So, what does this mean for those of us who strive to make health information easy to find, understand, and use? Should we forget about pamphlets and focus on widgets?
Not necessarily. Some groups, like people with disabilities, still have limited access to certain technologies. And some people say they don’t use the internet because they don’t know how or find it frustrating.
Before you jump to coding, learn about your audience. If they’re glued to their smartphones, a mobile app might be a good fit. If they don’t own mobile phones or have internet at home, an ol’ fashioned print material may work best.
Remember that a brochure or fact sheet created with the user in mind will be more effective than a website developed in a vacuum.
The bottom line: Avoid developing digital resources just because they’re trendy. Choose the format that’s most appropriate for your audience.
There’s been a lot of buzz lately about medication adherence. It’s understandable, of course. Doctors who prescribe medicine want patients to take it as directed. Patients who are prescribed medicine want to feel better.
But following prescriptions, especially multiple daily prescriptions, is hard. So let’s not make it worse by using overly complex language to talk about it.
Saying “medication adherence” is okay when talking to your colleagues… if you must. But when you’re talking to or writing for patients, throw it out the window! There are many better and clearer options. For example:
It’s important to follow the directions for taking your medicine.
Follow all instructions for your medicine.
Learn about your medicine and take it correctly.
Take your medicine as prescribed.
Take your medicine as directed.
Thus, we challenge you never to write something like: Medication adherence is an important part of being actively involved in your health care.
Don’t do it! The message might not stick. Instead, try one of our friendly, plain language alternatives. Or write your own. We know you can.
The bottom line: Stick to plain language and skip “medication adherence.”
Alt text: A doodle gestures at a complicated illustration and asks, “The visual really makes it clear, doesn’t it?!”
A while back, we talked about the dangers of crummy stock photos. This week, we’re tackling a different variety of dangerous visual: bad illustrations.
It’s no wonder that health communicators love illustrations. Lots of people learn better when information is presented visually, and a good illustration can make your point more elegantly and directly than text alone.
But illustrations can also go so, so wrong. Whether the offender is a cartoon, chart, graph, or infographic, a bad illustration can really muck up your health materials.
[Disclaimer: We’ve probably all created a bad illustration at some point in our careers. People in glass houses, etcetera. But in the name of health literacy, let’s pick on a few.]
We’re pretty sure the message here is: a California Raisin invites yellow peanut M&Ms on a wild ride through your innards. And what do you, the host of this internal-organ slip n’ slide for snack foods, get in return? Hairy, swollen, purple feet — and kidneys where your lungs should be.
The takeaway here? True love means sacrificing your eyes and blasting polka dots from your lungs into your partner’s gaping face hole.
But not all bad illustrations are confusing (or disgusting). Many of them just don’t need to exist. They may look fine at first glance, but then…
When all you’ve got is 2 numbers showing a boring 10 percent difference, spice things up by adding a meaningless x-axis, unnecessary lines, and 4 different colors. Voila! It’s argyle.
Heed these warnings, dear readers. People look to illustrations to help them understand what you’re talking about. So don’t make them waste their time trying to understand nonsense.
The bottom line:Don’t toss in illustrations or infographics just because. Use them carefully — and make sure they communicate your message clearly.
Readability formulas give you a rough idea of how easy a material is to understand, but they’re imprecise and often inaccurate. Nearly everyone agrees on their limitations, yet many agencies and organizations require materials to meet a certain readability score. Why?
First, readability scores have been around a long time — the earliest Flesch formula is almost 70 years old — so people trust them. They have the feeling of tradition, objectivity, and scientific rigor. People like the idea of a systematic way to evaluate good writing.
Second, they’re just so easy to use. When you finish writing, you run the Flesch-Kincaid analysis built into Word, tweak a few sentences, and boom, you’ve done your plain language due diligence. Easy-peasy.
Third, there’s the issue of scalability. Let’s say you’re a huge hospital or health plan and you need some way to make sure all of your communication materials are clear. What are your options? Some organizations will invest in training and building the capacity of their communication staff (hooray!), but many will turn to an automated readability formula.
Readability formulas aren’t awful at evaluating finished text — as long as you remember they’re a hint that you’re on the right track and not a seal of approval. The problems start when you use a readability score as a be-all and end-all measure. They easily tempt good writers into writing like bad writers in order to beat the formula at its own game.
For instance, let’s say you wrote this:
If you have any of the following symptoms, you might have a life-threatening infection. It’s very important for you to go to the hospital right away.
Seems pretty clear, but it scores a 9.2 grade reading level. Not good. So you try again.
If you feel sick, go to the hospital.
A score of 2.2! You totally nailed it.
And there’s the problem: You use shortcuts to get the score you want. You cut out a perfectly clear word (like “important”) because it has more than 2 syllables. You skip key concepts because they require words that will bump your score higher (like “life-threatening”). If you do these things, you will get a lower score — but it will also be much harder for your reader to get the full context of your message.
You’re a good writer — don’t let an algorithm boss you around.
The bottom line: Don’t go for the quick fix of a low readability score. As you write and edit, let the subject and your audience guide you — and trust your communication experience.
The Nielsen Norman Group (NN/g) is a leader in the field of user experience. And we really, really ❤ improving a user’s experience.
They offer many of their reports for free. If you’re looking for tips on recruiting for usability studies, making an iPad app, or improving the accessibility of your website, check them out!
Alt: One doodle with dog leg says to another doodle, “My physician diagnosed jargon mouth — and a canine protuberance on my lower appendage.” The other doodle says, “Sounds rough! But what’d she say about that dog on your leg?”
Google “diagnosis and prognosis” and you’ll find a whole bunch of webpages devoted to explaining the difference between these 2 words. And the difference is clear — diagnosis is what you have, and prognosis is how it will probably play out.
