It’s a very exciting week in health literacy land, dear readers! One of our all-time favorite resources has been updated to include the very latest in best practices of user-centered design, usability, and health literacy.
That’s right, the second edition of Health Literacy Online is here! This research-based guide has practical tips for creating easy-to-use health websites and digital health information tools.
Wondering how to improve user engagement? Not exactly sure what makes a helpful search function, um, helpful? No problem — Health Literacy Online has your back.
The guidance in the latest edition reflects the fact that many more people are now accessing the internet on mobile devices (you’re totally reading this on your smartphone, aren’t you?). In today’s mobile-heavy digital world, this is important stuff.
There’s also a really cool section about conducting user testing with participants with limited literacy or health literacy skills, plus valuable information about the cognitive processing and online behaviors of people with limited literacy skills.
A disclaimer here: We were involved in the development of this guide, so we’re a teensy bit biased. Regardless, we’re pretty confident that you’ll ❤ the second edition of Health Literacy Online, too.
The bottom line: Check out the latest edition of Health Literacy Online — you won’t be disappointed.
Write in the active voice, not the passive! You’ve probably heard this advice from some wise communicator types before — you know, like us. But how can you tell whether a sentence is active or passive?
“If only there were a simple test,” you think to yourself. “Ideally, one with a seasonally appropriate spooky theme.”
Well, dear readers, have we got the passive voice test for you! Just in time for Halloween, we present the Zombie Test, devised by Rebecca Johnson, PhD, from the Marine Corps University.
How does it work? Just insert “by zombies” right after the verb in your sentence. If the sentence makes sense with this undead addition, it’s passive — and you probably want to revise it. If it doesn’t make sense when you add “by zombies,” you’ve got an active sentence on your hands.
Behold the test in action.
The epidemiologists reassured by zombies the fidgeting trick-or-treaters.
That sentence doesn’t make sense with the added zombies, so it’s active. It’s already got a clear subject (the epidemiologist) who’s doing the action (reassuring), so you’re all set. But what about this?
The form needs to be processed by zombies before the prescription can be dispensed by zombies.
Who’s doing the processing and dispensing? There’s no subject! It’s passive! Run for your life!
But there are tools that can get you a lot closer to creating health education products that will work for your target audience. Earlier this month, we discussed the CDC Clear Communication Index. Today, we discuss another favorite: The Suitability Assessment of Materials, or the SAM. (Go to chapter 4, page 41 to get started with the SAM.)
The thing we ❤ about the SAM is that it includes factors that affect readability and factors that affect comprehension. The tool groups these factors into 6 areas:
Content
Literacy demand
Graphics
Layout and type
Learning stimulation and motivation
Cultural appropriateness
Swoon.
Distinct as these factors may be, they all play a role in how useful a material is, so it’s helpful to have them represented together in a single tool. Consider each of the 6 areas as the ingredients you need to combine to create a clear, useful product.
Using the SAM is pretty straightforward. Each of the 22 factors gets a score of 0, 1, or 2. At the end, you get a score that deems your material superior, adequate, or not suitable.
No surprise here, but we recommend revising your materials until they’re superior!
The bottom line: Use the SAM to help you develop better health communication products.
Infographics are all the rage lately — and it’s easy to see why. Their visual appeal makes them 30 times more likely to be read compared to text articles. Plus, information that’s presented visually is easier to understand and remember. What’s not to ❤?
Keep it accurate. Start with reliable raw numbers and choose a type of visualization that makes sense for your data (none of these, please!).
Choose ahero statistic. Make the most impressive fact you’ve got the focal point of your infographic.
Tell a story. Use your hero statistic and other supporting data to construct a narrative that drives home your main message (you do have a main message, right?).
Design thoughtfully. Use elements like contrast, visual weight, placement, and shape to make your hero statistic “pop.”
Keep it simple! Keep text to a minimum, include plenty of white space, and stick to a limited color palette so you don’t overwhelm your reader.
Design with sharing in mind. Horizontal infographics — or those that can be broken into horizontal sections — are easier to share on social media.
The bottom line: Good infographics aren’t just pretty pictures — they use visual data to tell a story. Use a hero statistic and simple, intentional design to make yours a winner.
In honor of Health Literacy Month, We ❤ Health Literacy is kicking off a new series of interviews with the movers and shakers on the health literacy scene — “Health Lit Live.”
