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Stage 4: Interactivity, functionality and accessibilityA good way to change behaviour is to engage patients by using interactive ele-ments. These could include things like a checklist, a question-and-answer section or a page on which patients can write their own notes. By getting patients to interact with material you are encouraging them to think about the things they can do – how-ever big or small – to infl uence their health. An an example, PHA UK has produced a patient manual containing a pre-holiday checklist to help patients remember all the medications, documents and contact details they might need while away. This simple checklist helps patients to feel pre-pared, both on a day-to-day basis and in case of emergency.

Health-literacy principles apply to web and digital materials too. As well as thinking about content, design, layout and interactivity, when it comes to web and digital materials you also need to consider functionality and accessibility.

For the PHA UK website we ensured:» The text size could be adjusted for those

with poor eyesight;» Navigation made it easy for users to fi nd

the information they needed quickly;» There was a print function for users

who preferred to read offl ine; and » Videos and animations had easy-to-use

controls.

Stage 5: User testingAs with doing research before starting a project, carrying out user testing before a

fi nal draft is approved can prevent valu-able resources from being wasted. Testing your materials on people who will be using it will highlight areas where infor-mation is missing, misunderstood or inap-propriate, and will allow you to gain valu-able feedback on the design and layout. This could save you time, money and resources.

ConclusionProviding information in a clear and easy-to-understand way educates patients and their families, allowing them to make well-informed choices about their healthcare. We have kept health-literacy principles in mind to help us develop appropriate, useful and consistent materials, and used a checklist to help remind us of the impor-tant elements (Box 1). NT

ReferencesDepartment of Health (2003) Tackling Health Inequalities: A Programme for Action. tinyurl.com/DH-inequalities European Health Literacy Group (2012) Final Report. Executive Summary (D17). The European Health Literacy Project (HLS-EU). tinyurl.com/Eu-health-literacy Kickbusch I et al (2005) Enabling Healthy Choices in Modern Health Societies. Background paper. Bad Gastein: European Health Forum. National Adult Literacy Agency, Health Service Executive (2009) Literacy Audit for Healthcare Settings. Dublin: NALA. tinyurl.com/Ireland-health-literacy Puntoni S (2010) Health Literacy in Wales: A Scoping Document for Wales. Welsh Assembly Government. tinyurl.com/Wales-health-literacy The Scottish Government (2009) Health Literacy: A Scoping Final Report. tinyurl.com/Scotland-health-literacy O  ce of the Surgeon General, O  ce of Disease Prevention and Health Promotion (2006) Surgeon General’s Workshop on Improving Health Literacy. Bethseda, MA: National Institutes of Health. tinyurl.com/USA-health-literacy Weiss B (2003) Health Literacy: A Manual for Clinicians. Chicago, IL: Americam Medical Association Foundation and American Medical Association. tinyurl.com/HealthLiteracyManual

Content● Is the content written to appropriate reading age/level? �

● Is the content based on changing behaviour? �

● Does the material have a clear purpose? �

● Is the number of concepts limited to what can be reasonably learnt? �

● Is the copy written in an active voice? �

Layout● Is the layout consistent throughout? �

● Does the material include visual elements to guide the reader? �

● Is there adequate white space? �

● Does the material use an appropriate font type and size? �

Interaction● Does the material provide interactive tools, video and audio to facilitate learning? �

● Does the material provide content that supports the reader through their journey? �

Design● Does the design refl ect the purpose of the piece? �

● Are visuals used to highlight desired behaviours? �

● Is there appropriate contrast between background and text? �

BOX 1. CHECKLIST FOR CREATING PATIENT MATERIALS

“Good managers will raise issues and deal with them early”Elaine Maxwell p37

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