So why all the confusion, dear readers? Most of us only hear these words in a medical context. And that context may be scary! When someone’s getting a stressful health update, it’s no time to make them parse medical speak.
That’s why we say avoid the diagnosis-prognosis confusion altogether and skip ’em both.
For diagnosis, just tell people what they have.
Instead of: He was diagnosed with jargon mouth disorder.
Try: He found out he has type 2 jargon mouth.
Instead of: Your diagnosis is dog leg.
Try: You definitely have dog leg. Anyone can see there’s a dog stuck to your leg.
For prognosis, just tell people what to expect.
Instead of: Here’s your prognosis for your chronic jargon mouth.
Try: Here’s what may happen next with your jargon mouth if you don’t change your arcane ways.
Instead of: The prognosis for people with dog leg is very good.
Try:Your life with dog leg won’t be so bad — you’ll always have a friend, and your left calf will never get cold.
(Okay, so maybe don’t use those exact words — but you get the idea.)
The bottom line: The “prognosis” for “diagnosis” is confusion — so just tell people exactly what they need to know.
Here’s a question we get a lot from health care providers: Are there ways I can measure a patient’s health literacy?
The short answer is yes. There are a lot of tests and tools (or “instruments,” as scientists might say) available. Here are 3 you may have heard of:
Rapid Estimate of Adult Literacy in Medicine (REALM) is all about word recognition. Patients are asked to pronounce (but not define) a list of common medical words. It doesn’t measure numeracy, but it only takes about 3 minutes.
Test of Functional Health Literacy in Adults (TOFHLA) measures reading comprehension and numeracy using common medical scenarios. It takes about 22 minutes. A shorter version (the S-TOFHLA) takes 7 minutes, but skips numeracy.
The Newest Vital Sign (NVS) measures reading comprehension and numeracy using questions based on an ice cream nutrition label. It was designed specifically for primary care settings and takes about 3 minutes.
All of these are useful screening tools, and we don’t recommend one over the other. Which one you use depends on factors like the setting, the amount of time you have, whether you need a tool in Spanish, and so on.
But it’s crucial to remember, dear readers, what these tools don’t measure — for example, cultural context or patients’ ability to actually use the information to make decisions about their health. That’s why our philosophy is to take a universal precautions approach to communication: Everyone benefits from clear, plain language and actionable information.
The bottom line: Focus on improving communication for everyone, not on measuring individuals.
Alt: A sad semicolon doodle stands below a treehouse, where several other punctuation doodles are hanging out. The treehouse has a sign that says, “NO semicolons allowed!”
Many of us here at We ❤ Health Literacy Headquarters also ❤ a certain controversial piece of punctuation: the semicolon. If prompted, we might even gush about its unique and graceful qualities. So it’s with a heavy heart that we must declare — once and for all — that the semicolon has no place in plain language communication. Here’s why.
First, many people don’t use the semicolon properly, making it a recipe for confusion. Because you share our grammar geekiness, dear readers, you know that semicolons are used to link 2 phrases that could stand on their own (i.e., independent clauses) but are related enough to warrant a stronger connection. Unfortunately, many people don’t know this; thus, they use it incorrectly.
Second, the semicolon can feel very formal and academic — stuffy, even. And while we don’t think it necessarily deserves the bad rap, we can’t deny the association (think legal documents, research papers, and never-ending lists).
So, skip the semicolons in your plain language health materials. If you find yourself staring helplessly at a sentence with a semicolon, the best solution may be to break it into 2 sentences. (After all, a semicolon connects 2 standalone phrases, right?)
You can also consider the other punctuation marks in your grammar toolbox. In case you haven’t noticed, we’re particularly partial to the em dash ( — ). And if you’re using semicolons to separate a long list of items, try good ol’ fashioned bullets instead.
But the semicolon fun isn’t totally over — in your personal correspondences and literary contributions, disregard this advice and use ’em to your ❤’s content.
The bottom line: Semicolons aren’t invited to the plain language party — but you can make it up to them later.
We thought we’d take a look back at our most popular posts and reflect on all the fun we’ve had. So without further ado, here are our top 5 posts from year 1:
Thanks to all of you for being such involved readers over the last year. We look forward to getting more of your great topic ideas and hearing your thoughtful comments for years to come!
The bottom line: It’s our birthday and we couldn’t have done it without you!
Alt: Three doodles look at a drawing of a street with a “patient” car and a “personnel” van traveling in opposite directions. The words “health literacy is…” appear above the drawing. One doodle says, “See?! It’s a 2-way street!”
We know that you all ❤ health literacy — and we bet you have some serious health literacy skills, too. But were you born with your amazing ability to parse tricky health information? Or did someone teach you these skills? We’re guessing it’s the latter!
This week, we’re taking a little trip down memory lane and sharing our appreciation for a document that helped lay the groundwork for educating health literacy superstars like you.
In 2008, The Centre for Literacy (now, sadly, closed) hosted a summit that set out to redefine health literacy, develop rationale for teaching health literacy in schools, and guide the creation of curricula. The product of their work was the Calgary Charter on Health Literacy. And it’s awesome.
The Charter provides a framework for some of our very favorite activities: providing health information that’s easy to use and understand, helping people transform information into action… we could go on. And on and on.
But the Charter’s most valuable contribution may be that it redefines health literacy as a mutual exchange between people and their health systems — a 2-way street of health information.
Just look at this gem from page 2:
“Prior definitions have largely identified health literacy as relating to the patient, and have under-emphasized the role of health system personnel. One of the goals of a health literate society is to have a more equal power relationship between those who work in the health system and those who use it.”