In our very first installment, our imaginary host Doug Doodleman raps with Dr. Cynthia Baur about the CDC Clear Communication Index, which she helped develop. Dr. Baur is a health literacy and plain language specialist and Senior Advisor in the Office of the Associate Director for Communication at the Centers for Disease Control and Prevention (CDC).
Doug: Thanks so much for joining us today here on the World Wide Web, Dr. Baur.
Dr. Baur: Thanks. It’s a pleasure to be here, so to speak.
Doug: So, CDC, eh? That makes me think: Hazmat suits! Outbreaks! Disease detectives! Do CDC communicators go out into the field to do cool stuff, too?
Dr. Baur: Depending on the situation,
communicators may go into the field as part of investigations and work alongside the epidemiologists, or disease detectives. For example, many communicators have deployed and are still going to West Africa for the Ebola response.
Doug: Wow! Communicators to the rescue! Okay, so tell me about this new-fangled CDC Index — it’s a tool to help people assess the clarity of their materials, right?
Dr. Baur: You’re right. A lot of readability formulas are pretty weak — just counting syllables or sentence length, which won’t tell you much. Communication checklists are often long and hard to use, with scores that can vary widely depending on who’s doing the scoring.
Doug: So what makes the Index better?
Dr. Baur: We took a different approach. Because
we’re a science-based agency, we created a science-based tool — one that takes some of the subjectivity out of scoring. We developed 4 questions and 20 items to score. We don’t ask people who are scoring to assess the quality of a document — instead, they’re looking for specific items, like “Is the main message at the top, beginning, or front of the material?” and “Does the material use numbered or bulleted lists?”
It’s more objective than other tools and it includes some aspects of communication that other tools don’t consider, such as how numbers are presented.
Doug: Okay, but let me be blunt: I’m an extremely busy doodle, what with being an in-demand illustrated individual and whatnot — and my dear readers are busy too. Even if the science supports it, who’s got time for another tool?
Dr. Baur: We get it. So we designed the Index with ease of use in mind. Once you become comfortable with it, you should be able to score a material in about 15 minutes.
Doug: Gosh! And what would I need to access this Index? A mainframe computer running UNIX? CDC clearance with a retinal scan and biometric —
Dr. Baur: Nope. Anyone can go to the website and begin using the scoring widget right away. That’s it.
Doug: Well that sounds easy! So Dr. Baur, my last question is this: Could you set me up with one of those cool windbreakers with the CDC logo on the back? So I could yell “Stay calm! There’s been a dangerous outbreak of jargon! Evacuate the — ”
Dr. Baur: No.
Doug: A hat?
Dr. Baur: No.
Doug: Okay! Thanks, Dr. Baur! And dear readers, be sure to stay tuned to your internet-based reading machine for the next installment of Health Lit Live!
It’s October, dear readers: Time to enjoy the fall colors, go apple picking, add pumpkin spice to everything you eat — and celebrate Health Literacy Month!
Of course, every month is Health Literacy Month here at We ❤ Health Literacy Headquarters. But we’ll jump at any excuse to spread the word, so this week we’re sharing a roundup of WHHL health literacy basics. Enjoy!
When it comes to health content, tone matters. We always aim for a friendly, conversational tone that feels helpful and accessible to our readers. A big part of clinching that tone is making sure we’re framing messages positively — after all, the goal is to inspire people to change their health behaviors for good (yay!).
Some content lends itself to positivity. It’s easy to write peppy, positive health content when you’re, say, encouraging someone to eat healthy or get active. But how do you stay positive when you’re writing about a challenging topic like how to manage an unpleasant chronic disease?
Well, first of all, cut the word “should” out of your vocabulary. Next, challenge yourself to write (and rewrite, if necessary) instructions or advice to sound positive — even when you’re describing a potentially negative experience.
Often, it’s a matter of saying something in the opposite way. (Hint: avoid words like “not,” “don’t,” and “won’t.”)
Example:
Instead of: “You may not have time to ask all your questions in the first visit with your new doctor.”
Say: “You may need a follow-up appointment to get answers to all your questions.”
Sometimes, it takes a little more work to keep something positive — especially if you’re talking about situations that can be dangerous. Adding some extra-friendly content can help soften tough messages.
Instead of: “You won’t be able to drive if your seizures aren’t controlled. You’ll need to take public transportation or ask for a ride.”
