The Task Force members, 50 in all, represented the broad spectrum of stakeholders in health including health care provider groups and associations, state and local health and education agencies, insurers, consumers, and adult literacy experts. In terms of state agency involvement, the task force included members representing the NC Division of Public Health, the NC Department of Health and Human Services (NC DHHS) Medicaid unit, and the state’s Area Health Education Center (AHEC) program. A consensus driven process led to the formulation of 14 recommendations.

In formulating their 14 recommendations, the task force took a universal precaution approach which is one of ensuring that communications are clear for everyone, regardless of literacy level. The recommendations focused on improving health care communications for all populations within the state rather than attempting to improve the literacy level of the general public. A 2010 assessment of progress on implementing the task force recommendations found that progress had been made on 11 of the 14 recommendations. No action had been taken to implement the remaining 3 recommendations. Silberman pointed out that by bringing together the right partners, the Task Force’s recommendations were generally implemented without the NCIOM’s active involvement. The NCIOM is not an advocacy organization so this level of engagement was critical to the success of the initiative, she said.

One recommendation of the task force was to create a NC Health Literacy Center of Excellence charged with

  • educating health professionals,
  • identifying evidence-based guidelines or best practices for health communications,
  • disseminating health education materials, and
  • assisting adult literacy professionals.

While a new center was not created, many of the recommended functions of the proposed center are now being carried out by the North Carolina (NC) Program on Health Literacy ( and the N C Health Literacy Council ( The NC Program on Health Literacy is housed at the University of North Carolina at Chapel Hill. It is a research- and teaching-oriented program that is actively involved in the identification of best practices. With Agency for Healthcare Research and Quality (AHRQ) support, the program developed the Health Literacy Universal Precaution Toolkit that supports primary care practices. The toolkit can be accessed at

The NC Health Literacy Council is housed at the University of North Carolina at Greensboro. The council primarily works with adult literacy

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