Category: We Heart Health Literacy

As health communicators, we deal with survey data on the regular. Surveys can be a powerful tool to help us better understand our priority audiences and their information needs. But without thoughtful interpretation, survey data can be confusing at best — and misleading at worst.

So this week, we’re bringing you some food for thought about a key ingredient in every survey: the respondents. Answering the questions below will help you interpret, apply, and explain survey results with more nuance — and with a better sense of the people behind the data.

• Who took the survey? The first step in understanding survey results is getting a grip on exactly who answered the questions. For example, if 97 percent of your respondents regularly talk to cats, it’s pretty important to know that you only surveyed cat owners. Ideally, your survey’s eligibility requirements will overlap with key characteristics of your priority audience. But if they don’t perfectly align — say, your audience is cat owners but you were only able to survey people with spooky hairless sphynx cats — make sure you take those differences into account as you interpret the results.

• Who didn’t take the survey? If you sent the survey to 1,000 cat owners and only 100 responded, it’s important to think about what that response rate might mean. Start by taking a look at the demographics — were people of a certain race, age, or income level more likely to respond? Then you can think about what these differences mean for your results.

• How many people took the survey? In survey research, size really matters! After all, 90 percent of 1,000 people is very different from 90 percent of 10 people. And a result that seems noteworthy in a sample of 10 people — like 3 people who say that when they talk to their cats, their cats talk back — may not be so impressive if it’s 3 in a sample of 1,000. Larger sample sizes typically mean better-quality survey data — so keep sample size in mind to keep your results in perspective.

• How many respondents answered each question? Some survey questions may only apply to certain respondents. Let’s say you ask, “How often does your beloved cat bring you offerings of dead birds?” People with indoor cats are likely to skip that question (barring any unfortunate overlap with pet parakeets). So it’s important to always take careful note of the base — the number and description of respondents who answered each specific question. In this case, that would be the number of outdoor cat owners in your total sample size.

• Was the sample random or non-random? In a perfect world, we’d always use a random sample. Random samples are the next best thing to interviewing every single person in a population. But random sampling can be expensive and time consuming, especially if you’re researching a very specific population — people who have 12 or more cats, perhaps. So if your survey uses a research panel or another non-random sampling method, just remember that the results may not be generalizable to your whole priority audience.

• What’s the quality of the results? It’s important to take all survey results with a grain of salt. After all, we’re relying on people to self-report answers — and who wants to admit exactly how many times they have tried to dress up their cat as Mufasa from The Lion King? But the size of the grain will vary! A random sample of 10,000 people may yield high-quality results — so maybe just a dash of fine table salt. A non-random sample of 100 is a bit more iffy — think a generous dusting of coarse kosher flakes. Consider the quality of the results before you apply survey findings to your materials — and if you’re communicating survey results to others, make sure your framing mentions how much salt you recommend.

The bottom line: Take a closer look at respondents to better understand and explain survey results. 

Tweet about it: Surveys are a great tool for understanding our priority audiences. But first, we need to understand who’s taking the survey! That’s why it’s a good idea to take a closer look at respondents, says @CommunicateHlth: https://bit.ly/3wsqf5l

In public health, dear readers, talking about “vulnerable” communities, populations, or individuals is standard fare. We’ve all said it many times when referring to communities we’re prioritizing with our communications or programs. But this week, we wanted to make a case for retiring it from our vernacular. Why? Well, the term can put the blame on the very people we’re trying to help. And beyond that, it’s a card-carrying member of the “just plain vague” club — in a pretty problematic way.

We recently went to a conference where Dr. Tabia Henry Akintobi, a professor at the Morehouse School of Medicine, astutely pointed out that calling people “vulnerable” implies that the problem lies with them. This term carries a negative connotation of weakness and seems to suggest that certain people have some intrinsic characteristic that makes them more likely to get diseases or have worse outcomes from those diseases. It puts the onus on the people who are affected, rather than on the public policies and societal institutions that are truly to blame.

In addition, terms like “vulnerable groups” can obscure the actual people you’re talking about. It’s important to acknowledge not only the source or cause of a population’s oppression — but also the identities of the people who are oppressed! Calling a group “vulnerable” and leaving it at that erases specific populations with a vague, useless catchall.

