Communicating With Patients and Families: Developing Clear Written Information
Web-based module highlighting ways to make your written information more readable
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What Is Health Literacy?
American Medical Association Foundation defines health literacy as:
"the ability to obtain, process, and understand basic health information and services needed to make appropriate health decisions and follow instructions for treatment."
Health literacy is not restricted to only a person's ability to read and write, however, and does not apply only to the written word. Other factors that play a role in how well someone understands health information that they are told, see, hear, or read include:
- experience with the health care system
- cultural and linguistic factors
- the format of materials
- how information is communicated
If a person also has a communication disorder, difficulties with processing and using health information can only increase.
It may be helpful to think in terms of plain language, which is defined by the
U.S. Office of Disease Prevention and Health Promotion as a message "in which people can find what they need, understand what they find, and act appropriately on that understanding." Again, the concept of plain language is not restricted solely to the written word but to all forms of communication.
Why Is Health Literacy Important?
Being able to understand health information and make decisions from that information is vital to a person's well-being. Studies have shown a link between low literacy and poor health outcomes. For example:
- People with lower health literacy skills had a higher incidence of diabetes-related problems (
Schillinger et al., 2002)
- Poor literacy was associated with a higher risk of hospital admission (
Baker et al., 2002)
- Low functional health literacy in women with diabetes was associated with factors that may negatively impact birth outcomes (
Endres et al., 2004)
- Inadequate health literacy was associated with poorer physical and mental health in older adults (
Wolf et al., 2005)
Results of the
National Assessment of Adult Literacy (NAAL) were released in 2003. The NAAL looked at
adult skills in the following areas:
- Prose literacy—ability to search, comprehend, and use continuous text, such as magazine articles or brochures
- Document literacy—ability to search, comprehend, and use non-continuous text, such as maps, tables, and job applications
- Quantitative literacy—ability to identify and perform computations embedded in text, such as balancing a checkbook or filling out an order form
For each category, a person's skills were determined to be below basic (only simple and concrete literacy activities), basic (everyday literacy activities), intermediate (moderately challenging activities), or proficient (complex activities).
Key findings from the NAAL include:
- 43% of adults have below basic or basic prose literacy
- 34% of adults have below basic or basic document literacy
- 55% of adults have below basic or basic quantitative literacy
- For all 3 categories, only 13% of adults have proficient skills
The NAAL also included a health literacy component that looked at a person's ability to read and understand health information. Results indicated the following:
- 53% of adults had intermediate health literacy skills, 12% had proficient skills, and the remaining 35% had below basic or basic skills
- Women had average higher health literacy skills than men
- Hispanic adults had lower health literacy skills overall than any other ethnic or racial group
- Adults who spoke English only had higher health literacy skills than adults who spoke another language or spoke English as a second language
- Older adults (over age 65) have lower health literacy skills than younger adults
- Adults living below the poverty level have lower health literacy skills overall than those living above the poverty level
- Those with private health insurance had higher health literacy skills than those receiving Medicaid or Medicare funding or had no health insurance
- Adults with below basic skills were more likely to receive health information from the radio or television than from written materials (including the internet)
The Health Literacy of America's Adults: Results from the 2003 National Assessment of Adult Literacy
An important point to keep in mind, however, is that even people with proficient literacy skills appreciate receiving information that is clear and concise. This is particularly true for health information, which often has an emotional component related to the well-being of the person or loved one. Think of it this way—a person who can easily read and understand the warning label on a bottle of aspirin in the drug store may have significant difficulty reading a brochure handed to them in a doctor's office after being told they had diabetes or needed surgery. Everyone can benefit from clear information.
What Role Can SLPs and Audiologists Play In Health Literacy?
As specialists in human communication, SLPs and audiologists can provide insight into how to communicate complex messages to individuals who have limited literacy skills or understanding. Simply being an SLP or audiologist is not enough, however, to be competent at developing health literate/plain language messages. Developing such information is not as easy as it seems and requires input from various stakeholders and audiences. The first step is to learn more about health literacy and take advantage of online tutorials about developing plain language materials and messages. ASHA has developed a
resource list with links to relevant articles, websites, and tutorials to help you get started.
What Role Does ASHA Play In Health Literacy?
ASHA's vision, "Making effective communication, a human right, accessible and achievable for all" speaks to a commitment to consumers of speech, language, and hearing services. ASHA provides resources about communication and related disorders for the public in a variety of formats, including brochures, articles, radio and TV public service announcements, and Web-based information. Work is underway to ensure that consumer messages incorporate health literacy principles. In addition, ASHA is working to educate members about health literacy so that messages about the work of SLPs and audiologists can be understood and acted upon by the widest audience possible.
Tips for Developing Health Literate/Plain Language Materials
There are many publications, online tutorials, and other materials available that describe how to develop materials and messages that will reach the widest audience possible. You are strongly encouraged to use these resources as you develop information for the public. The following summarizes some basic points about communicating health messages.
- Know your audience—who they are and what they need
- Be clear about your message—what do you want them to do and what do they need to know to do it
- Engage your target audiences as reviewers to make sure you are getting it right
- Use short sentences
- Write with the active voice
- Use "you" and "we"
- Include little to no jargon; if jargon or acronyms area included, be sure to define them
- Emphasize key points in headings
- Chunk information (keep information that is related together in one area)
- Be clear about what you want them to do with the information you are providing
- Include a lot of white space in print materials
- Use bulleted lists
- Use pictures and graphics that are relevant to the message
Tips for writing Web information is available from the Office of Disease Prevention and Health Promotion
Toolkit for Making Written Material Clear and Effective is available from the Centers for Medicare and Medicaid Services
Health literacy and patient safety: Help patients understand)
- Slow down and take time to talk with the person/family
- Use plain language with limited terminology and jargon
- Use pictures to emphasize key points
- Give small amounts of information and repeat it
- Use a "teach-back" method (ask the person to tell you what you just told them)
- Encourage questions
See also: ASHA's
Health Literacy Resources.