Karen Baker, MHS
September 30, 2014
Plain Language: A Tool to Promote
Health Literacy
First: Health Literacy
• What is health literacy?
• Why is it so important?
• How can we address it?
Engagement Depends on
Health Literacy
…”capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.”
--Healthy People 2010, 2000; IOM, 2004
Health Literacy by the Numbers
16, 21, 14
77,000,000
53
238,000,000,000
2030
5
A Human and Economic Toll
• Patient safety
• Rx adherence
• ER utilization
• Hospitalization
• Prevention
• Disease management
• Costs
• Mortality
6
Trends That Affect Health Literacy
• More focus on prevention, self-care.
• Aging population = more interventions.
• Outcomes are being measured, incented.
• Affordable Care Act mandates use of plain language.
• Insurance industry is responding.
• Patients are assuming more responsibility.
• President signed Plain Writing Act in 2010.
• Patients have access to EHRs.
An Unfamiliar Landscape…
8
…And a Foreign Language
• “Your prostate biopsy was positive for cancer.” (In
office)
• “You should either take ciprofoxacin 1-2 hours
before eating or drinking dairy products or avoid
eating and drinking these products for four hours
after taking ciprofoxacin.” (Drug leaflet)
• “We’re going to draw some blood…” (In lab)
• “The left atrium is markedly abnormal.” (EHR note)
• “Anterior abdominal wall defect in region of
umbilicus consistent with fat-containing umbilical
hernia.” (Ultrasound report)
Why Does It Matter?
Health Literacy Universal Precautions
Structure the delivery of health care as if everyone
may have limited health literacy.
• You can’t tell by looking.
• Higher literacy skills ≠ understanding.
• Health literacy is a state, not a trait.
• Everyone benefits from clear communication.
--Dean Schillinger, MD
Plain Language: A Solution That Works
Steps To Success
1. Know your audience.
2. Organize your message.
3. Write clearly.
4. Design for your audience.
5. Test with users.
1. Know Your Audience
Can You Read It?
Dloh eldnah, dna ediug ssolf neewteb hteet gnisu a eltneg
kcab-dna-htrof noitom. Evom ssolf pu dna nwod tsniaga
ruoy htoot ot pleh evomer euqalp dna doof selcitrap
evoba dna woleb eht enilmug. Esnir ssolf sa dedeen, dna
taeper rof hcae htoot. Ot esu eht kcip, ecalp eht pit fo eht
kcip neewteb ruoy hteet ta eht enilmug…
How Did You Do?
• How did reading this
make you feel?
• Would you know what
to do?
Readers With Lower Skills:
• Take words literally.
• Read slowly and miss meaning.
• Skip over unknown words.
• Miss context clues.
• Tire quickly.
• Get frustrated and give up.
Readers of Health Content May:
• Feel stressed or fearful.
• Be shocked at a diagnosis.
• Not feel well at this moment in care.
• Worry about how they’ll pay their medical bills.
• Have limited time with the doctor.
• Be on medicine that impairs them.
Know Your Audience…
It’s Not Just About the Words
• Race/Ethnicity
• Age
• Gender
• Socioeconomic status
• Body type
• Relationship depicted
• Provider (if shown) ethnicity and gender
2. Organize With the User in Mind
• Put most important information first.
• Have a purpose, and highlight it.
• Chunk it! Use lists, bullets, tables, etc.
• Write headings and subheadings that tell people
what is coming and that they can scan.
3. Write Clearly (Think Living-Room
Language)
• Use active voice.
• Break up long sentences.
• Focus on one idea.
• Use pronouns.
• Use familiar words.
• Do not rely only on
grade level to judge
readability.
Get Active
• It Was Heard Through the Grapevine By Me
(Marvin Gaye)
• You Will Always Be Loved By Me (Whitney
Houston)
• My Heart Was Left by Me in San Francisco (Tony
Bennett)
• You Are Loved by Her (The Beatles)
• You may have been told by your doctor that you
have osteoarthritis.
Shorter Is Better
• Watch for long, complex sentences. Break them up
into short sentences that focus on only one idea.
Maybe you’ve heard about different treatments for knee
osteoarthritis and wondered which ones work and what you
can do to help yourself.
Many people can manage knee pain for a long time without
surgery. Nonsurgical treatments are generally safe, and you
can do many of them on your own.
Get Personal
Find a Plain Alternative
Contribute Lead to; Help cause; Add
Demonstrate Prove; Show; Teach;
Explain
Difficulty Trouble; Problems
EffectiveWorks well; Useful;
How well it works
Evaluate Check to see if;
Check; Rate; Decide;
Think about
Monitor Watch for; Keep
track of; Check;
Look for
Avoid Jargon
Consider your audience.
Now that you’re off book, remember how we
blocked it. Enter up left, in front of the cyc.
Cross down center, but arc the cross. When
you get to the hot spot, cheat out, or your
comic bit with the prop won’t read. And make
sure to pick up your cues.
Beware the Formula
Reading level is 5.8 Reading level is 5.8
If You’re Using a Formula…
• What’s the quickest way to
lower reading level?
• What should you always do
after you rewrite?
• If the reading level is
6th-grade or lower,
does it mean that your
content is plain?
4. Design to Help Users
• Use headings and subheadings.
• Use white space.
• Pictures and/or videos help people learn.
• Color and font can help people navigate.
• Lists and bullets and boxes attract attention.
5. Test With Target Audience
• Test early, test often.
• Test with people who are like your audience.
• Test content, design, functionality.
• Use test results to improve product.
• Any testing is better than no testing!
The Results Are In…
• “I did not know a lot of this information. Thank you for sharing it with me.” (Low-Salt Diets)
• “This info was very helpful, since I had never had this condition explained to me.” (Diabetic Ketoacidosis)
• “Give more background and information on the three tests listed.” (Tests for ADHD)
• “Add some hope.” (Depression and Suicide)
To Sum It Up: 5 Things to Remember
1. Know your audience. (Anyone can have low
health literacy.)
2. Organize your message. (Make it easy to
follow.)
3. Write clearly. (You are in your living room…)
4. Design for your audience. (Use visual cues.)
5. Test with users. (Make sure you achieved the
goal.)
It’s more fun to talk with someone who doesn’t use long, difficult words but rather short, easy words like “What about lunch?”
-Winnie The Pooh
Thank you!
If you have questions for the
instructor or about the
workshop, please contact:
Karen Baker
Healthwise
208-345-1161
To learn more about the
Center for Plain Language, go to:
www.centerforplainlanguage.org
Or contact:
Rebecca Gholson