Category: We Heart Health Literacy

It’s hard to make health messages easy to understand. (Can we get an amen, dear readers?) But can you guess what’s even more difficult? Getting people to remember and act on our messages. In this edition of the We ❤ Health Literacy Book Club, we introduce a book with a method that can transform the way you communicate ideas: Chip Heath and Dan Heath’s Made to Stick.

You can find sticky ideas in all sorts of places — from stellar advertising campaigns to urban legends to great speeches. And, according to the Heath brothers, the reason these ideas stick with you is no great mystery.

There are 6 distinct traits (or principles, as the Heath brothers call them) of sticky ideas — and it’s pretty easy to put them to work. For example, resist the urge to say all-the-things. Instead, prioritize and find the core idea. (Sound familiar?) That’s the Simple principle.

Here’s another one: Humans are hard-wired to expect patterns. So when you break a pattern, you get people’s attention. This means that in order to keep your audience’s interest, you have to make them want to know more by creating “curiosity gaps.” That’s the Unexpected principle.

Made to Stick is a breeze to read, but — true to its name — it sticks with you. The Heath brothers share stories that illustrate what sticky successes (and non-sticky failures) look like. They walk you through before and after examples to demonstrate how to repackage messages. And they describe the nuances of each principle, explaining which kind of appeals work best in different situations.

The bottom line: Change behaviors by getting your health messages to stick with the 6 principles in Made to Stick.

You probably know that we ❤ health literacy. (Did our name give it away?) And since you’re reading this, you probably do too. But every once in a while, it’s important to ask ourselves: Why does health literacy matter?

It’s easy for those of us in the field to forget how many people out there don’t understand how crucial health literacy is. Part of our job, then, is to spread the gospel. We must always be prepared, dear readers, to respond to an earnest question from a colleague or a challenge from a misguided “dumbing down” dissenter.

We think these facts make a pretty good quick pitch:

• Only 1 in 10 U.S. adults have the skills needed to use health information that is routinely available in health care facilities, retail outlets, and the media.
• People with poor health are 5 times more likely to have below basic health literacy skills than people in good health. (This reality is compounded by the fact that health literacy skills decrease when you’re stressed or sick.)
• People with limited health literacy skills often get worse care and have more medication errors, longer hospital stays, and higher death rates.

It’s no abstraction. Health literacy — or the lack of it — has a direct impact on people’s well-being and health. The good news is that by making health information easier for everyone to understand, we can improve health outcomes for millions of Americans. And, we might add, this is waaaaaay more cost-effective than complex medical interventions.

How about you? What makes you passionate about health literacy and drives you to spread the word? Tell us in the comments below.

The bottom line: Sometimes it’s important to take a step back and remember why we all ❤ health literacy — and why we need to keep spreading the word.

We interrupt our regularly scheduled FAQ series to celebrate 2 years of We ❤ Health Literacy! (The “terrible 2s” only apply to people and not weekly health literacy musings, right?)

To celebrate, we’re sharing this year’s top 5 posts for your re-reading amusement. Enjoy!

• How Not to Use Illustrations and Infographics
• It’s time to cut the clip art!
• Our Favorite Health Homepages
• Ebola and Health Literacy
• Other Things We ❤: Grammar Girl

And of course it wouldn’t be a We ❤ Health Literacy birthday without a big thanks to all of you for being the best and brightest readers. We’re so grateful for your support, and we look forward to getting more of your great topic ideas in year 3!

Oh, and if you want to get us a present, we ❤ it when you encourage your fellow health literacy geeks to sign up.

The bottom line: It’s our birthday (again) and we couldn’t have done it without you!

In this edition of We ❤ Health Literacy FAQs, we’re taking a look at style guides. We tend to get 3 main questions about them — hopefully the responses below will help!

What style guide does CommunicateHealth use?
We have an in-house style guide that’s focused on plain language, specific health terms, and our unique voice and tone. For all other debates we default to an imprecise mix of guidance from the Chicago Manual of Style and our preference for writing how we speak (granted, a bit more abstract). Lots of our clients have their own style guides, too.

How do I get others on board with breaking old grammar rules?
Language is always evolving. This is especially true now, given the advent of writing for the web and the growing popularity of plain language. It’s time to accept that some grammar rules are meant to be broken. Advocate for writing conversationally. The rest will follow.

