About ten percent of American adults can access, read, understand, and act on basic health information, making this condition a major barrier to improving public health. The journal of the American Medical Writers Association featured articles on this problem and potential solutions.
An overview by Sharon Nancekivell leads off the series. She reviews the dismal statistics that complicate the jobs of everyone involved in the healthcare system. Beth A Lanning and Eva I Doyle present a meatier article, Health Literacy: Developing a practical framework for effective health communication. This piece builds on models of health communication as an interactive process between sender, receiver, medium, and message, with the culture influencing the interaction of all of these components at all times. A wonderful table examines the health communication components and suggests ways each can influence functional health literacy skills: reading, understanding, and acting. The article provides a fascinating framework for thinking about health literacy problems, and it helps one begin to think about solutions.
Leonard and Cecilia Doak provide the most practical advice with Writing for Readers with a Wider Range of Reading Skills. Stating sames simply does not mean "dumbing down." Avoiding jargon, using common vocabulary, and eliminating extraneous material helps readers of all levels understand and retain material. Focused material brings better results; skilled readers may be able to keep as many as seven items in short-term memory, but three points is more typical. Most patients only read health-related text once and take action based on what they remember. Factors that aid retention include short sentences, written in the active voice and a conversational style. Present the context for new information before the information:
Information before context: Eating broccoli, spinach, collard greens, lettuce greens, rhubarb, Brussels sprouts, kale, beet greens, and carrots can reduce your risk of certain kinds of cancers.
Context before information: The foods you cat can affect your health. You can reduce your risk of certain cancers by eating broccoli, spinach, collard greens, lettuce greens, rhubarb, Brussels sprouts, kale, beet greens, and carrots.
Materials must not only be easy to read, they must look easy to read. Clear, 12-point fonts, white space, liberal use of headings, and illustrations all help break-up a "gray page" and make the document look reader-friendly. Visual aids especially assist readers; studies suggest that patient understanding, recall, and compliance may increase up to 500% when pictures are included with the text.
The most problematic healthcare documents are legal forms such as informed consent and HIPAA notices. These must be written to meet the requirements of the law, resulting in documents at a college reading level. The Doaks suggest one alternative, a two-part document. The first part could be a "plain language" notification of the material, and the second could be the actual legal text. A piece in the current issue of Scientific American examines technology-based alternatives to help patients understand their procedures and all of the risks. Interactive materials not only provide a mechanism for education that does not require face-time with the healthcare provider, it also can give feedback on what the patient spent the most time reviewing, guiding the face-to-face discussion.
Healthcare literacy presents a huge challenge for medicine and public health. These articles provide a great springboard into the topic, giving us a framework for discussion as well as some practical tips for those of us authoring materials.