# A health-literacy certification standard for oncology portals, letters and apps

Source: https://onco.cc/ideas/idea-moon-literacy-first-design-standard/  
OnCo record `idea-moon-literacy-first-design-standard` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Cancer information tools must meet a tested standard: reading age around 12, main languages of the population, audio versions and clear numbers, or they are not certified for use.

## Summary

Patient letters, portals and apps are written for the people who build them. A certification (like accessibility standards WCAG) for health literacy would specify reading level, numeracy formats (natural frequencies, icon arrays), translation coverage matched to the served population, and testing with low-literacy users. Health systems and regulators would require certification for patient-facing oncology tools.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: Certified tools raise comprehension and portal use among patients with lower education and non-dominant languages and narrow the gap in trial awareness and adherence.
- Rationale: Accessibility standards changed the web because they were checkable and required; health literacy standards exist in guidance but are not enforced.
- Proposed test: Certify a portal and letter set in one system; compare comprehension and engagement across education strata before and after, and against a control system.
- Maturity: speculative
- Actor: engineering

## Sources

- Bottleneck evidence (Patients lack understanding, navigation and agency): Basch et al., Overall survival results of a trial assessing patient-reported outcomes for symptom monitoring during routine cancer treatment (JAMA 2017): https://doi.org/10.1001/jama.2017.7156

## Connected records

- bottlenecks: [Patients lack understanding, navigation and agency](https://onco.cc/bottlenecks/b-patient-voice/), [Trials do not represent the people who get cancer](https://onco.cc/bottlenecks/b-trial-diversity/)

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