We should note that calling out problems with “vulnerable” isn’t new, but it seems especially important to talk about now. As more and more people are confronting how deeply racism is woven into the fabric of our country and our society, we need to think about how our words could reinforce harmful patterns. When we list race as a risk factor, we conceal racism as the true cause of most racial health disparities — and when we call people “vulnerable,” we risk perpetuating the discrimination and unfair treatment that damaged their health in the first place.

So what’s an alternative?

When you’re talking to your health-communicating colleagues, consider “disproportionately affected by” (or “impacted” or what have you). It’s not the most elegant phrasing, but it’s accurate and everyone will know what you’re talking about (think: “populations disproportionately affected by COVID-19”). And if you need something more appropriate for consumers, consider the plain language “hit hard by” (as in: “communities hit hard by the pandemic”).

And instead of using “vulnerable” as a catchall, name the groups you mean. Sticking with a COVID-19 example, let’s say you’re talking about racial and ethnic groups that are at increased risk of getting COVID and having worse outcomes. Instead of “vulnerable populations,” list out the races and ethnicities you’re talking about: people who are Black, Hispanic or Latino, and American Indian or Alaska Native.

And if you can, describe the root causes that increase health risks in certain groups. For example, you could say: “We’ve identified Black people as a priority audience because structural racism and centuries of disinvestment in Black communities have damaged Black people’s health and increased their risk of getting and dying from COVID-19.”

The bottom line: Calling communities “vulnerable” puts the blame on those communities — and leaves too much room for interpretation. Let’s stop using it!

Tweet about it: We use the phrase “vulnerable communities” a lot in #PublicHealth and #HealthComm — but it’s pretty problematic. @CommunicateHlth explains why: https://bit.ly/3q5BKy5

As you know, dear readers, preventing HIV is a major public health priority. And we can’t talk HIV prevention without talking PrEP and PEP. (Rhyming acronyms, anyone?)

When they’re used correctly, these 2 medicines are very effective at protecting people from HIV. That’s why, as health communicators, we need to tell our audiences about PrEP and PEP as part of HIV materials — and make sure we clarify the difference.

Here’s how to give a very basic explanation of PrEP and PEP in plain language:

• PrEP (pre-exposure prophylaxis) is medicine for people who don’t have HIV but are at risk of getting it. If you have sex with someone who has HIV or you inject drugs and share needles with other people, taking PrEP every day can keep you from getting HIV.
• PEP (post-exposure prophylaxis) is another kind of medicine that can prevent HIV, but it’s for emergency situations. For example, you can use PEP if a condom breaks and you’re not sure if your partner has HIV or you accidentally stick yourself with a used needle. It only works if you take it within 3 days of coming in contact with HIV.

As always, remind your audiences to talk to their doctor to learn more. And remember that people who need PrEP and PEP may not be able to afford them on their own — so include information about paying for PrEP and paying for PEP.

The bottom line: When you’re writing about HIV prevention, make sure you explain PrEP and PEP in plain language.

Tweet about it: When you’re writing about #HIV, it’s important to explain PrEP and PEP in #PlainLanguage. Not sure how? @CommunicateHlth can help: https://bit.ly/2TYfvhJ #HealthLit

Here at We ❤️ Health Literacy Headquarters, we come across the word “adverse” a lot. Adverse drug events, adverse reactions, adverse childhood experiences… it’s a real health jargon regular! And, like most jargon terms, “adverse” has no place in consumer health materials.

Of course, as a health communicator, you’ll often need to communicate about an adverse something-or-other. For example, if you’re describing treatment options for a disease, explaining the potential side effects is really important!

But you can write about risks, side effects, and other unpleasant outcomes without calling them adverse anything! Here are a few simple plain language swaps to use instead.

Try this:

• Most people have mild side effects from the vaccine.
• If you have a bad reaction to the medicine, call your doctor right away.
• Kids who have difficult experiences in childhood are more likely to have health problems as adults.

Not that:

• Most people have mild adverse events from the vaccine.
• If you have an adverse reaction to the medicine, call your doctor right away.
• Kids who have adverse childhood experiences are more likely to have health problems as adults.

The bottom line: Ditch “adverse” in favor of plain language terms like “side effects” and “bad reactions.”

Tweet about it: “Adverse” is a health jargon regular (think “adverse events”) — but it’s not a good fit for #PlainLanguage health materials. @CommunicateHlth suggests some simple swaps: https://bit.ly/3cfJKqE #HealthLit

As health communicators, we spend a lot of time encouraging people to avoid health risks. And often, the first step is convincing them that there is a risk in the first place!

