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Table 1 Six steps for developing low literacy educational materials

From: The design of a low literacy decision aid about rheumatoid arthritis medications developed in three languages for use during the clinical encounter

Key concept Study phase
1. Convene a working team and solicit stakeholder input early Phase 1 – Focus groups
English-speaking RA patients
Spanish-speaking RA patients
Cantonese-speaking RA patients
Rheumatologists
2. Identify key concepts to be communicated Focus groups provide feedback on main areas of content:
• Broad category of medicines for RA
• Benefits of DMARDs across mono- and combination therapies
• Talking with the doctor about RA drugs
• Learning about risks
• Ways to reduce risk
• Cost
3. Map concepts to a behavioral theory, such as social cognitive theory and construct a brief intervention to support the use of written materials Phase 1 -social cognitive theory suggests that materials should:
• improve knowledge
• positively influence outcome expectations
• emphasize facilitators of behavior change
• address impediments to behavior change
• facilitate the creation of goals
4. Carefully design materials using low-literacy principles Phase 2: adopt AHRQ summary guide for low literate, limited English language proficient patients
• Use illustrations
• ≥ 14 pt font
• Adequate white space
5. Refine materials using input from the target population Phase 2
• In-depth, semi-structured interviews
• Review adapted guides with patient advisory board
6. Assess success of efforts in target audience and learn from failures Phase 3 – pilot test of decision aid, evaluate acceptability and outcomes of knowledge and decisional conflict