Category: We Heart Health Literacy

Does the term “collaging” ring any bells for you, dear readers? From grade-school art class, perhaps? Maybe you pasted together images to represent your hopes and dreams, and they told a clearer story than you could have communicated with words alone.

That’s also the idea behind collaging as a testing technique! Collaging is an innovative way to learn things that participants aren’t likely to come out and say directly.

According to Dr. Gerald Zaltman, who founded the technique (also known as the Zaltman Metaphor Elicitation Technique) at Harvard Business School, collaging helps you learn “what people don’t know they know.” A lot of our thinking happens at the subconscious or unconscious level, and images can help these hidden thoughts surface.

Collaging uses images to draw out participants’ values, emotions, and mental frameworks. It works best as a formative or exploratory research activity — when you want to find out what people need or how they think about a particular topic. And since the focus is on images instead of words, it’s especially useful for participants with limited literacy skills.

You can do collaging as a 1-on-1 exercise or in a focus group setting. Here’s how it works:

• Participants get a collection of images (all participants get the same ones)
• The moderator asks participants to create a collage that represents their values, beliefs, or desires related to a particular topic
• After about 20 minutes, participants share their collages and talk about what each image represents for them

And while this technique works great in person, it’s easy to adapt for remote formats, too. Platforms like Aha! Live Conversations let you move the whole collaging process online.

We see collaging as a win-win: it can empower participants to share stories and make connections they’ve never thought about — and reveal insights that researchers never knew to ask about. Yes, please!

The bottom line: When words aren’t quite getting you there, try collaging as a testing technique.

Tweet about it: Looking for creative testing techniques for your #HealthLit materials? Try collaging — and use images instead of words to tease out what people think: https://bit.ly/3bzrgAg

In our first social media installment, we discussed the blog — one of the very first forms of social media. Today, we’re going to talk about a platform that’s a little newer to the scene (though it may not feel very new at this point): Twitter.

Twitter has been shaking up the social media game since 2006. It’s taught people how to make an impact in 140 characters or less — which we definitely ❤︎. Seriously, a platform that actually requires you to be concise in your communication? Sign us up. (Just kidding, we’re already there! #FollowUs)

Twitter offers easy access to the latest news, gossip, and clearly written, actionable health updates (of course) — all in real time. But as awesome as that is, it can be a little bit overwhelming. So, where to start? How can you make your content stand out in the literally endless stream of tweets flooding folks’ feeds?

Not to fear, dear readers! We have some tried-and-true tips to help you make the most of those 140 characters.

• Show your personality! Use an informal, friendly tone so users will want to hear more from you.
• Reel ’em in. Lead with a strong hook so they’ll be dying to read your whole tweet and visit the page you’re linking to.
• Write actionable content. Use phrases like “Check this out!” or “Learn how you can…” to encourage people to tune in.
• Include relevant hashtags (#) so users can find your tweets as they search — it can get you double the engagement of a tweet without hashtags.
• Use no more than 2 hashtags in a tweet. You know what they say: too much of a good thing can be bad (and it can decrease engagement by 17%).
• Add visual interest with photos, videos, and GIFs. Tweets with images get 150% more retweets.

Now, flap your wings and tweet away!

The bottom line: Make your 140 characters count. The ingredients for a perfect tweet include: a little personality, some visuals, and the right hashtag.

No doubt you know by now, dear readers, how important it is to keep your health content clear, simple, and direct so it’s easy for people with limited literacy skills (and everyone else) to understand. What you might not know is that cognitive scientists have an explanation for why some of our favorite plain language guidelines make such a big difference: something called working memory.

Working memory is the brain function responsible for storing, organizing, and using information. It’s where we keep facts and details, do equations, and form new thoughts — all key pieces of understanding written information. But our working memory only has a finite amount of storage space, and it’s “temporary storage” — like a scratchpad that’s only so big.

One thing we know about audiences with limited literacy skills is that they’re likely to have more issues with working memory than their higher-literacy counterparts. That makes them more likely to get distracted, reread words, or lose their place — and perhaps give up reading altogether.

So what’s the savvy health writer to do in order to keep readers, well, reading? Enter cognitive cues. Cognitive cues are strategies for designing and arranging content in ways that hold your reader’s attention. Think of them like visual signals that help emphasize important content — and minimize distracting content — to support readers’ working memory.

