Principles of Plain LanguageDr. Annetta L. Cheek, ChairCenter for Plain Language

Presented at the University of Maryland Horowitz Center for Health Literacy

3-10-09

What is Plain Language?Material is in plain language if readers can

• Find what they need

• Understand what they find

• Use it to fulfill their needs

And they should be able to do this the first time they read or hear it!

Think about your audience!

• You must understand your audience’s knowledge of and familiarity with a topic.

• What is plain language for one audience may not be plain language for another audience.

Why do we recommend plain language?

• There is lots of evidence showing that plain language benefits the writer and the reader.

• Readers save time and are more likely to get the information or benefit they are seeking.

• Writers save money, because readers make fewer mistakes, respond more quickly, ask fewer questions, comply more fully with requirements.

We’ll look at just a couple examples

• Significantly fewer calls from customers.

• One office, in Jackson, MS, decided to rewrite one standard benefits letter into plain language.

Veterans Benefits Administration

• More veterans applied for benefits.

Fewer calls from customersOld letter Plain

Language letter

Calls to each counselor each month

91.4 16

Total calls each year, 10 counselors

10,968 1920

• Every several years the Veterans Benefits Administration sends a letter to all veterans, asking them for an up-to-date beneficiary.

• If a veteran dies and the beneficiary listed in his VA file isn’t valid, the VA must find a valid beneficiary.

• It costs the VA several thousand dollars to do the research to find a valid beneficiary.

Another VBA example

Response rate

Original letter 35%

Plain language letter

58%

Higher response rate, lower costs

Estimated savings

$8 mil every mailing cycle

• Revised regulations about radio operations on pleasure boats to improve their clarity.

• A Washington-based firm studied the ability of users to find answers to questions in the old and new versions.

• The test groups included both new and experienced users.

Federal Communications Commission

Less time for users to solve a problem (in minutes)

Type of user Old rule New ruleExperienced 2.43 1.50Inexperienced 3.51 1.73

FCC pleasure boat radio regulation

Overview of Plain Language Techniques

None of the techniques we’ll discuss define plain language – rather, they are ways to achieve plain language

Together, these techniques help you be clear and concise.

Use:

Informative headings

Active voice

Pronouns

Lists and tables

Common words

Logical organization

Avoid:

Abbreviations, jargon, legal terms, Latin

Unnecessary words, redundancy

Information the audience doesn’t need

Long sentences

A general principle – Less is more!

Plain language usually – but not always – helps you be more concise.

Organize logically for the readerThere are several standard ways to organize:

Chronological

Most important first

General first, special and exceptions last

If you find material more than once, suspect poor organization

Headings

Questions – Why should we use headings?

Statements – Headings help guide readers

Topics - Headings

There are three types of headings

The most useful headings

• But don’t make up the questions – use question headings only if you know the audience’s questions.

• Are question headings, because people generally come to our documents with questions.

Use active voice

• Subject, verb, predicate – Who, does what, to what or whom.

We charged the incorrect amount.

• The best sentences are like the ones you first learned in school.

Avoid passive voice

• Passive voice is harder to understand.

• Passive voice can confuse the audience because it’s not clear who does what.

• Passive voice is one of the major problems of bureaucratic writing.

What is passive voice?

The actor follows the verb.

Some form of the verb “to be” is combined with the past participle of another verb.

The frog was swallowed by Fred.

Passive VoiceCan disguise who does what:A frog was swallowed.

Active VoiceMakes it clear who does what:

Fred swallowed a frog.

Passive VoiceIs often longer:The application must be completed by the

applicant and received by the grants office by June 1st. 17 words

Active VoiceCuts the number of words:We must receive your completed application by June 1st. 9 words

Use pronouns to speak to the audience

• Using general nouns such as “beneficiary” or “purchaser” requires the audience to “translate” before they can be sure you are talking to them.

• Research shows that people relate better to information that talks directly to them by using pronouns.

How to use pronouns Refer to your organization as “we”

Refer to the reader as “you” in the text and as “I” in questions

Make sure you define “we” and “you”

Without pronouns

To establish eligibility for a voucher, an applicant must show that the applicant has a low income and that the present care of the applicant is inadequate. 27 words

With Pronouns

To establish your eligibility for a voucher, you must show you have a low income and your present care is inadequate. 21 words

Do not use these “pronouns”!

