By Sandra Zaragoza, Sr. Marketing and Communications Specialist, Health Confianza
Melanie Stone, DrPH, MEd, Co-director of Health Confianza, Assistant Professor of Family & Community Medicine and Director of Community Service Learning, The University of Texas at San Antonio
San Antonio, TEXAS — Health communications are an ever-present part of our daily lives — a flyer at a health fair, an in-take document at the doctor’s office, a wellness TikTok, an infographic, or a written follow-up we receive from our health provider.
While health communications are around in different forms, they may be filled with medical jargon, complex sentences and hard-to-follow guidance.
In short, they may not be written in plain language. Plain language is defined as communication with clear wording, structure, and design for the intended audience to easily:
– find what they need
– understand what they find
– use that information
Increasingly, the health care and nonprofit communities are recognizing the important role of plain language in removing barriers to health care, enhancing patient safety and increasing the patient’s ability to make informed health decisions.
At the same time, training in plain language communication is not a part of standard education for health care providers, which means plain language must be intentional.
Fortunately, we are beginning to see more health providers, community health workers and health communicators learning plain language skills and making this a communication priority in their organizational policies and practices.
Spotting the Mistakes
One of the easiest ways to start employing plain language is to be able to spot when it doesn’t meet the standards. To that end, the Institute for Healthcare Advancement (IHA) created a list of the 10 most common errors that health providers make when communicating with patients.
IHA points out that health providers tend to create prescription instructions “that are written at an 11th grade reading level or higher, rather than 5th grade reading level at which the majority of the country’s population reads.”
Another common error, according to IHA, is handing out reading material that is printed in a font size too small for the patient, particularly seniors. The type should be at least 12-point font with adequate space between lines.
Additionally, the power of graphics is often overlooked when creating materials, according to experts.
IHA points out that simple visuals for medical instruction can enhance patient understanding. However, they warn that graphics should demonstrate and explain concepts in the text and should never be abstract or for decorative purposes only.
Overburdening patients with numeracy skills is another area to be mindful. Providing context for numbers (use 1 in 5 versus 20%), removing the need for the reader to perform calculations, and using appropriate visuals can help improve plain language numeracy.
Unfortunately, mistakes in health communications come with both a human and financial impact, with an estimated $236 billion in unnecessary health care expenses annually due to the inability of patients to understand what medical providers are communicating to them, according to a 2008 article in Nurse Educator.
The good news is that there is guidance, techniques and tools that encourage the use of plain language.
History of Plain Language
The Plain Writing Act of 2010 requires federal agencies to train staff to use plain language when they communicate with the public. As part of that act, the federal government offers plain language guidance.
Among the most common techniques for achieving plain language:
- Reader-centered organization
- “You” and other pronouns
- Active voice, not passive
- Short sentences and paragraphs
- Common, everyday words
- Easy-to-follow design features (lists, headers, tables)
Additionally, The Center for Plain Language offers 5 Steps to Plain Language that each include more detailed information:
- Identify and describe the target audience
- Structure the content to guide the reader through it
- Write the content in plain language – keep it short and to the point
- Use information design to help readers see and understand
- Work with the target user group to test the design and content
Health literacy experts recommend that health professionals initially introduce the medical term that the patient will encounter (e.g. myocardial infarction), immediately followed by the plain language version (e.g. heart attack). This will help the patient connect the terms. Also, use analogies the patient may be familiar with to help make the medical concept clearer, such as the mechanics of a car representing your cardiovascular system.
How to Check if it’s Plain Language
There are paid and free tools that can help a health communications professional review and assess adherence to plain language principles.
Some examples are:
Free Resource: The National Library of Medicine’s Health Education Materials Assessment Tool (HEMAT)
Paid Resource: Health Literacy Innovation’s Health Literacy Advisor (HLA) – software that assesses and improves the readability of your documents using plain language principles
While technology can be a useful tool to enhance plain language (e.g. using a chatbot to write your information in a conversational tone), a human editor is still needed to check for accuracy, potential misunderstandings, and overall use of plain language principles.
Keeping Plain Language Top of Mind
One way to keep an organization or team thinking in terms of health literacy and plain language is to make sure they have access to trainings, refresher courses and webinars.
The U.S. Centers for Disease Control & Prevention, the Center for Plain Language, Health Confianza are just some of the organizations that offer affordable health literacy education.
“Communication is only effective if the receiver actually comprehends the message sent,” said Melanie Stone, DrPH, MEd, co-director of Health Confianza. “I often remind health care professionals, ‘What’s the point of your medical knowledge if you cannot convey it to the person who needs it?’ I challenge our trainees with the quote from Albert Einstein, “If you can’t explain it simply, you don’t understand it well enough.” Plain language helps ensure people understand what you are saying the first time you say it.”
Related Health Confianza Articles and Resources
A Brief Intro to the 5 Ts of Teach-Back
4 Tips for Better Health Communication
Organizational Health Literacy Toolkit