The Stoplight Method: A Qualitative Approach for Health Literacy Research.

The Stoplight Feedback Toolkit was developed to engage patients with low health literacy in qualitative research, to overcome known barriers to participation, and to field test written health materials. Three focus groups of patients with low health literacy were conducted using the Stoplight methods. Participants with inadequate health literacy were identified using data from electronic health records at an academic medical center, using a validated screening question. Participants were recruited by phone using a script that was written in plain language. Three focus groups were conducted with a total of 10 unique patients. In each focus group, a facilitator read the health materials aloud to the participants and then walked them through a guided process of stoplight coding of the materials, consensus discussion, and user feedback. Color-coded materials, verbal comments and feedback, and behavioral observations were collected as qualitative data. Data were analyzed, sorted into themes, and mapped onto health literacy and plain language best practices. The Stoplight methods were successful in engaging patients with low health literacy to overcome barriers to participation, as well as in soliciting qualitative results that guided recommendations for improvement of the materials.