And if you must, you can develop a separate plain language style guide for consumer writing. Keep the stodgy old one for professional audiences.

How do I create a plain language style guide?
This task can be daunting, dear reader — but keep in mind that Rome wasn’t built in a day. A quality style guide is created over time. Keep a running list of issues that come up. When you get into a debate over whether it’s 9th grade, ninth grade, or grade 9, make a note of your decision. When you come up with a great plain language definition for chronic obstructive pulmonary disease, write that down, too! Before you know it, you’ll have the outline of a style guide.

The bottom line: Style guides are important for keeping your content consistent, but they’re meant to be flexible.

Over the years, we’ve had a lot of conversations about punctuation (or over-punctuation) in plain language writing. And some of you, our dear readers, have asked: If punctuation can be a sticking point for readers with limited literacy skills, does that mean I can’t use contractions in my plain language writing?

First, we totally agree about punctuation overkill. Health writers, beware: Gratuitous punctuation marks can make life harder for people with limited literacy skills. Plus, if your content needs that much punctuation, it’s a red flag that your sentences are too long or complicated (just think of what can happen when semicolons get involved!).

Ultimately though, we put contractions into a different category — specifically, the “write how you talk” one. You’ve probably already noticed how much we value striking the right tone in health writing, and we’d argue that writing conversationally is a really important part of that.

So our rule of thumb is to use a contraction if you’d say the contraction out loud. Don’t stress about the apostrophe!

But it’s not quite that simple. (What fun is a rule that you can’t ever break, right?!) There are exceptions. For us, the big one is when you need to be really clear about the difference between something that “is” and something that “is not.” Here’s an example:

• Okay: Drinking alcohol while taking this medicine isn’t safe.
• Better: Drinking alcohol while taking this medicine is not safe.

Someone quickly skimming the first message might walk away thinking it’s safe to drink while taking that new med, while the second message is crystal clear.

The bottom line: We ❤️ contractions because they make content conversational.

Tweet about it: To contract or not to contract in #PlainLanguage writing? @CommunicateHlth says keep contractions in health education materials when you’d say them out loud. Read more: https://bit.ly/3G95DnD #HealthLit

We asked you, dear readers, to share your burning health literacy questions. Over the next few weeks, we’ll do our best to answer them.

Up first: The word “procedure.” Is there anything simpler? Of course there is!

We offer you 2 solutions — depending on how specific your content is. The gist: You can say what you mean in a friendly, accessible way without relying on a jargon word like “procedure.”

If you’re using “procedure” in a general sense, ask yourself if you can replace it with “appointment” or “surgery.” A lot of the time the answer will be yes. These words are good substitutes and will help your content sound friendly and accessible.

For example:

• Follow these steps to get ready for your procedure appointment.
• Your doctor’s office will schedule a date for your procedure surgery.

On the other hand, if you’re telling people about a single type of procedure, just use the name of the procedure — after explaining it, of course.

• Follow these steps to get ready for your procedure colonoscopy.
• Your doctor’s office will schedule a date for your procedure biopsy.

Either way, there’s really no need for “procedure.”

The bottom line: It’s fine to use a specific term (like “colonoscopy”) or a general one (like “surgery”). In most cases, both are better than using a vague jargon term like “procedure.”

Transgender issues have been in the media spotlight lately. (If you’ve been able to avoid news of Caitlyn Jenner’s coming out, we’re impressed!) Like many others, we’re hoping this media attention translates into meaningful awareness of the discrimination and harassment that transgender people often face when seeking access to jobs, schools, housing, and — most relevant to our work — health care.

As health communicators, we have an opportunity to positively influence transgender people’s experience when they seek health information or care. That’s why we’re sharing insights from user experience (UX) designer Kylie Jack’s excellent visual how-to guide for what she calls “gender UX.” It got us thinking that there’s a lot health writers can do — just by changing how we ask about gender.

Whether you’re designing a health app or revising a patient intake form, ask yourself: Why do I need to know this person’s gender? A lot of the time, you actually don’t. That’s great! You can skip that question, and your form will have more white space. Bonus.

If you do need to ask about gender, tailor the question to the reason you’re asking it. If your app just needs to know which pronouns to use, ask directly about pronouns — and remember to include a gender-neutral option like “they.” Or, if your office staff need a title to use on the phone, ask whether the person uses Mrs., Ms., Mr., or a gender-neutral option like Mx. (now sanctioned by the Oxford English Dictionary!).