Check out these examples of some plain language standbys in the context of cognitive cues.

• Use boldface and other visual cues to call out key messages. This can help your readers find — and remember — the most important information on the page.
• Use images and graphics to support your text. Just steer clear of images that are off-topic or overly complicated — they can be more distracting than helpful.
• Give context first. Giving context at the beginning of a sentence helps readers know whether or not content applies to them, so they can skip it if it doesn’t — leaving a little more room in their working memory.
• Break paragraphs into small chunks or lists, and group similar information. Presenting content in small chunks or groups of like information — with lots of white space — is less likely to overwhelm a reader’s working memory.
• Replace jargon terms with plain language alternatives. Readers who struggle with working memory may have trouble remembering the meaning of a word they don’t know — even if you’ve defined at the beginning of the material.

Sure, you’ve heard us give tips like these before — but don’t they take on some new meaning now that they’re in context? We just ❤ that.

The bottom line: Use cognitive cues to create health content with your readers’ working memory in mind.

We see the words “hazardous” and “hazard” all the time. Journalists ❤︎ them, and with good reason — they tend to get our attention and keep us reading. But there are, ahem, hazards to using these words — namely that they’re often vague or misleading. After all, a hazard could be anything from a joke to something really awful!

So, why take “hazard” out of your health content? Because, as health communicators, our goal is to share clear information without causing panic or confusion.

Here’s what we see as the perils of these fearsome words.

• They’re vague. Readers may miss out on key information and either underestimate a serious risk or get worried about something that’s not a big deal.
• They’re misleading. Leave the clickbait to Buzzfeed. Using attention-grabbing words like “hazardous” may get people to read your content, but it’s not great at building trust.
• They’re usually not necessary. If you can’t be more specific, use a word that’s easier to understand — like “danger.”

Check out these examples:

• Many Americans live just a few miles away from a hazardous waste site. (Vague.)
• Alcohol can be hazardous to your health. (Still vague!)
• Hazards ahead for your healthy habits this holiday season! (Vague and misleading.)

Instead, consider:

• Many Americans live close to sites where harmful chemicals were used in the past.
• Drinking too much alcohol can cause serious health problems, like liver damage.
• Many people have trouble sticking to physical activity and healthy eating routines during the holidays.

The bottom line: In plain language writing, there’s usually a better way to go than “hazard” or “hazardous.”

Here at We ❤︎ Health Literacy Headquarters, we’re big fans of a team approach to creating great health communication products. Each member of the team — writers, designers, researchers, user experience wizards — brings their own skills, perspective, expertise, and approach. And as countless children’s television shows and popular board games teach us, teams need to work together and communicate well to be successful.

One great tool to help teams communicate is sketching. That’s right, drawing with a pen and paper the old-fashioned way. This can be super helpful when it’s time for writers to hand off content to designers.

The next time you’re ready to pass content to a designer, take a few minutes to visually capture anything that goes beyond the words. Working on a webpage? Sketch out where you think the images or call-out boxes should go. Writing content for an app? Draw how you envision the text fitting into the different screens.

Sketching can do a lot more than you may think. Here’s why we ❤︎ it.

Anyone can do it. You don’t need to be a design genius or know how to use a fancy wireframing program — just grab a pen and paper, and you’re off to the races!

It’s fast and cheap. Fancy wireframing programs have their place — but often, they’re more than you need. With sketching, you can explore lots of potential ways to structure your content without sinking a ton of time into each one.

It helps you see how your content will look. Ever spent hours crafting a brilliantly detailed intro paragraph before learning that there’s only space for 20 words? Sketching while writing helps you develop content within its visual context.

Designers ❤︎︎ it. Obviously, designers are visual people. Instead of a document with paragraphs upon paragraphs of explanations, try giving them a sketch!

“A stitch in time…” Sketching can help you and others on your team get on the same page quickly and avoid misunderstandings — saving everyone time, money, and frustration.

The bottom line: Sketching is a great way to communicate visual ideas — and anyone can do it. What’s not to ❤︎?

As much as we ❤︎ the English language, dear readers, we also feel haunted by the vague, archaic, jargon-y, and generally unhelpful words that often sneak into health communication. (You may recall our rants about exceeding preventable substances. Well, not quite — but you get us.)

