CPL Workshop-Fall 14: Plain Language: A Tool to Promote Health Literacy (Karen Baker)

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

kbaker@healthwise.org

208-345-1161

To learn more about the

Center for Plain Language, go to:

www.centerforplainlanguage.org

Or contact:

Rebecca Gholson

gholsonr@gmail.com