He/she

His/her

S/he

Let’s use pronouns and active voice

• Applications can be submitted any day of the week, including weekends and holidays.

• They will be opened the next business day.

• If your application is acceptable, you will be notified, usually within 48 hours.

• You can submit your application any day.

• We will open them the next business day.

• If we accept your application, we will notify you, usually within 48 hours.

Using lists and tables

• Make sure that all the items in a list are constructed in a parallel way – each item should start with the same part of speech.

• Try not to mix “and” and “or” in one list, it can be confusing.

• Lists can be a very powerful way to convey information.

Here’s a CMS exampleMedicaid: Apply if you are aged (65 years old or

older), blind, or disabled and have low income and few resources. Apply if you are terminally ill and want to receive hospice services. Apply if you are aged, blind, or disabled; live in a nursing home; and have low income and limited resources. Apply if you are aged, blind, or disabled and need nursing home care, but can stay at home with special community care services. Apply if you are eligible for Medicare and have low income and limited resources.

And in list formYou may apply for Medicaid if you are:• Terminally ill and want hospice services; • Eligible for Medicare and have low income and

limited resources; or• 65 years old or older, blind, or disabled and

have low income and few resources and– You live in a nursing home; or– You need nursing home care but can stay at

home with special community care services.

And one moreDuring this same period, prescriptions for HRT declined rapidly, following highly-publicized reports from the Women’s Health Initiative (WHI) study that showed an increased risk of breast cancer, heart disease, stroke, blood clots, and urinary incontinence among postmenopausal women who were using hormone replacement therapy that included both estrogen and progestin. (50 words in one sentence)

During this time, prescriptions for HRT declined rapidly. The Women’s Health Initiative (WHI) publicized studies showing increased health risks among postmenopausal women who were using both estrogen and progestin . Risks included:

•breast cancer

•heart disease

•stroke

•blood clots

•urinary incontinence (41 words in 3 sentences)

And as a list

Use common words

• Big words do not make you look smarter!

• Avoid uncommon words, bureaucratic words, foreign words, and jargon.

• Even highly educated people read faster and with better comprehension if you stick with common words.

Common words

Instruct TellReceive, Obtain Get

Parameter Limit

Assistance Help

Regarding About

Retain Keep

Avoid abbreviations

jargon

legal terms

Latinisms

Abbreviations

• Using abbreviations turns your material into a research project for readers.

• Readers complain more about abbreviations and acronyms than about any other feature of bureaucratic writing.

• If your abbreviation has another, more common meaning, your audience will forget your special meaning and remember the more common one.

How can you fix abbreviations?

• Instead, use “nicknames” such as “unit” instead of WPU for Witness protection unit, or “case review” instead of PQCR for Peer Quality Case Review.

• Don’t use more than two, and at most three, abbreviations in each written document.

JargonBureaucratic writing is often full of jargon

metabolic demands

circulation system

hypertension

expiry date

Bureaucratic and legalistic words

• Herein• Hereafter• Hereby• Pursuant to• In accordance with• Shall (use “must” instead)

Latin terms

• “i.e.” and “e.g.” are major problems.

• Many people do not know what these mean.

• Many who do know the meanings don’t remember which is which.

• Other Latin terms to avoid – “via” “per”

Keep sentences short In most material, sentences should average 20 words or fewer, with no sentence longer than 40 words.

On the web, limit the average to 15 words, with no sentence longer than 30 words.

Consider this sentence

If this continues, over time some recurring infections may have to be treated with different and stronger antibiotics and the very real possibility that eventually no antibiotic will be effective in killing the bacteria. (34 words in 1 sentence)

All you need is thisIf this continues, some recurring infections may have to be treated with stronger antibiotics. Eventually some infections may resist all antibiotics. (21 words in 2 sentences)

Eventually, we will have to use even stronger antibiotics to kill some infections. Some may resist all antibiotics. (18 words in 2 sentences)

But this is even better for a general audience

.

One more exampleThe National Cancer Institute's Cooperative Planning Grant for Cancer Disparities (CDRP) Research Partnership Program issued by the Radiation Research Program is an effort to strengthen the national cancer program by developing models to reduce significant negative consequences of cancer disparities seen in certain U.S. populations. (45 words)

Do you need more than this?

