The Equity Checklist: How to Review Patient Education Materials for Bias and Exclusion

Introduction

Equity in patient education materials shapes how patients feel about their care. When materials exclude groups, use stereotypes, or make hidden assumptions, the result is distrust and poorer outcomes. Bias often slips in without intention, through word choice, examples, or tone.

This article offers a practical checklist to help healthcare organizations review materials for inclusivity and equity.

What Bias and Exclusion Look Like in Patient Education Materials

Bias in patient education materials is often subtle. It can show up in ways that writers and reviewers do not always notice:

- Language bias. Technical jargon, deficit framing such as “non-compliant patient,” or essentializing labels like “diabetic” instead of “patient with diabetes.”
- Cultural bias. Content that assumes one way of eating, one family structure, or one lifestyle is the norm.
- Representation gaps. Photos, stories, or examples that reflect only one demographic group.
- Accessibility gaps. Materials that overlook patients with limited English proficiency, low literacy, or disability.

These issues may seem small, but together they can signal to patients that the content was not written for them.

The Equity Checklist: 6 Core Areas to Review

1. Language and Tone

Ask whether the language is respectful, non-judgmental, and centered on the patient. Avoid framing that blames the patient.

For example:

- Instead of “non-compliant”, write “has not been able to take medicines as prescribed”.

- Instead of “diabetic patient,” write “patient with diabetes.” Putting the person first emphasizes humanity rather than reducing them to a diagnosis.

Why it matters: language shapes the relationship between patients and providers. Blaming or labeling discourages engagement, while partnership-focused wording encourages patients to take an active role in their care.

2. Readability and Literacy Level

Confirm that materials are written at a 6th to 8th grade reading level. Avoid acronyms or jargon unless they are clearly explained the first time they appear.

For example:

Instead of “Patients with type 2 diabetes must achieve glycemic control through adherence to pharmacological interventions and lifestyle modifications,” use: “If you have type 2 diabetes, keeping your blood sugar in a healthy range is important. Medicine, healthy eating, and being active can all help you manage it.”

Why it matters: materials written above patients’ reading levels create barriers. Clear writing reduces errors, improves adherence, and builds confidence.

3. Cultural Relevance

Check whether the examples reflect different cultural contexts. A nutrition guide that assumes every family eats the same foods misses large portions of its audience. Good content acknowledges that health beliefs and dietary patterns vary.

For example, if a handout recommends yogurt at breakfast, provide alternatives for patients who may not eat dairy. Or, if a material suggests whole wheat bread, consider that some cultures may use rice or flatbreads as staples.

Why it matters: culturally relevant content tells patients, “this applies to me.” Without it, patients may disregard the information entirely.

4. Representation and Inclusivity

Look at the examples, patient stories, and visuals. Do they reflect diversity in gender, age, ethnicity, and background? Representation should feel authentic, not surface-level.

For example, avoid using a single photo of a person of color while the rest of the material reflects only one demographic. Instead, integrate diversity throughout patient scenarios, testimonials, and imagery.

Why it matters: patients are more likely to trust and engage with content when they can “see themselves” in it. Surface-level inclusion feels tokenistic and undermines credibility.

5. Accessibility

Confirm that materials can be used by patients with different needs. This includes:

• Plain language for patients with low literacy.
• Compatibility with assistive technologies like screen readers.
• Large print or high contrast options for patients with low vision.
• Clear headings and simple navigation for patients with cognitive challenges.
• Alternatives for patients who may not be comfortable with digital formats.

Why it matters: accessibility ensures no group is unintentionally excluded. It ensures that all patients — regardless of literacy, disability, or digital access — can act on the information provided.

6. Consistency Across Channels

Ensure that information is the same whether the patient reads a handout, logs into a portal, or hears instructions from a clinician. Updates must be applied everywhere, not just in one format.

For example, if new blood pressure targets are adopted, the printed discharge sheet, the patient portal, and the clinician’s talking points should all reflect the same numbers.

Why it matters: inconsistent content creates confusion and erodes trust. Patients quickly notice when messages conflict, and they may not know which version to follow.

Practical Example: Spotting Bias in a Patient Education Material Paragraph

Original:

“Diabetic patients often fail to stick to a diet, which makes it harder for their doctors to manage blood sugar levels.”

Rewritten:

“Many patients with diabetes find it challenging to make changes to their eating habits. Your care team can support you with practical steps, like setting small goals and connecting you with a nutritionist.”

The original version is judgmental and essentializes patients by their condition. The rewritten version acknowledges difficulty without blame, uses person-first language, and offers support.

Why an Equity Checklist Builds Trust

Equity is more than compliance. Inclusive materials show patients that they are seen, respected, and understood. When patients recognize themselves in examples and feel addressed respectfully, trust grows. Organizations that prioritize equity see better engagement, higher satisfaction, and improved outcomes.

How to Start an Equity Audit Today

You do not need to overhaul every material at once. Start small:

1. Choose one key document.
2. Review it against the six checklist areas.
3. Identify one or two priority fixes, like replacing essentializing labels or simplifying language.
4. Implement those fixes, then expand the process to other materials.

Building equity reviews into your content workflow ensures long-term consistency.

Conclusion

Equity in patient education is about more than words. It is about trust, inclusion, and safety. Small changes in tone, language, and representation can have a big impact on how patients engage with care.

If your organization wants to review and adapt patient education materials for equity, accessibility, and trust, we can help.