No Semicolons Allowed

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.

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

Happy birthday to us!

Illustration of the WHHL birthday party.

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:

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!

Other Things We ❤: The Calgary Charter on Health Literacy

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.”

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

How Much “Dose” Do You Need?

Alt: Several pill bottle doodles hold signs that say things like, “Friends don’t let friends do dose,” and “Don’t dose it!” One doodle watching from a distance says, “Well, I guess that dose it for me!” Another groans.

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

How to Explain Measurements

Illustration of person explaining a common measurement.

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.

Rethinking Readability Scores: Part 1

A doodle shows a document to a second doodle with cat head. The document reads, “Your skull be felined.” The first doodle says, “Oooohhhh yeah! Got this baby down to a sub-second grade reading level!”

Readability scores can give health communicators an immediate sense of accomplishment. Who among us hasn’t been pleased to say, “My material went from an 11th-grade reading level to a 6th”? It may be tempting to rest on our readability laurels, but what does a reading grade level really tell us?

Unfortunately, not all that much. Readability formulas use the number of syllables, words, or sentences in a document to calculate a score in the form of a grade level, like 10th grade. This means that, theoretically, your audience needs at least a 10th-grade reading level to understand your content.

And that’s exactly what the score is — theoretical. If you take that same document and score it using 3 different readability formulas, you’ll get 3 different scores. And they may range from 8th grade up to 14th. Not all that helpful, is it?

That’s because a grade-level readability score is not a measure of health literacy. Short sentences with short words are just that — short. They’re not necessarily understandable, actionable, interesting, or useful to your audience.

In other words, readability scores can miss a lot. They don’t assess whether your material:

  • Uses words that your audience understands
  • Uses easy-to-read fonts and numbers in a clean design
  • Has a tone that’s appropriate for your audience
  • Includes images that connect to your main messages
  • Takes your audience’s knowledge and experiences into account

Our advice: Focus on the factors that help your audience understand and use your material, and readability will follow.

So, if readability formulas are flawed, why do so many people keep using them? Great question! Check out Rethinking Readability Scores: Part 2 to get the answer.

The bottom line: Skip the grade-level readability formulas and focus on making edits that will help your readers understand and use your content.


Tweet about it: What do readability scores tell us? Unfortunately, not all that much, says @CommunicateHlth. Learn why: https://bit.ly/39vzcWc #HealthLiteracy #HealthComm

You’re at Risk for Health Literacy Fever. Wait, Are You?

2 doodles in hazmat suits shield a heart-eyed doodle from health literacy germs falling from the sky. “Watch out!” says one. “That’s Health Literacy Fever!” The heart-eyed doodle cries out, “But I waaaaant it!”

If we told you that your chances of getting health literacy fever are 33%, would you be concerned? What if we said you have a 1 in 3 chance of coming down with the fever? Would that make a difference?

We know that people struggle with numeracy, so talking about numbers in any form can be a challenge for health communicators. Throw probabilities, fractions, and percentages into the mix, and it only gets worse.

People tend to understand frequency expressions (like “1 in 3”) better than percentages, so that’s a good place to start. But even then, people may have a hard time getting meaning from numbers alone.

So along with the numbers, we suggest giving context in plain language. For example, “You have a 1 in 3 chance of getting health literacy fever. That puts you at very high risk.”

And, as is often the case in clear communication, adding a visual can help. For example:

Three doodles stand between the words: "You have a 1 in 3 chance of getting... health literacy fever! That puts you at very high risk." One of the 3 doodles has hearts for eyes.

So this, dear readers, is how we work with numbers:

  • State numbers as clearly as possible
  • Use plain language to give context
  • Add visuals to help people understand their meaning

The bottom line: Pay attention to numeracy — use simple numbers, offer context in plain language, and use visuals to drive the meaning home.

Tweet about it: Percentages, numerals, fractions, oh my! Check out these tips for using numbers in #HealthLit materials: https://bit.ly/2WpL9UE

Which Is Better: Hospitalized or Admitted?

