Table 9 Expert Opinion-Based Principles from the Broader Literature for Successful Health Literacy Interventions

Use high intensity interventions

Use multiple literacy-directed strategies to support knowledge acquisition and understanding.

For example, design PtDAs using plain language, simple numbers, and a range of visual and linguistic techniques. Delivery of the PtDA requires multiple reinforcing contacts to support active decision-making.

Use theory-based interventions when appropriate

Theory can be used to maximize the impact of PtDAs. For instance, behavioral and communication theories applied in PtDAs can motivate engagement with the PtDA, or, if appropriate, engagement in specific behaviors.

Pilot test before full implementation

Pilot testing a PtDA involves examining the information needs and communication preferences of lower literacy populations, and examining the whole process of decision making among lower health literacy patients.

This means checking not only understanding of the language and content, but also whether the PtDA helps users to clarify values, communicate with health professionals, and implement a decision.

Increased emphasis on skill building

PtDAs should be designed to help with skill building. This suggests that demonstrating and modeling values clarification and physician interactions in PtDAs may improve outcomes among low literacy users of PtDAs.

Delivery by a health professional

Deliver PtDAs by a health professional (e.g., pharmacist, health educator, nurse, physician) rather than by non-clinicians. This also suggests that delivery of PtDAs in the context of clinical care might result in the best outcomes.