Category: We Heart Health Literacy

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.

Now that beach season is finally upon us, it’s time for another installment of the We ❤ Health Literacy Book Club. For this one we’re branching out a bit — the book isn’t so much about health literacy as it is about public health in general, but we ❤ it and we bet you will, too.

Randy Shilts’ award-winning And the Band Played On achieves something that not many public health books do — it’s a total page-turner! Originally published in 1987, it tells the story of the first 5 years of the AIDS epidemic in the United States. And it really is a story — the book is an almost-daily account of the key players living through the early days of the epidemic.

Stilts’ work is deeply rooted in his criticism of the initial reaction to the AIDS crisis — he condemns the medical world, the scientific community, and most particularly the Reagan administration for a flawed response that cost an unspeakable number of lives.

It’s a moving story that also serves as a reminder to do our homework. The issues we communicate to consumer audiences may have complex, emotional, and nuanced stories behind them — and we’ll be better at our jobs if we’re familiar with their implications.

The bottom line: Get the whole story of the early days of AIDS from Randy Shilts’ And the Band Played On.

With summer around the corner, it’ll soon be time for things like picnics, long strolls in the park, and… helping people prevent dehydration. So here’s another installment of “Complicated health terms: When to skip them, when to teach them.”

As health educators, we often have to decide if a complex medical term is essential to our message or not. “Dehydration” is one of those words.

Say you’re writing a blog post about how to stay safe and healthy this summer. Since dehydration isn’t the only topic you’ll touch on, you don’t need to complicate things with that particular term. It’s probably enough to say: “Be sure to drink plenty of water because your body loses water when you sweat.”

On the other hand, if you’re writing something more in-depth that’s targeted to a particular audience — amateur athletes or older adults, perhaps — it makes sense to use “dehydration” and explain it. You might say something like:

Be sure to drink plenty of water when you’re out in hot weather. If you don’t drink enough, your body will lose too much water when you sweat — which can cause problems like headaches, dizziness, feeling tired, and muscle cramps. This is called dehydration, and it can be a very serious health problem.

The bottom line: Whether you need to use “dehydration” depends on your audience and the purpose of your material. Keep things simple and only use it when you need to.

Dear readers,

We’re taking a break from our usual tip to give a very big thank you to each and every one of you. This little idea we had nearly 2 years ago now has well over 1,000 subscribers — not to mention our fans on Twitter and our blog.

We love interacting with our readers, so don’t be shy — send us an email, leave a comment on our blog, or tweet to let us know what YOU want to hear about. Are there certain jargon terms you wrestle with and just haven’t found a great alternative for? What battles are you fighting with subject matter experts who still aren’t buying this plain language thing? What health literacy resources make your heart go pitter-patter?

And please spread the word. Let your colleagues know they can sign up today.

Thanks again — we really can’t do it without you. (Well, we could, but it’d be pretty silly.)

Cheers,
The We ❤ Health Literacy Team at CommunicateHealth