Alt: A game show host doodle on “It’s a Match” reads the question, “Mary had to [blank] the hospital.” One doodle holds up the answer “Be admitted to.” Another answers, “Spend the night at.” The host says, “That’s a match!”

Today’s post will address one of our favorite topics: unnecessarily complex health terms!

Let’s start with a pop quiz. Pretend you’re writing a patient handout. What’s the best way to tell someone she’ll have to spend the night in the hospital?

  • a. You’ll be hospitalized overnight
  • b. You’ll be admitted to the hospital for the night
  • c. You’ll need inpatient care at the hospital
  • d. You’ll need overnight observation in the hospital
  • e. It’s a trick question — the question is the answer

Exactly — with an “E.” Just skip the fancy words and say what you mean: “You’ll have to spend the night in the hospital.”

There’s no need to risk confusing people with overcomplicated language. “Hospitalization” has 6 syllables! We’ve said it before, dear readers, and we’ll certainly say it again: just keep it simple.

And in case you were wondering, the title of this post is a trick question, too.

The bottom line: Instead of using complex terms like “hospitalized” or “admitted,” use words that everyone knows.

Tweet about it: Hospitalized? Admitted? Inpatient care? How about “spending the night?” http://bit.ly/1ny0bRN #HealthLit via @CommunicateHealth

Good design helps everyone.

Illustration of person fighting to design confusing health info.

This week, we share our top design tips for health information. Enjoy!

  1. Plan where your content will live. Will it live on a printed flyer, on a website, on a mobile app, on a houseboat in the Florida Keys? Each platform requires a different design approach. Wherever your content will live, plan for design accordingly — before you develop the content.

Source: usability.gov

  1. Chunk content. Organize your content into easy-to-look-at chunks. This will make your material look appealing and keep your reader from getting overwhelmed. Keep your paragraphs and line lengths short.

Source: healthfinder.gov

  1. Make room for white space. We never tire of preaching the benefits of white space. Keep in mind that white space is not always “white.” It’s just space on the page that gives your content (and reader) room to breathe.

Source: NYC.gov

  1. Achieve balance. It turns out in both life and design, we need balance. The composition of a page, from its layout to its colors, needs to appear balanced.

Source: Burton.com

The bottom line: When developing health information materials, don’t forget that good content needs good design.

Readability and Plain Language and Health Literacy — Oh My!

Alt: Three doodles appear under the terms “Readability,” “Plain Language,” and “Health Literacy.” The first doodle says, “Now THIS looks like somethin’ I’d read!” The second doodle says “I’m understandin’ ALL this info up in here!” And the last doodle runs off, saying, “I’m gonna go make some informed decisions!”

So what exactly is the difference between plain language and readability? And what about health literacy? How do they fit together? Or are they the same?

Never fear, dear readers! We’re here to take a quick look at what it really means to talk about readability, plain language, and health literacy. They’re all important — and they’re definitely related — but each term means something different.

Readability is how easy (or not) something is to read. Readability formulas measure this by looking at the length of the words and sentences in a document. They can tell you what grade level your document is written for, and they’re everywhere — Microsoft Word even has one built in. But we’re not fans of these formulas because they don’t take into account plain language principles or the user’s context.

Plain language is writing that people can understand. It ensures that people can easily grasp your message the first time they read it. We’ve written about many plain language principles before, like:

When you get plain language right, readability naturally comes with it. But something written in plain language won’t improve health literacy if people don’t know what to do with the information.

Health literacy is a person’s ability to access, understand, and use health information so they can make informed choices about their health. It’s a complex concept that depends on the quality and clarity of the communication as well as the skills and experience of the user. On the communication side, plain language is important — but writing for health literacy also means making the content relatable and actionable for your audience.

Whew. Now you have the facts you need to settle all those heated cocktail party disputes. (No really. We talk about this stuff at cocktail parties.)

The bottom line: Readability, plain language, and health literacy are all important — so it pays to understand what makes each unique.

Tweet about it: What’s the difference between readability, plain language, and #HealthLit? @CommunicateHlth explains: https://bit.ly/2uLSRsU