February 10, 2009 Features

Health Literacy

Improving Web and Print Materials for the Public

Second in a three-part series

Although not all audiologists and speech-language pathologists can cite the formal definition of health literacy, many understand the concept. For example, when asked their opinion of ASHA's "Let's Talk" consumer education materials in a recent survey, a number of respondents noted that their clients have difficulty understanding the text. Examples of their comments reflect the growing understanding of the issue of communicating clearly with patients and families:

  • "These seem to be written at a reading level higher than what is recommended for the general population."
  • "I would prefer that the information be less wordy. The wording makes them not appropriate for some patients."
  • "We tried using one on early identification in a public newsletter in a small, neighboring community, but were told by readers that it was too hard to understand the information. It was disappointing. Maybe they should be rewritten at a lower/easier reading level?"
  • "I work in a rural hospital and many of my patients' families have a low level of education which can make the handouts difficult to understand. More pictures would help."

Online Information

Taking the lead among allied health professions, ASHA conducted an audit of all its online and print public education information. The audit revealed that ASHA has produced information on more than 150 topics such as childhood development, the wide range of communication disorders, and prevention.

In response to member concerns and a growing body of literature on health literacy, ASHA set out to improve its consumer education materials. The results will help members communicate more clearly with their clients and help the public understand what audiologists and SLPs do and when to seek their services.

In 2006 ASHA began revising its Web-based information to make it more accessible to the public. As a first step, more than 40 pages in the speech, language, and swallowing section were edited to be more consistent, current, and user-friendly. The goal was to reduce jargon, use more bulleted lists, "chunk" information, and ease online navigation.

To address the needs of ASHA's large public audience—patients, parents and other caregivers, teachers, administrators, physicians, students, and more—information was organized into three categories according to the level of detail: basic information about the disorder, signs or symptoms, and other available information; more detailed information on topics such as the causes of disorders, incidence/prevalence data, and related articles from The ASHA Leader; and detailed information with links to treatment efficacy topics, ASHA policy documents, and research information.

Using the education (described by grade level) required to understand the information as a measurable guide of success, pages were assessed before and after revision. Many pages on the site were written at or above the 12th-grade level and were revised to be closer to the reading level of eighth- and ninth-graders. Further online revisions are planned to meet the needs of American adults who, on average, read at about the sixth- to eighth-grade level.

Images were also added to this section of the Web site to help users locate their desired sections; in addition, a consistent and clear icon now links potential clients to ASHA's online "Find a Professional" database. A Spanish-language section was also added to this Web site.

Print Materials Under Revision

Much of ASHA's information for public audiences is available in print materials such as brochures and flyers—and an initial assessment showed that most included too high a reading level (some at college-level), too much text and jargon, and limited graphics. ASHA is working to improve these materials to better meet the needs of targeted audiences. After the supply of a brochure on voice disorders was distributed, for example, staff edited the brochure. The newly reprinted version reduces jargon, uses consistent terminology ("vocal cords" rather than inconsistent use of both "vocal cords" and "vocal folds"), and includes more meaningful photos and illustrations.

Revising print materials, like online information, takes time as ASHA analyzes the best ways to communicate clearly with the public about complex clinical topics.

Member Contributions

ASHA is ahead of most professional organizations in recognizing the importance of health literacy, revising its information, and educating members. ASHA's Web site has included a regularly updated page on health literacy for a few years. The ASHA Leader has published a number of articles on health literacy (visit the ASHA Web site and search on "health literacy"). Information has appeared in other ASHA communication vehicles such as the Access SLP Health Care and Access Audiology e-newsletters.

Members are also making important contributions. Alice Kahn and Mary Pannbacker assessed the readability of patient education materials from ASHA and the American Cleft Palate-Craniofacial Association. Paul Rao, Eva Hester, and Mercedes Benitez-McCrary have contributed articles to The ASHA Leader and presented on this topic at the ASHA convention. In 2009, an article on health literacy and the role of the SLP from Eva Hester and Regena Stevens-Ratchford will be published in the American Journal of Speech-Language Pathology. As this list—although not exhaustive—demonstrates, the focus on health literacy is growing in the professions.Members are thinking more about the issue and working to communicate more clearly with patients and families every day.

If you are interested in improving your verbal and written communication with your clients and patients, visit the ASHA Web site. ASHA welcomes feedback on the work being done on consumer-focused information. 

Part 1 (Jan. 20) of this three-part health literacy series discussed the basics of clearly communicating health information. Part 3 will explore the link between health literacy and cultural competence in the professions.

Amy Hasselkus, MA, CCC-SLP, associate director of health care services in speech-language pathology, can be reached at ahasselkus@asha.org. 

cite as: Hasselkus, A. (2009, February 10). Health Literacy : Improving Web and Print Materials for the Public. The ASHA Leader.

A Health Literacy Example: Revising a HIPAA Privacy Notice

ASHA has heard from members struggling to communicate clearly with their patients. To help describe the process of developing information for clients and families, let's consider what might be involved in writing a HIPAA privacy notice. The typical privacy notice is long, text-heavy, and full of medical and legal jargon. To help practitioners write notices in plain language, the Health Resources and Services Administration (HRSA) published a resource freely available online. Using this information as a guide, consider the following example:

You are a private practitioner who needs to write a privacy notice. First, you assess your caseload and note the following characteristics:

  • More than half are from homes where English is not the first language
  • Some are children who are cared for by their grandparents
  • Many do not have formal education beyond high school

Realizing that most adults in the United States read at the eighth-grade level or below, you decide to try to write a privacy notice at the sixth- to seventh-grade level to reach the majority of your patients. Following recommended guidelines, you also make sure that any visuals you choose reflect your diverse caseload.

When thinking about the layout, you decide to use a larger font size so that it is easier for the older patients to read. You also make sure there is plenty of white space by using two columns and more spacing so that it doesn't "look" hard to read. This change will make the notice longer but it's worth it if more people can understand the information you are giving them.

You then think about the content. You realize that there are words and phrases commonly seen in privacy notices that some of your clients will have difficulty with, such as "disclose" and "access to your records." The HRSA document suggests alternative terminology that may be more meaningful to your clients. For example, you can reflect these concepts of access and disclosure in a statement such as "This notice tells you about how your health care records may be used or shared. It also tells you how you can ask to see your records" (sixth-grade reading level). Ideally, you will be able to test your materials with your clients to determine how well they understand it and if they know what to do as a result of reading it.

By spending time to make sure the information you share with patients is understandable, you encourage your patients to ask questions about their records and participate more fully with you in their treatment. 


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