Practical Tips for Health Literacy
Health Literacy is the ability to read, compute, understand and act on health information to make informed decisions. Health literacy affects people's ability to navigate the healthcare system, including filling out complex forms and locating providers and services; share personal information, such as health history, with providers; engage in self-care and chronic-disease management, and understand mathematical concepts such as probability and risk. Low health literacy is a serious threat to the well-being of persons seeking medical care. With the increasing diversity of clients, we may observe that our communication skills are less effective with people from backgrounds different from our own.
Possible signs of low literacy and illiteracy include:
- Poor compliance with treatments and appointments
- Watching and mimicking others
- Not knowing the names of regularly used medications
- Making excuses for not reading (e.g., forgetting glasses)
- Bringing someone who can read to appointments
- Vocalization or sub-vocalization when reading
- Confusion or frustration when reading
Health information can overwhelm even persons with advanced literacy skills because medical science progresses rapidly. Moreover, health information provided in a stressful or unfamiliar situation is unlikely to be retained. Quite simply, the responsibility is ours as health professionals to facilitate health literacy through communication in plain language. Without clear communication, we cannot expect people to adopt the healthy behaviors and recommendations that we champion. When people receive accurate, easy-to-use information about a health issue, they are better able to take action to protect and promote their health and wellness.
Plain language is a strategy for making written and oral information easier to understand. It is one important tool for improving health literacy. Plain language is communication that users can understand the first time they read or hear it. With reasonable time and effort, a plain language document is one in which people can find what they need, understand what they find, and act appropriately on that understanding. Remember too that speaking plainly is just as important as writing plainly. Many plain language techniques apply to verbal messages, such as avoiding jargon and explaining technical or medical terms.
So how can you communicate using plain language? Following are some strategies you can use in your day-to-day practice:
- Consider health literacy by making information accessible. This refers to the ability of practitioner to improve how they use information to educate clients. Adapt the information to individual needs, circumstances and abilities to show how it is relevant. Communicate in a comprehensive way using more than one way of exchanging information - combine oral instructions with written information. Be sure to include demonstrations and audiovisual aids.
- Communicate effectively and simply in an atmosphere conducive to communication. Announce the subject, convey the message, and ask clients to say in their own words what they remember of the information or methods taught. This 'teach-back' technique provides opportunities to identify misunderstandings and correct them.
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When providing written materials such as home programs or handouts, consider the following
tips and guidelines:
- Content. Ensure the purpose is immediately outlined and clear to the reader. Ensure content is balanced, accurate, and up-to-date and that you include a publication or revision date on all materials.
- Organization. Use subheadings, question and answer format, bullet points, and summaries to make it easier to read.
- Layout. Use ample white space. Use serif typefaces (these are the ones with “little feet” on the letters), minimum 12-point font size, and good contrast between text and background. Note that black text on a white background is best. Avoid capitalizing all letters in words, italicizing, and the use of Roman numerals.
- Illustrations. Use instructive, culturally appropriate illustrations but only if they augment the message. Be sure to position illustrations next to the text they refer to and clearly label all illustrations.
- Language. Aim for a 5th to 6th grade reading level. Use clear, simple, common language, and short sentences and words. Avoid jargon and define specialist terminology. There are many tools available to help you determine reading level. These include the Fry Readability Formula and the Flesch-Kincaid Grade Level Readability Formulas (available at www.readabilityformulas.com). Microsoft Word also includes a feature providing reading ease statistics including word count and readability level. Avoid abbreviations. For example, while ROM is familiar to the therapist, the patient may not understand what this means.
- Writing style. Use plain English and make every word count; be clear and brief. Use concrete and familiar words sticking to one or two syllable words when possible. Avoid long sentences and use short lists or bullets instead.
- Limit the number of messages. Place the most important information first. Stick to one idea at a time focusing on what your reader needs to know. Give your audience no more than three or four main ideas per document or section of your document. Tell your audience what they will gain from understanding and using the material you are providing (i.e., Answer the question, “What's in it for me?”).
Clinicians, including nursing and therapy, can assist in ensuring that all health-related information and education provided to recipients of our services match that person's literacy abilities; cultural sensitivities; and verbal, cognitive, and social skills.
