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Component 1.4

Language/Health Literacy/ Communication


Limited English proficiency (LEP):

refers to individuals who are unable to communicate effectively in English because their primary language is not English.

Health literacy:

defined by the HHS National Institutes of Health as the degree to which individuals have the capacity to obtain, process and understand basic health information and services they need to make appropriate health decisions. Patients with limited English proficiency (LEP) and/or limited health literacy are less able to access health care services, understand health-related information and follow health care instructions. Limited English proficiency and poor health literacy are associated with poor health outcomes and higher health care costs. Clinicians and patients need to be able to understand each other. If patients with limited English proficiency lack access to language assistance services, they will have a difficult time understanding the care they receive and will be less satisfied with services

Universal precautions for health literacy:

steps that practices take when they assume that all patients may have difficulty comprehending health information and accessing health services. Health literacy universal precautions are aimed at:

  • Simplifying communication with all patients and making sure they understand information, to minimize the risk of miscommunication.
  • Making the office environment and health care system easier to navigate.
  • Supporting patients’ efforts to improve their health.4

Non-written formats:

verbal formats and graphic formats such as visual brochures, videos, infographics, and graphic demonstrations.


  • Use the Ten Attributes of a Health Literate Organization to guide thinking/implementation.1
  • Offer language assistance to patients who have limited English proficiency and/or other communication needs, at no cost to them, to facilitate timely access to all health care and services.2
  • Use “I Speak” cards with patients who do not speak enough English to respond to questions about language preference, to identify the language they speak.3
  • Display interpretive services posters in waiting and reception areas to make patients aware that free interpreter services are available.2
  • Ask all new patients what language they prefer to speak and read, and if they would like an interpreter. Record patients’ language assistance needs in the medical record.3,4
  • Practice universal precautions for health literacy.3,4
  • Assess whether patient materials are easy to read and understand.3,4,5
  • Assess and meet the direct language needs of patients during visits by using clinicians who speak the same language, providing in-person interpretation by trained language interpreters and using visual aids.2


  1. Institute of Medicine’s Ten Attributes of Health Literate Health Care Organizations: http://www.ahealthyunderstanding.org/Portals/0/Documents1/IOM_Ten_Attributes_HL_Paper.pdf
  2. Oregon Office of Equity and Inclusion: http://www.oregon.gov/oha/oei/Pages/hci-resources.aspx
  3. Providing Quality Family Planning Services (QFP), Recommendations of CDC and U.S. Office of Population Affairs, 2014, page 48: http://www.cdc.gov/mmwr/pdf/rr/rr6304.pdf
  4. Agency for Health and Research Quality (AHRQ) Health Literacy Universal Precautions Toolkit, Second Edition, January 2015: http://www.ahrq.gov/professionals/quality-patient-safety/qualityresources/tools/literacy-toolkit
  5. CMS Toolkit for Making Written Material Clear and Effective: https://www.cms.gov/Outreach-and-Education/Outreach/WrittenMaterialsToolkit/index.html