The ghost we want to exorcise today? “Healthful.” Shudder.

Some people think “healthful” is just a dressed-up version of “healthy” — but that’s not totally true. Technically, “healthful” means “promoting good health” and “healthy” means “in good health.” So, according to conventional grammar rules, you’d describe a diet or lifestyle as healthful — not healthy.

That’s all well and good, but here’s our technical analysis of the word “healthful”: it sounds weird. As you probably know by now, best practices for health literacy tell us to write the way we speak, which makes your content easier to understand and less distracting. And most people just don’t talk about things being healthful.

We recommend sticking with “healthy,” even when it’s not the grammatically correct choice (don’t worry, we won’t tell your 7th grade English teacher). For example, we give you permission to say: “A healthy diet can help lower your risk for chronic health problems like heart disease.”

The bottom line: “Healthful” isn’t helpful — as a general rule, opt for “healthy” instead.

This week, we’re weighing in on one of the great debates of our grammatical lifetimes: do you use a single space or a double space after the period (or other punctuation) at the end of a sentence?

Fortunately, the answer is simple. Single space, dear readers. One. Space. Only. There’s absolutely zero need for double spaces anymore.

Did that come through clearly enough? Great. Now here’s why.

Using double spaces after a sentence was originally used to improve readability, particularly when typing on a typewriter. Typewriters use a monospaced font — meaning each character has the same width. So the extra spaces were useful — they helped clearly separate sentences from each other.

Nowadays, our computers use proportional fonts (fonts in which characters have different widths) — and that makes it easier to see where one sentence ends and the next one begins.

So. Why. Write. Like. This?

When. You. Can. Write. Like. This!

If that’s not convincing enough, the industry standard is to use a single space after a sentence. Happy single spacing!

The bottom line: Double spaces after a period = too much space between sentences.

The AMC TV series The Walking Dead (in which people try to survive a zombie apocalypse) can certainly be a lesson in zombie preparedness. But did you know it can also teach us about writing for health literacy? Here are 10 lessons in plain language survival.

1. Stick together. In a post-apocalyptic world, going it alone rarely works out. The same goes for developing original health content. Before you start, find out what else is out there, what works, and what doesn’t. This information can make a big difference, so fight the urge to go rogue.
2. Get organized. Any group navigating a zombie hellscape knows that organization — Who’s leading? Who’s prepping meals? — is key. And in health communication, well-structured content is a necessity. Put the most important information first, and use bulleted lists, headers, and short sections to present information clearly.
3. Know the difference between a walker and a biter. In other words, know your audience. What do they call walking corpses with an insatiable taste for human flesh? Lamebrains? Lurkers? Rotters? Be sure to use terms consistently and define them as needed — for example: “Learn to fight zombies (lamebrains).”
4. Clear the area. Zombie survivalists know better than to get comfortable somewhere without first finding and killing any lurking zombies. What does this mean for you, dear readers? Cut out the fluff! Find and remove unnecessary details, jargon, and technical terms from your health materials.
5. Bury your dead. Kill off clichés, that is. If you’re tempted to use a phrase like “think outside the box,” think again. Bury that cliché and replace it with something more straightforward. Do you mean, “be creative?” Write what you mean.
6. Be aware of your surroundings. This is pretty obvious when zombies are around — and it’s just as important for writing effective content. What is your audience looking for? What challenges might they face? Remember, context is your friend.
7. Don’t make noise. Zombies aren’t too smart, but they do know that where there’s noise, there’s food. You can pass the plain language test by being quiet. Use simple, transparent terms and only say what you need to. Complex language could bring an undead horde to your door — or, worse, confuse your readers!
8. Be active. We’ve said it before, and we’ll say it again: active is better than passive. Any character who has made it through 7 seasons of The Walking Dead has done so by facing dangers head on. And in clear writing, the active voice is essential.
9. Keep a lookout. Even when you find a safe place to wait out the apocalypse, don’t relax without putting someone on guard duty! No matter how carefully you craft your content, an editor is essential. Don’t skip the second set of eyes.
10. Be human. After all, what’s the point of surviving in a world of zombies if you’ve lost all connection with people? Whenever possible, write how you speak.

The bottom line: Look no further than The Walking Dead for some excellent lessons for health communicators.