Category: We Heart Health Literacy

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: Yes, that’s right.

Doug: I gotta say, usually we’re not so keen on readability tools and formulas here at We ❤ Health Literacy headquarters — they don’t tend to work so hot.

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!

The bottom line: Check out the CDC Clear Communication Index and make sure your health content measures up.

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!

• Team Plain Language!
• You, dear reader…
• Plain language is not “dumbing down.”
• Readability and plain language and health literacy — oh my!

Share these posts to give your colleagues and friends a quick Health Literacy 101 — and to start a conversation about why health literacy matters.

The bottom line: October is Health Literacy Month! Celebrate by spreading the word on why health literacy is important.

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.

Today we’re going to tell you about something we really ❤: Plugins (also known as plug-ins, add-ons, or extensions). To be clear, we’re not talking about air fresheners, but rather tiny tools that enhance your web browser. Plugins can help you create better websites for your users — and you know we really, really ❤ that.

So if you haven’t yet explored the wonderful world of plugins (or even if you have), we’re here with some basics. We’ve listed some all-too-familiar scenarios below and linked them to a plugin that can solve that problem. Handy, eh?

Design inspiration

• I love the font that website uses — what is it?
• I want the color in so-and-so’s logo on my site. What color is it exactly?

Accessibility help

• I wonder if the color contrast is strong enough for people with vision impairments.
• Will my website work well for someone who’s using a screen reader?
• My site looks great on a desktop, but how does it look on a laptop or phone?
• Did I miss any other common accessibility improvements?

Common frustrations

• Oh shoot, I closed that tab by accident. How do I get it back?
• I wish I could scribble notes right on this website to share with my team.
• Are any of the links on my page broken?

Isn’t this fun? And these are just a few plugins for a few browsers. Spend some time checking out the plugin store of your favorite browser (like Chrome, Firefox, or Safari) and start making your life easier today.

P.S. If you want to know more about accessibility, check out our post about making health information accessible.

The bottom line: Use browser plugins to create better, more usable websites.

With the 24-hour news cycle, digital media’s omnipresence, and newspapers and magazines galore, we face a constant stream of information. If you’re anything like us, dear readers, sometimes all this stimulation just makes you want to take a nap.

In this vast media universe, it can be tough to pick out the important bits — particularly when it comes to messages about our health. But at the end of the day, what we all really want to know is: What’s in it for me (WIIFM)?

Anticipating and answering this question in your health content can help your messages stand out from the pack. People might pay closer attention if they immediately see opportunities to:

• Save money or time
• Lose weight
• Improve their health or the health of their loved ones
• Feel better or be happier

Think about this message:

“You can make small healthy decisions each day — like choosing to take the stairs instead of the elevator.”

That message provides a helpful tip, but doesn’t explain the benefit of acting on it. Now, consider this alternative:

“You can make small decisions each day that will help you lose weight. For example, take the stairs instead of the elevator. If you walk 100 stairs every day, you’ll burn 100 extra calories in a week.”

This message helps explain WIIFM — and it might just cut through all that noise.

The bottom line: Grab people’s attention and get them to act by answering the question “What’s in it for me?”

All relationships have their tough moments. (Well, except for ours, dear readers — of course.) Your mom nags you about that overdue haircut, your roommate leaves his dishes in the sink for 3 days, your friend never pays you back that $20.

But even though our friends and family can drive us a little crazy, they can also have a positive impact on our physical and mental health. That’s because the people in our lives can offer a major benefit: Social support.

There are a few different kinds of social support:

• Emotional — like when someone shows empathy, concern, or affection
• Instrumental — like when someone gives you a ride or cooks you a meal
• Informational — like when someone offers advice or guidance
• Companionship — like when someone spends time with you or shares your interests

So, how exactly does social support relate to health? You get a kiss on the cheek and your headache goes away? Well, not quite. Thankfully, there are models that help explain how social support works.

• The stress-buffering model says that social support can help people cope with a stressful situation by protecting (or buffering) them from the bad health effects linked to stress. According to this model, social support is most helpful during stressful times.
• The direct effects model says that social support has a positive effect on health overall. For example, the social support people get through ordinary interactions enables them to keep their emotions in check, thereby improving their mental health.

As health communicators, we aren’t directly involved in conversations between our readers and their loved ones. (That would be creepy.) But we can still promote social support. For example, we can:

• Give tips on how to help a family member or friend through an illness
• Remind patients to reach out to friends and family members for support
• Let patients know how to access relevant support networks
• Draft talking points to help health care providers talk about sensitive topics

The bottom line: Social support can have a positive impact on health, so be sure to promote it in your health content.