If you need to know someone’s sex assigned at birth for medical reasons, make it super clear that’s why you’re asking and say you’ll keep it confidential (if you can). For example:

Sex assigned at birth:

• Male
• Female
• Other ______________

This information will help us figure out which screening tests are right for you. We’ll keep it private.

And whenever possible, include an open-text field in your answer options. This guarantees that everyone will be able to answer the question accurately and comfortably. For example:

Gender:

• Male
• Female
• None or Agender
• Other ______________

When you ask the right question and provide answer options that work for everyone, you’ll get more accurate information. Most importantly, you’ll make things easier for people who are faced too often with a health care system that isn’t prepared to recognize that they exist — let alone to meet their needs.

The bottom line: Gender is complex — and it can be a sensitive subject. Only ask for the information you really need, and include open-text fields whenever you can.

As health communicators, behavior change is our bread and butter. Often, our approach is to tell people to adopt healthy behaviors and ditch unhealthy ones.

This instinct makes sense. If your goal is to help Fred manage his diabetes, you might start by communicating directly with Fred. Maybe you’ll give him an easy-to-follow schedule for taking his insulin and share some healthy eating tips (written in plain language, of course).

So, is that it? Not according to the Social Ecological Model.

This model says that successful health promotion addresses both individuals and their environments. That’s because we don’t live our lives — or make our health decisions — in a vacuum. Whether we like it or not, our families, communities, culture, and other external factors all affect how we act. So, changing people’s environments can often change their behavior.

Take our pal Fred, for example. Fred might be more likely to take his insulin at the right time if his friends and family know the schedule and help remind him. And he might be more likely to eat healthy if fresh foods are easy to get at the corner store.

You might be thinking: That’s great, but how do I, a humble health communicator, change my readers’ environments? You may not be able to single-handedly rearrange your readers’ life circumstances. But you can help promote positive influences. For example, you could:

• Create a diabetes management campaign that targets patients’ social networks
• Work with local community groups to encourage shopkeepers to sell fresh fruits and vegetables at a fair price

As a health communicator, it’s important to understand the role a person’s environment plays in shaping health behavior. Some influences, like mass media or the national economy, are harder to change. But others, like social support and community resources, are within reach.

So give Fred a hand, and look for opportunities to support healthy choices by influencing environmental factors.

The bottom line: If you change people’s environments, you’ll be more likely to change their behaviors — so try taking a social ecological approach to health promotion.

Tweet about it: The Social Ecological Model is a trusty behavior change theory that explains how our environments influence our health decisions. Learn more from @CommunicateHlth: https://bit.ly/2UVphhX #HealthLit

You know what’s great? Data.

Data can tell us how people think, feel, and act. They can confirm or refute what we believe is true. They can give us a sense of where we are compared to where we’ve been.

It’ll come as no surprise that we find data on literacy especially valuable. And that’s why we ❤ the National Assessment of Adult Literacy (NAAL).

The NAAL is a national survey of American adults ages 16 and up that assesses functional English literacy — like how adults use printed and written information to do things at home, at work, and in their communities.

In 2003, the U.S. Department of Education (which is responsible for the NAAL), updated the survey to include a section on health literacy. Needless to say, we really ❤ that.

To assess health literacy, 19,000 adults completed survey tasks related to:

• Clinical environments, like filling out a patient form during a doctor visit or understanding medicine dose instructions
• Prevention information, like identifying signs of illness and following screening guidelines
• Health care system navigation, like understanding what a health insurance plan will pay for or giving informed consent

Based on the NAAL, we know that only 12% of adults have proficient health literacy skills. In other words, nearly 9 in 10 adults have limited health literacy skills. And if you check out the HHS National Action Plan to Improve Health Literacy, you’ll see that people need proficient skills in order to prevent disease, navigate the health care system, and respond to public health alerts.

A decade later, the 2012 Program for the International Assessment of Adult Competencies (PIAAC) confirmed the 12% statistic. It also found that an even lower percentage of U.S. adults — just 9% — showed proficient numeracy skills.

The bottom line: Although it’s not the newest data, the 2003 National Assessment of Adult Literacy is still the strongest national dataset we have on health literacy.