Category: We Heart Health Literacy

Want to know the quickest way to upset a writer at We ❤︎ Health Literacy Headquarters? Say that writing health content in plain language is “dumbing down” the information. This not only upsets us, but it insults the 9 out of 10 Americans who struggle with understanding and using health information.

A big part of the “dumbing down” myth stems from the need to limit information. Deciding between need-to-know and nice-to-know information is an important step in developing clear health communication materials. We often hear medical experts say that if we don’t give people all the information, we’re doing them a disservice. But we argue that the disservice is in overwhelming people with so much information that they miss the key message.

If your mechanic gave you a detailed explanation of how your car engine worked every time you went for an oil change, you would probably:

• Have no idea what she was talking about
• Zone out
• Start looking for a new mechanic

Most people just want to know whether their car is okay, and if not, how much it will cost to fix it. If they want to know more, they’ll ask.

Being clear, straightforward, and easy to understand isn’t dumb. In fact, it’s really quite smart — and a challenge to do well. If it were easy, everyone would be doing it!

The bottom line: Plain language is smart. And when you use it to write health information, there are big payoffs for readers.

Let’s be honest — how many times have you gotten an email written in all caps that has left you with a positive impression? Never, right? Except maybe that email letting you know YOU WON THE LOTTERY!

Fantasies aside, a quick survey of folks at We ❤︎ Health Literacy Headquarters shows that getting an email in all caps leaves the reader feeling that the author:

• Is angry and yelling
• Doesn’t have the vocabulary to get his point across
• Must be working on an ancient computer that doesn’t have different font styles to indicate emphasis
• Accidentally hit the “caps lock” button when she fell asleep on her keyboard

In addition to leaving us with an all-around yucky feeling, the consensus is that using all caps negatively affects readability and legibility. Most people read by scanning the shapes of letters. Using all capital letters removes a lot of that variation — forcing the reader to work harder to understand the text.

Don’t believe us? Compare these examples:

• If you need a nurse right away, dial 111 on your bedside phone.
• IF YOU NEED A NURSE RIGHT AWAY, DIAL 111 ON YOUR BEDSIDE PHONE.

Now ask yourself:

• Which one of those would you prefer to read when you’re sick, stressed, and confused?
• Which version makes it easier to scan and find the emergency number?

The bottom line: Do your readers a favor and unlock your caps.

Here at We ❤︎ Health Literacy Headquarters, our goal is clear communication. Whenever we use a medical term or other jargon in consumer materials, we offer a plain language definition using everyday words. Most of the time, this is a fun and interesting challenge.

But then there are the times we need to define things that people don’t like to talk about — like bodily functions (even that term is problematic!). When it comes to our bodies and what comes out of them, we’re faced with 3 categories of terms:

• Medical/clinical (like defecate, urinate, and vomit)
• Words for kids (think poop, pee, or puke)
• 4-letter words for grown-ups that we won’t print here

What’s a plain language health writer to do? Using only medical terms sounds impersonal and detached — and your audience might not know what you’re talking about. Using the words for kids may give the impression that you’re talking down to your audience. And using the 4-letter words… well, we like having clients, so we don’t see that as an option.

The answer is to keep it simple. Usually this means providing the medical term and then using familiar words from childhood to define it. For example:

• Diarrhea (watery poop)
• Vomiting (throwing up)

Is it ideal? No, but it gets your point across! After all, it’s better to be understood than to be demure.

The bottom line (no pun intended): Always give a plain language definition for medical terms, even if it means using slang or words from childhood.

If you’re communicating about environmental health, it’s likely that you’ve encountered the word “exposure” many times. Environmental health professionals just love it. But the rest of us? Not so much.

The term tends to conjure up images of trench coats and scandal. If you’re into photography, “exposure” means something else entirely. Or perhaps, if you were old enough to stay up past 9 p.m. in the early 1990s, it makes you think of a really great TV show set in Alaska. And if you actually live in Alaska, you might picture someone shivering outside in the snow.

Must we use this complicated and problematic term? No! There are lots of ways around using “exposure” when you write about health. Here are a few common uses of the word with suggested alternatives.

Before: Every day, millions of Americans are exposed to secondhand smoke.
After: Every day, millions of Americans breathe in secondhand smoke.

Before: Exposure to mercury can cause serious health problems.
After: If you come into contact with mercury (by touching it or breathing in fumes), it can cause serious health problems.

Before: More than half of our exposure to radiation comes from radon.
After: People are around radiation every day. Surprisingly, most of this radiation doesn’t come from microwaves or x-rays. It comes from radon gas.