The Cooperative Planning Grant for Cancer Disparities (CDRP) Research Partnership strengthens the national cancer program by developing models to reduce negative consequences of cancer disparities. (25 words)

Omit excess words• Generally, “less is more.” • Challenge every word you write. Do you

really need it? • Bureaucratic writing contains many

unnecessary words. • Eliminating excess words is a skill you’ll

work on your entire writing career.

A couple examples

The Office of Cancer Survivorship was established in 1996 by the National Cancer Institute in recognition of the large number of individuals now surviving cancer for long periods of time.

The National Cancer Institute created the Office of Cancer Survivorship to recognize many individuals now survive cancer for long periods.

Or even better:

The Office of Cancer Survivorship recognizes the many individuals now survive cancer for long periods.

Another example• We are faced with the challenge of making

sure that all divisions of the organization were aligned with the strategic direction and goals of the new structure.

• We need all divisions to accept the new goals and structure.

And one last examplePrevalence can also be expressed as a

percentage and it can also be calculated for a specific amount of time prior to January 1, 2004 such as diagnosed within 5 years of January 1, 2004. (35 words)

Prevalence can also be expressed as a percentage and calculated for a specific period before January 1, 2004, such as “diagnosed within 5 years of January 1, 2004.” (28 words)

Don’t tell the audience what they don’t need to know

Dietary supplements are not over-the-counter medicines. This can be very confusing. The part of the Food and Drug Administration that controls dietary supplements is the same part that controls foods sold in the United States.

News flash!

Readers don’t care that the part of the Food and Drug Administration that controls dietary supplements is the same part that controls foods sold in the United States.

In general, they don’t care what federal agency is doing something. They don’t care when an organization was created. They don’t care what law a program is based on. They don’t care what the official name of the program is.

Here’s a question sent to FEMA:

I just found out that the products I have been using to clean my home are toxic! Have I damaged my health by using these products?

Do you think this is what the person needed as a response?

•Answer: First of all, what is meant by toxicity? Somewhere on the order of 70,000 different chemicals have been identified as toxic. A chemical produces a toxic effect at concentrations that alter the normal state of the organism. For many chemicals, there is a dose at which there are no toxic effects, there is a dose at which the effects are reversible, and there is a dose at which the effects may have permanent consequences. An example of some toxic chemicals that many of us are exposed to regularly are caffeine, tobacco, and alcohol. At doses normally consumed by the average person, the "high" effect felt by the individual response can be quite different. One person may be able to drink 5 cups of coffee with out visible effects, while another person might get the shakes after 2 cups of coffee. This is an example of how the dose and response varies from one person to the next. At some point, each of these chemicals can have a much more serious effect on the individual. At extremely high doses . . .

The Ministry of Health has developed Version 16 of the New Zealand Influenza Pandemic Action Plan (NZIPAP), which is the result of 18 months of intensive work around pandemic planning by the Ministry of Health, district health boards and central government agencies. The NZIPAP recognises that Ma¯ori, Pacific peoples, and people from lower socioeconomic groups, who have poorer health outcomes than the rest of the New Zealand population, may be similarly disadvantaged in the event of a pandemic. Therefore, work is currently underway to ensure that the specific needs of ethnically diverse Pacific communities are recognised and addressed, in the event of a pandemic. This work is being led by a multidisciplinary Pacific expert group, including primary care and public health clinicians, academics and community representatives. (126 words)

The Ministry of Health has developed a plan to respond to an outbreak of pandemic flu. This plan recognizes that the segments of New Zealand’s population, such as the Maori and Pacific peoples, that currently have poorer health may be especially at risk in a pandemic. The plan will ensure that if a pandemic does occur, we can take care of the health needs of these peoples. (67 words)

Summary

Plain language:

• focuses on the reader, not the writer.• saves the writer time and money because

readers call or write back less often with questions.

• gives better customer service.• gets better results.

Questions?

Resources

www.plainlanguage.gov

www.centerforplainlanguage.org

www.health.gov/communicaton/literacy/

How to reach us

Dr. Annetta Cheek

acheek@patriot.net

Joanne Locke

joannelocke@gmail.com