You may be tempted to tell them all the scary things that could happen if they don’t change their ways. (Don’t be too accommodating to cats, or they may… dun dun dun… TAKE UP RESIDENCE ON YOUR HEAD!) But we know that fear appeals are tricky to use effectively.

So what’s a health communicator to do? Fear not! The Extended Parallel Process Model (EPPM) is here to save the day. The EPPM, developed by Dr. Kim Witte, explains that health risk messages tend to get people thinking about 2 things: threat and efficacy.

Perceived threat describes how people think about a particular health risk. It has 2 parts:

• Perceived severity (“How bad is cat head, really?”)
• Perceived susceptibility (“What’s the chance of me personally getting cat head?”)

Perceived efficacy describes how people think about behaviors to prevent the health risk. It also has 2 parts:

• Perceived response efficacy (“Does keeping your hair wet at all times really prevent cat head?”)
• Perceived self-efficacy (“Can I personally go through life with eternally wet hair?”)

According to the EPPM, how we perceive threat and efficacy determines our health behaviors.

How does this work in practice, you ask? Let’s say you try a fear appeal. You make a scary TV commercial that shows a person with a truly dire case of cat head. At the end, in big spooky font, the commercial says: “CAT HEAD: IS IT COMING FOR YOU?”

The first person who sees your commercial thinks, “How unfortunate for that poor fellow. But my cat just isn’t the clingy type, so clearly cat head can’t happen to me.” They don’t perceive that the threat is relevant to them (low perceived susceptibility), so they don’t take any action to avoid it.

The second person who sees your post thinks, “Oh no! I, too, have a head and a cat. So I could catch cat head any moment!” You got their attention — but now they’re too terrified to take any preventive measures (sky-high perceived severity and susceptibility). Instead of taking action, they choose to hide under the bed.

What went wrong here? According to EPPM, the key to an effective health risk message is a delicate balance between perceived threat and efficacy. Fear can be a powerful motivator, but we don’t want to motivate people to hide under the bed. We want them to feel that the threat is personally relevant to them, but also feel confident that they can take steps to prevent it.

So let’s try this message again, with a better balance of threat and efficacy: “Anyone who treats cats with too much courtesy is at risk for cat head. But the good news is that you can protect yourself by keeping your hair cold, wet, and inhospitable to cats. Ask your doctor if wet hair is right for you.”

We don’t know about you, dear readers, but we’re feeling more in control of our cat head risk already.

The bottom line: Take a cue from the Extended Parallel Process Model — balance threat and efficacy to help your audience avoid health risks.

Tweet about it: How can we motivate our audiences to prevent health risks? According to the Extended Parallel Process Model, it’s all about balancing threat & efficacy. @CommunicateHlth explains how you can strike the right balance in your #HealthLit materials: https://bit.ly/2T8hKP2

We’ve talked about a few different platforms in our social media series (including the Twitter, Facebook, and Instagram trifecta). But today, we’re tackling a very different social networking beast: TikTok.

We know what you’re thinking, dear readers — TikTok? Really? The platform Gen Z uses to show off their dance moves and make fun of millennials’ style choices? We’re here to tell you that TikTok is much more than that. It’s a place where anyone can post short videos about anything — including health content!

From workout tips to eye health mythbusting to COVID vaccine explanations, TikTok has it all when it comes to health-related topics. But why should you fling your content into the TikTok void? Consider this: as of last year, TikTok had been downloaded more than 2 billion times — and it was the most-downloaded app in 2020.

So in the spirit of reaching people where they are, use these tips to TikTok-ify your health content:

