Clear communication from doctors, nurses, hospitals and clinics is essential for patients to manage their health care effectively. But creating easily understood materials isn’t simple. Many health workers don’t realize when they’re using technical terms, and many non-medical people have problems reading and understanding scientific and mathematical concepts.
Fortunately, several web sites offer helpful advice about how to create patient-friendly educational print materials. Two of the most useful are the National Cancer Institute’s Clear and Simple web page and the Harvard School of Public Health’s Health Literacy Studies web page.
Below are a few tips from those sites and health literacy experts.
1. Before creating health education brochures, videos and other materials, understand who you want to reach. Is your audience going to read a brochure or letter? Would a video or web link work better? People respond better to health materials that are targeted to their “demographic” — adolescents are unlikely to pay attention to brochures featuring photos of elderly people, for example, while older people may be unlikely to use certain technologies, such as text messaging. “Most health information is directed at the ‘know,’ or just the facts — but we also should consider what people will do with this information as well as how they will feel about it,” said Helen Osborne, a Massachusetts-based health literacy consultant. “As adults today, we don’t do things unless we feel it’s important and relevant and possible.”
2. Get feedback before, during, and after you create the materials, from the people you are trying to reach. You may think a photo is great, while others think it looks insulting. Similarly, lay readers may misinterpret some terms that medical people consider basic. One example is “hypertension,” which some readers may not know is the medical term for high blood pressure.”The key is to make sure to go to at least a few people who represent your audience,” Osborne said. “Ask enough people until you stop hearing the same comments.” After creating the materials, continue to ask for feedback – and keep editing.
3. Don’t overwhelm the audience with too much information. Too much information at once can distract the reader from your main goal. Several research studies have found that patients frequently don’t recall much of what doctors and nurses tell them. Instead, consider including a phone number, web address, or place to go where readers can get more information.
4. Check the reading level of your text. A large percentage of the adult population in the United States has difficulty reading and interpreting charts and numbers. According to Teaching Patients with Low Literacy Skills, a book available on the Harvard Health Literacy Studies website, a sixth grade reading level is adequate if you want to reach 75 percent of U.S. adults, and 3d grade if you want to reach 90 percent. The U.S. Department of Education’s National Assessment of Adult Literacy, a survey of 19,000 adults, found that more than 1 in 5 adults scored in the “below basic” quantitative skill range, and more than 1 in 10 scored in the “below basic” prose and document skill range – meaning they had no more than the most rudimentary skills in understanding numbers and how to read prose text and documents. Aside from the grade level calculator available on the Microsoft Word program, there are several reading level analysis programs available through sites such as lexile.com and micropowerandlight.com.
5. Analyze your text’s “suitability.” Reading level programs look at the complexity of words and sentences. But if you put your text together in one big chunk, the reader may not want to look at it. The “suitability assessment of materials” is a brief questionnaire that evaluates how user-friendly print materials are for readers. Aside from reading level, it takes into account whether the purpose is obvious, what types of graphics are used, and how the text is laid out. It is available on many web sites, as well as through the Harvard School of Public Health’s literacy page.
6. Get the reader to interact actively with the content. One nutritional chart on diabetes, for example, provides readers with space to write down changes they can make in what they eat each day. Health materials that actively engage readers are often more effective at getting their message across.
7. Don’t condescend. “Don’t talk down to me,” Osborne said. “I may not know something, but that doesn’t mean I’m stupid.” Health messages are more likely to get across when the audience feels respected.