Category: We Heart Health Literacy

We’ve written about the controversial topic of problems with readability formulas — and we’re back to further explain our position.

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!

You can also subscribe to their weekly newsletter.

The bottom line: Brush up on your user experience know-how with free resources from NN/g.

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.

Tweet: Would you rather get a prognosis for your diagnosis, or learn what to expect from your health condition? @CommunicateHlth takes a guess: https://bit.ly/2jXeiFA

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.

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.

Tweet about it: Save the semicolons to punctuate fancy jargon and stick to simpler options in #HealthLit materials. @CommunicateHlth explains why: https://bit.ly/2SXQ5Mu

It’s been 12 months of We ❤ Health Literacy — and we can’t believe this tiny idea for a weekly email has grown so much! We’re just shy of 1,000 recipients and excited for another year. (And please encourage your fellow health literacy geeks to sign up!)

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:

• You, dear reader…
• Which is better: A photo or an illustration?
• How to Use (or Not Use) Stock Photos
• The Great Pronoun Dilemma
• Indecent Exposure

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!

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.”

Yes! Yes! Yes! Shout it from the rooftops, dear readers. It’s that good. If you love it as much as we do (and that’s a lot), you can put your name on it. Visit the site to add your signature to the bottom of the Calgary Charter.

The bottom line: Check out the Calgary Charter on Health Literacy to get inspired about making health literacy part of a well-rounded education.

Tweet about it: Check out @CommunicateHlth’s tribute to the Calgary Charter on #HealthLit (eracy): https://bit.ly/358yGGP

As you doubtless already know, dear readers, “dose” certainly isn’t the most confusing health-related word out there (don’t even get us started on “hypertension”). But it’s also not our favorite — it’s both a tad clinical and a touch vague. You don’t have to strike it from your vocabulary completely, but think of it like a pungent cologne: “dose” works best in small doses. Use it sparingly!

So what’s the alternative? To get around “dose,” try talking about the “amount” of medicine or “how much” people need to take. Observe:

• Make a list of all your medicines, including how much you take and when you take it.
• The amount of medicine you need depends on how much you weigh.

Sometimes, you can also replace “dose” with a specific quantity.

• Instead of: If the first dose doesn’t make you feel better, it’s okay to take a second dose.
• Write this: If 1 aspirin doesn’t make you feel better, it’s okay to take 2.

And once in a while, “dose” really is the best word for the job. For example: If you miss a dose, take it as soon as you remember.

So use your judgment — just don’t over-dose your health content! [Mic drop.]

The bottom line: Follow our prescription for clear communication and use “dose” only as needed.

Tweet about it: They say it’s the dose that makes the poison, so use “dose” sparingly in #HealthLit content, says @CommunicateHlth: https://bit.ly/2JzoX2j

As we’ve discussed before, people struggle with numbers. Today, we’re talking about how to explain common measurements — or, in other words, “How much stuff is that?”

It’s hard to visualize common measurements like an ounce, an inch, a cup — or a ton. An easy solution to this problem is to make comparisons to everyday objects.

For example:

• A serving of meat is 3 ounces (about the size of a deck of cards).
• The cleanup program removed 500 tons of dirt from the area around the chemical spill — that’s 50 dump truck loads!

Here are a few other comparisons that we’ve found helpful:

• 2/3 cup = a doorknob
• 1/4 inch = a pencil eraser
• 1 inch = the widest part of a quarter
• 3 inches = the long side of a credit card
• 6 inches = the long side of a dollar bill
• 1 ton = a Toyota Yaris hatchback

Your equivalents may not always be exact measurements, but that’s okay. The idea is to give people a general sense of “how much.”

The bottom line: When writing about amounts, sizes, or weights, help out your readers by making comparisons to everyday objects.