• Be authentic. One of TikTok’s greatest strengths as a platform is that it provides real content from real people. The best-performing videos showcase the person’s authentic experience and voice — whether they already have a huge following or just downloaded the app yesterday. So feel free to let your winning personality shine through when you’re creating content for TikTok!
• Use humor. One thing that successful TikTok videos generally have in common is that they’re funny. Not all health topics will lend themselves to humor, of course — but sometimes a lighthearted approach can help people talk about a tricky subject. And sometimes it just helps us handle hard stuff! Take the proliferation of bubonic plague TikToks during the pandemic, for example.
• Hashtag it. If you spend any time at all on social media, hashtags are probably familiar faces. TikTok hashtags work in much the same way that hashtags work on Facebook, Instagram, and Twitter — so use them to add your voice to the conversation! Make sure to tag your videos with relevant and trending hashtags. And always use “#fyp” or “#ForYou” so it’s more likely your TikToks will land on people’s For You pages (where the TikTok algorithm shows you content it thinks you’ll like).
• Respond to others’ TikToks. You can reply to someone else’s video with a feature called “stitching.” Your TikTok will show a clip of the video you’re stitching, followed by your content. It’s a great way to have a conversation — or even combat some health misinformation!
• Caption your videos. Always add captions (on-screen text that displays dialogue) to your videos. Captions don’t only benefit people who are Deaf or hard of hearing — they also make your content accessible to people who have their sound muted! There’s even a handy new feature to add captions automatically.

The bottom line: TikTok is an opportunity to share your health content in new and fun ways. (And seriously, all the cool kids are doing it.)

Tweet about it: TikTok for #HealthComm? That’s right, says @CommunicatHlth. Get tips for using Gen Z’s fave platform to share your #HealthLit content: https://bit.ly/3eOV133

Here’s something we can probably all agree on: sometimes, making health-related decisions is really hard. We’ve written in the past about shared decision-making and tools to support it. But this week, dear readers, we wanted to take a deeper dive into decision aids.

As health communicators, we know we need to talk about the pros and cons of each possible choice — that’s a must-have for informed consent! But when someone is facing a particularly difficult choice — like how to approach end-of-life care — we can take it a step further.

That’s where decision aids come in. A decision aid is a tool that goes beyond a general list of pros and cons to help people think through how the risks and benefits of each option stack up for them personally. And while decision aids can’t replace a conversation with a doctor, they can make those conversations more efficient and productive.

Use these tips to make your decision aid shine:

• Keep it brief. If your decision aid looks long or dense, people will be much less likely to use it — so save that nice-to-know info for later.
• Make it personal. To engage patients, include interactive elements like yes/no or multiple-choice questions, write-in fields, and sections for notes. Consider using a digital format that allows for a bite-snack-meal approach so users can further personalize their experience.
• Use numbers wisely. Check out these numeracy best practices to make sure you’re clearly and accurately communicating about risk or the chance of a certain health outcome.
• Talk about values. Health outcomes aren’t the only variable at play when people make medical decisions. Make sure your decision aid helps people consider how each option aligns with their values and beliefs, their family situation, their finances, and anything else that may be important to them. (Keep in mind that sometimes decisions can come down to things like whether people can take a day off work or how okay they are with some pain or discomfort.)
• Include clear next steps. For example, that could mean talking to a doctor about their decision and any questions they still have.
• Test, test, test! There’s only one way to know for sure that your decision aid is hitting the mark — go out and test it with your intended audiences!

For a more detailed rundown of decision aid best practices, see this evidence-based checklist from the International Patient Decision Aid Standards Collaboration.

The bottom line: When people are facing tough choices about their health, decision aids can help them think through their options and make the choice that’s right for them. 

Tweet about it: Making health-related decisions isn’t always a walk in the park, but health communicators can help. @CommunicateHlth weighs the pros (and pros!) of creating #HealthLit decision aids: https://bit.ly/2SrWVgZ #HealthComm

As health communicators, we’re always looking for creative ways to share health messages — whether that’s through pictograms, videos, or good old-fashioned words. We also like to keep an eye on how language is changing over time — and emojis are a big part of that!

Quick refresher for the analog among us: emojis are small images you can drop into written text, like so: ?❤️? ?. Researchers have found that people use emojis as a written equivalent to gesture — so while emojis can’t replace text in health materials, they can complement it and make it feel more conversational. That’s why we ❤️ emojis here at We ❤️ Health Literacy Headquarters.

You won’t be surprised, dear readers, to hear us say that emojis aren’t appropriate for every audience, situation, or message. To figure out how emojis might fit into your health materials, consider the following:

• Who’s your audience? Some older or less tech-savvy audiences may be less familiar with emojis.
• What’s your topic? Emojis contribute to a fun, lighthearted tone — so if that’s not what you’re going for, probably best to skip ‘em.
• Is it a digital material? For the most part, people don’t expect to see emojis in print.
• What’s your accessibility plan? Most screen-readers will read the name of each emoji (for example, reading ? as “grinning face”). But some browsers or devices won’t load them properly — so make sure your content still makes sense without them.
• Is your message clear? Some emojis have developed… let’s call them alternate meanings. If you’re not fluent in internet, google or check an emoji site first to make sure your emojis don’t have any unwanted connotations.

