthcare organisations.

An example of this is ensuring healthcare forms are user-friendly by:

• using plain everyday language
• asking the minimum necessary
• presenting content clearly
• having a healthcare provider to go through the questions with the patient.

The idea of reducing barriers to the access and use of healthcare settings for everyone has been used in the Universal Precautions approach.

Universal: being holistic

The word ‘universal’ indicates that this approach means more than implementing a few measures here and there, like using short forms in plain language (even though this is a good start). It is a systems approach, meaning that, ideally, all healthcare organisations and healthcare processes should be designed for the skills and abilities of people with limited health literacy. This includes simplifying communication (written and oral). supporting patients in their efforts to improve their health, and designing the practice in a patient-friendly way, including the physical environment as well as the processes.

Universal: being inclusive

The universal precautions approach thus assumes that every patient has limited health literacy and that healthcare systems should be designed around the skills and abilities of these patients. You can compare this to the use of wheelchair ramps in public buildings: You can build stairs that most people can use but some cannot, so you add a (often neither aesthetically pleasing nor user-friendly) ramp to make the building accessible. Or you integrate the ramp as a design feature into the building. As everybody can use the ramp, even though most people could also use the stairs, this approach is probably more efficient.

The same goes for healthcare systems. Limited health literacy is far more common than impaired mobility – in many countries, every second encounter between healthcare professional and patient is influenced by it. Therefore, assuming your patient has limited health literacy is probably the way to go. Consequently, if healthcare systems are designed around people with limited health literacy, people with high health literacy can still use them. This seems more efficient than designing healthcare systems for people with high health literacy and then patching it up here and there to include the other 50%. It is also more patient-friendly, as people with limited health literacy may feel less exposed, may need less help from staff and, as a result, do not need to feel ashamed, like Mr Bell.

The Universal Precautions Toolkit

A Universal Precautions approach to health literacy is supported in primary care practice by the comprehensive AHRQ Health Literacy Universal Precautions Toolkit, which aims to reduce the complexity of healthcare, increase patient understanding of health information, and enhance support for patients of all health literacy levels.

We encourage you to explore the toolkit approach and contents by accessing it online.