Date Available


Year of Publication


Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Lynne Jensen

Clinical Mentor

Dr. Judi Dunn

Committee Member

Dr. Karen Butler


BACKGROUND: Low health literacy is prevalent in the United States. As a result, the Agency for Healthcare Research and Quality (AHRQ) developed universal health literacy precautions to improve patient understanding of health information. Using universal precautions and specific tools, such as teach-back, has been shown to decrease morbidity and improve patient outcomes.

PURPOSE: The purpose of this quality improvement project is to assess provider knowledge of health literacy in a primary care setting. A secondary purpose is to assess the use of patient education material for patients with diabetes, hypertension, and hyperlipidemia that meet universal precautions.

METHODS: This study was a single-center, cross-sectional quality improvement study on the use and understanding of health literacy. This project was a one group pre- and post- intervention design to evaluate the perceptions and knowledge of providers regarding health literacy before and after an in-service. The focus of the in-service was on universal health literacy precautions and the teach-back method. The sample consisted of 22 primary care providers for the pre-survey and 18 primary care providers for the post-survey.

RESULTS: The percentage of providers that reported doing well at providing patients with a list of their medications and clear instructions on how to take them increased from 27.3% to 72.2%. While not statistically significant, there was an increase from 36.4% to 66.7% of providers who follow up with patients to determine if action goals were met. Providers identified diabetes education materials to be used routinely in clinic.

CONCLUSION: Provider understanding and use of the AHRQ’s universal health precautions is essential to improving patient outcomes and satisfaction. The teach-back method is a simple and easy tool for providers to use during patient interactions that can improve patient knowledge and adherence to treatment regimens. To improve overall patient health, patient experience, and quality of life, providers must ensure universal health literacy precautions are delivered to all patients.