And of course, we can’t talk about emojis in 2021 without noting that some health-related emojis have emerged as real MVPs during the COVID-19 pandemic — like a face wearing a mask ?. And Apple and Google are releasing a new, blood-free design for their syringe emoji ?. Since people are already using the syringe to represent COVID-19 vaccination, this change will help make vaccination seem a bit less scary — and we ❤️ that.

The bottom line: Try using emojis to add a fun, conversational feel to your digital health materials. 

Tweet about it: Want to add a ✨ fun, conversational feel ✨ to your digital #HealthLit materials? Consider inviting emojis to the party ?, says @CommunicateHlth: https://bit.ly/2QPiwPA

This week, in the spirit of spring cleaning, we’re taking a break from our normal content to tell you about a few important housekeeping items.

The most important thing is that we’ve moved! You may know that while our weekly emails come to you via MailChimp, our blog content has been permanently hosted on Medium. But not anymore. Now, dear readers, your very favorite We ❤ Health Literacy content will live at — wait for it — We ❤ Health Literacy Headquarters!

That’s right, from now on we’ll be hosting our own content on its very own cozy blog corner of our very own website. Please note that we’ll be ironing out any kinks over the next few months — like making sure everything is tagged correctly and so forth. But fear not! You don’t have to do anything to keep getting our weekly emails. Just know that if you want to reference a post on the web going forward, it’s bye-bye Medium and hello CommunicateHealth website.

Speaking of which, you may have noticed that we recently launched a newly designed CommunicateHealth website! We’re very excited about our new lewk (we do plain language and hip language), and we’ve added lots of new content to our portfolio.

If you have questions about any of this, feel free to respond to this email and we’ll get back to you. And we’ll see you next week with our regularly scheduled installment of We ❤ Health Literacy!

Here at We ❤ Health Literacy Headquarters, we’re always looking for ways to build stronger connections with our audiences. And using the right voice and tone is one way to forge that connection! So this week, we’re sharing tips to help you identify a clear voice and tone in your health writing.

First, a little refresher on what voice and tone mean. Voice is constant. It’s a key part of your identity — an expression of personality that comes out through your writing. In the corporate world, it’s often called “brand voice,” but it’s not just for the Apples and Fords. Whether you work for a Fortune 500 company, a government agency, or a community nonprofit, you need a consistent voice.

But what is voice, exactly? Think about how you can recognize your favorite singer even if you’ve never heard the song before — that’s because their voice is distinctive across different songs (or in our case, health materials!).

Tone, on the other hand, is situational. It varies based on the specific topic, the context, and your audience’s likely emotional state. So while voice stays the same across a website or campaign, tone may change slightly from page to page or tweet to tweet.

Think of it this way: No matter who you’re talking to, you’re still yourself — that’s your voice. But you wouldn’t talk to your best friend the same way you’d talk to your boss, or your sworn enemy, or the teller at your bank — you vary your tone based on who you’re talking to and what the conversation is about.

So, how do you figure out the right voice and tone to use? We often define voice and tone as a series of adjectives — like “friendly, compassionate, and sincere.” And to really bring out the nuance, it can be helpful to think about what your voice or tone is and what it isn’t. For example, you might describe your health communication campaign’s voice as:

• Optimistic, but not naive
• Friendly, but not overly familiar
• Informational, but not dry

When it comes to tone, you’ll need to get more specific. What’s the health topic at hand? What is the audience likely thinking or feeling while reading about it? For example, a playful, quirky tone might be perfect for sharing general healthy eating tips, but it wouldn’t be a good fit in nutrition tips for people starting chemotherapy. In that case, the tone might be:

• Motivating, but not overly upbeat
• Comforting, but not patronizing
• Serious, but not dire

The bottom line: To build a stronger connection with your audiences, think through the voice and tone of your health comm materials before you write.

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Tweet about it: Want to make your #HealthComm materials sound just right? Being intentional about voice and tone can help, and @CommunicateHlth’s got tips! https://bit.ly/3d1ksNJ #HealthLiteracy