The next time you’re tempted to use the word “exposure,” try one of these more decent alternatives instead.

The bottom line: “Exposure” isn’t a word we use in everyday conversation, so skip it when you can!

Update (January 2020): Since we wrote this post more than 7 years ago, the scrappy underdog singular “they” has made great strides (insert inspirational training montage here). In 2017, the Associated Press and Chicago Manual of Style welcomed “they” into the fold. In 2019, the American Psychological Association gave “they” its blessing. And to really seal the deal, Merriam-Webster named “they” 2019’s Word of the Year.

If you need to follow a style guide that hasn’t gotten the “they” memo, you can find some alternative solutions below — but you can count us as officially officially okay with “they.” Hooray! The great debate is finally over!

Writing about health means writing about people. And people need pronouns. So if you’re a health writer, at some point you’ve probably asked yourself: Which pronoun do I use for a generic individual, like “your doctor” or “the patient”? He? She? He/she? They? Something else entirely?

Despite a long history of “they” as a gender-neutral personal pronoun, many academics and traditionalists still use masculine pronouns (he/his) when writing about a generic someone. But using “he” throughout is outdated, inaccurate, and frankly a little cringey at this point. So what are the other options?

Saying “he or she” all the time is clunky. Writing “s/he” or “(s)he” looks awkward and can trip up readers with limited literacy skills. Rephrasing sentences so they’re plural often works. But if your entire website reads that way, it can sound impersonal and distant.

One solution is to alternate feminine and masculine pronouns — or shake things up with unexpected pronouns. For example, you could sidestep gender stereotypes by saying, “Ask your doctor what she would recommend.” Or, “Make sure your caregiver knows you want him to call 911 if this happens.” This approach is a step in the right direction, but it ignores the needs of gender non-binary people.

The truth is, people already use “they” as a gender-neutral pronoun in everyday speech. Like, “Whenever someone at the office brings me a cookie, I give them a great big smile.” And one of the first rules of writing for health literacy is to write the way your audience speaks. Get where we’re going with this, dear readers? We thought so.

The bottom line: When faced with the pronoun dilemma, the choice is yours. We choose team “they.”

Tweet about it: Hooray! @MerriamWebster named “they” 2019’s Word of the Year! Check out @CommunicateHlth’s thoughts for #HealthLit communicators: https://bit.ly/2QIQpy9

For our first edition of We ❤ Health Literacy, we thought it would be fun to do a little experiment. Consider the following introductions:

Intro A

The writing team frequently discusses strategies to effectively facilitate the composition of content that readers will find engaging and attractive. In their work, they have found that consumers of materials containing health-related information respond more positively to content that is written in an informal, conversational tone — as opposed to content expressed utilizing a more formal, academic approach.

Tired yet? Now, be honest: Would you ever say any of this out loud? Do you routinely speak about yourself in the third person? (Doing it to be funny doesn’t count.)

Intro B

We talk a lot about how to create materials that our readers will actually want to read. Again and again, we’ve found that people respond better to content written in the same way we’d talk to them. No one wants health information that reads like an encyclopedia.

Isn’t that better?

When you write health information — particularly when you’re writing for behavior change — be conversational. Think about how you’d communicate to someone sitting right in front of you:

• Use second-person pronouns (like “you”) to personalize content
• Use contractions (like “can’t” or “doesn’t”) because that’s how we talk
• Use colloquial terms when those are the words that your readers are comfortable and familiar with

And yes, that sentence ended with a preposition. Technically correct? Perhaps not. But again, dear reader, we’d ask you this: Would you normally say, “Those are the words with which readers are comfortable and familiar”?

The bottom line: Write how you speak. Your readers will thank you.

The US Department of Health and Human Services (HHS) has released The National Plan to Improve Health Literacy — with support from Sebelius and others who see the relationship between improving health literacy and increasing access to cost-effective, high-quality health care.

The action plan contains seven goals, each with specific strategies for different sectors of the health system, such as payers, the media, government agencies, and health care professionals, to improve health literacy. These goals emphasize the importance of creating health and safety information that is accurate, accessible, and actionable. (Read the full press release from HHS.)

“We each have a role to play in improving health literacy,” notes CommunicateHealth co-founder Stacy Robison, who served as a contributing editor of the National Action Plan. “Improving the way public health professionals and the media communicate health information will go a long way toward achieving our goal of a health literate society.”

Listen to an interview with the lead editor of the National Action Plan, Dr. Cynthia Baur, to learn how individuals and organizations can use the action plan.