Plain-language resource (PLR) development and patient health literacy: do the current recommendations address the need?

Plain-language resources (PLRs), if developed with health literacy principles in mind, can facilitate patient autonomy and shared decision-making. We investigated to what extent the currently available PLR development recommendations support patient health literacy requirements. Published (January 2017–July 2024) and grey literature (as of December 2024) English PLR development recommendations were analyzed to identify the frequency and qualitative guidance that met the definitions of functional, interactive and critical health literacy. Overall, 14 peer-reviewed publications and 13 grey literature PLR development recommendations were included in the analyses. Half of these were developed by government agencies and were intended for clinical researchers. Overall, only ~40% specifically incorporated health literacy principles. All recommendations described the development of text formats for PLRs; guidance on other PLR formats, such as visual and audio, was limited. Recommendations often equated understanding of content with purely reading and writing comprehension and thus offered guidance only on text structure and grammar. Available recommendations did not address accessibility more comprehensively. Direction provided on the target reading level was highly variable, which may be confusing for PLR developers. While many recommendations offered guidance for considering social and cultural determinants, guidance on reducing potential commercial determinants was sparse. Very few recommendations supported the application of knowledge gained for collective community action. Most of the PLR development recommendations supported functional health literacy, and some supported interactive health literacy; however, critical health literacy remained largely unaddressed. Current and future PLR development recommendations should better address patients’ health literacy needs and support collective action, so that these high-value resources are more useful to patients and non-medical audiences. • PLRs can facilitate health literacy among patients and the general public, thus improving their autonomy to participate in shared decision-making. • Currently available PLR development recommendations support the fundamental principles of health literacy, mostly functional health literacy, and to some extent interactive health literacy. However, future recommendations should also address the unmet need of critical health literacy. • There is a dearth of recommendations for developing unbiased content without commercial undertones. This gap risks undermining the value and impact of PLRs. • Our findings have wide implications as they provide pragmatic pointers on improving the standards of PLR development recommendations from a patient health literacy perspective.