Say: “If your seizures aren’t controlled, it’s not safe for you to drive. But there are lots of ways to get around without driving. Start by finding out about public transportation options in your area, including carpooling and rideshares.”
The bottom line: There may not be a silver lining, but you can make a negative message sound more positive.
As you know, dear reader, we spend a lot of time thinking about plain language and clear writing. But we also know that putting health literacy into practice isn’t all about sitting at a keyboard tapping out user-friendly fact sheets (though we do ❤ a good fact sheet).
For many of you, integrating health literacy into your work means having meaningful conversations about health with real, live patients.
Here are a few of our favorite health literacy strategies for health care providers:
The teach-back method. After you share information with patients, check understanding by asking them to say — in their own words — what they need to know or do.
The show-me method. Use this cousin of the teach-back method to check that patients can follow specific instructions. For example, ask patients to show you how they would use an inhaler or do a back-strengthening exercise.
Brown bag medicine review. Before their next appointment, ask your patients to bring their medicines and supplements in so you can review them together. During the visit, ask how they’re taking them and discuss any mistakes or misunderstandings.
As with any kind of spoken communication, don’t forget the basics — like making eye contact, being friendly, and nodding along while listening.
For more ideas, check out this handy health literacy toolkit for health care providers from the Agency for Healthcare Research and Quality (AHRQ). We ❤ that AHRQ framed the toolkit around health literacy universal precautions — because everyone, not only people with limited health literacy skills, benefits from clear communication.
The bottom line: Health literacy is relevant to how we talk, not just how we write. Use the teach-back, show-me, and brown bag review methods to check for understanding.
As you know, dear reader, we’re a little obsessed with making online health information understandable and easy to find. That’s why we’ve already shared 2 of our favorite testing methods for web and mobile: Card sorting and tree testing.
Even though technology gets us excited, there’s another medium we just can’t quit: Good, old-fashioned paper. Think of how helpful it is to get a print-out on healthy eating from your doctor that you can just stick on the fridge. Or a stack of educational pamphlets to share with family members about the surgery you need to get.
Since we don’t live in a paperless world quite yet, we need to make sure our print materials are as clear and usable as possible. That’s where testing comes in. By testing a print material, you can identify major obstacles to understanding — and fix those issues before you spend money and time on printing and distribution.
Testing print materials can be quick and budget-friendly, too. Even just asking 2 or 3 people in your target audience can have a big payoff.
Meet with each participant in person, let the participant read over the material, and then ask the following questions:
What are your overall impressions of this material?
What do you like/dislike? Why?
In your own words, what do you think this material is trying to tell you?
What is this material asking you to do?
How confident are you that you could do what the material is asking you to do?
What, if anything, is confusing or hard to understand?
Remember, even if you think the content is clear, your readers may not. Consider asking participants to identify the main message by marking up the material. For example, you can ask them to:
Underline the most important information
Cross out the least important information
Circle anything they find confusing
A few tests will show you areas to improve. And, once you make revisions, you’ll be better equipped to give you readers more “aha!” moments — and fewer head-scratching ones.
The bottom line: Test print materials to learn which messages are unclear or ineffective. Even a few participants can help you find areas to improve.
If you want an engrossing book with colorful characters that’s also filled with medical details to feed your inner health nerd, look no further than Susan C. Ball’s Voices in the Band. Part memoir and part history, it chronicles Dr. Ball’s experiences treating patients with AIDS at the Center for Special Studies at New York-Presbyterian Hospital.
Building on the narrative in And the Band Played On, Ball tells the stories behind the horrifying statistics of the 1990s when, at one point, AIDS was the leading killer of people ages 25 to 44. “I never got used to the idea of discharging a thirty-year-old man to a nursing home,” she says.
She goes on to describe the gradual shift that happened after the development of anti-retroviral medicines. “The terrible days of no treatment, no options, and little hope became part of our lore, not part of our current reality.”
The book is a vivid account of the consequences of low health literacy. Ball describes conversations with patients who either didn’t believe the medicines could help them or who said their prescriptions were just too much to manage. And she states that many deaths from AIDS in the United States now “occur in people who aren’t taking their medication, or who aren’t taking it correctly.”
It’s also a thought-provoking meditation on the difference between care and treatment, because in the middle of the crisis, sometimes all a doctor could do for her sick patient was to sit with him and hold his hand.
The bottom line: Voices in the Band tells the personal stories of people living and dying with AIDS with clarity and compassion.
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