Article originally appears in the August 30, 2018 issue of the SNEB eCommunicator.
It has many names – low literacy, readable, plain/clear language (my preference, reader-friendly) but one goal – communicating clearly. We often point to the reading level of our audiences as the reason to write below a certain reading level – writing at or below 8th grade for the U.S. public but lower reading levels may be more appropriate for your audience. Here are 2 compelling reasons for clear communication: 1) everyone benefits from plain language because it takes less time to read and understand; and 2) clear language means less text. Here are my tips for clear communication. Additional resources follow the list.
- Use the active voice – it tells the reader who is doing the action.
- The power of 3’s – try to limit your lists to three items (think of the 3 bears or the 3 musketeers).
- Words matter – choose simple words (why use ‘cardiovascular health’ when ‘heart disease’ will do?), avoid nutrition jargon and acronyms. Also, avoid sayings that may confuse the reader/listener (imagine talking about food and you say ‘like 2 peas in a pod’ causing listeners to be distracted from your important nutrition message).
- Use readability formulas correctly (prepare your text and use the right formula – they aren’t all the same).
- Use numbers sparingly and consider using a visual to reinforce them (show 75% by a visual of 3/4 or ask 3/4 of your audience to stand up). Numeracy lags behind literacy for most Americans.
- Design matters – white space, font size, paragraph headings (they’re a ‘heads up’ for the reader to alert them to what’s coming next). Writing for the web? Be aware of reader skimming patterns when placing important information – an F pattern when reading text or a Z pattern for less text-heavy parts of a webpage explained @ http://babich.biz/zpattern/.
- Include interaction. Give the user opportunities to write on written material.
- Photos are best especially when they are of people or food. And make sure your food photos are culturally appropriate.
- Pilot even if you have limited time, resources and people available.
- Use questions. This suggestion came from a literacy expert. She noted that questions invite the reader to keep reading.
Read these articles
>>>Assessing readability formula difference with written health information materials: application, results and recommendations
Variability between readability formulas may vary by as much as 5 grade levels – SMOG is recommended for written health materials but only if the text is long enough.
https://www.ncbi.nlm.nih.gov/pubmed/22835706
>>> Appropriate language in clinical settings beneficial in diabetes care
Do words matter when working with patients? According to this literature search @ https://www.healio.com/endocrinology/diabetes-education/news/in-the-journals/%7B343d816f-644d-4538-b2f0-11f630f7092c%7D/appropriate-language-in-clinical-settings-beneficial-in-diabetes-care negative terms aren’t the best language to use in diabetic care and may lead to disengagement by patients as well as poor clinical outcomes.
>>>Federal government readability score card (2017 – 6th year)
In the early 2010’s the federal government began a plain language push due to a law requiring the federal government to write documents for the public in plain language beginning 2011. Here is one ‘report card’ on agencies’ plain language efforts.
https://federalnewsradio.com/wp-content/uploads/2017/10/2017-Federal-PL-Report-Card-White-Paper.pdf
Infographics
>>>Why use plain language? (Infographic)
Short, but sweet, 10 steps to plain writing and some word substitutions.
https://www.census.gov/content/dam/Census/about/about-the-bureau/policies_and_notices/10_simple_steps.pdf
>>>Plain language please (infographic)
Real world examples of the positive effects of plain language, some ‘before and after’ text, word substitutions.
https://visual.ly/community/infographic/education/plain-english-please-infographic
>>>In plain language please! (infographic)
Word and phrase substitutions as well as examples of wordiness to avoid.
https://americantesol.com/blogger/infographicplainenglish/
Speaking clearly
>>>Plain language in spoken communication
Good tips for speaking clearly.
https://www.plainlanguage.gov/resources/articles/plain-language-in-spoken-communication/
>>>Listening and speaking
Tips for health care providers includes the reminder to ask the patient to repeat, in their own words, what they need to do.
https://healthliteracy.com/2018/02/01/listening-speaking/
Books
>>>Teaching Patients with Low Literacy Skills by Cecilia Doak, Leonard Doak and Jane Root (2nd ed, 1995)
Now out of print but available for download (with the authors permission) @ https://www.hsph.harvard.edu/healthliteracy/resources/teaching-patients-with-low-literacy-skills/
>>>Health Literacy from A to Z: Practical Ways to Communicate Your Health Message by Helen Osborne (2nd ed, 2018)
https://healthliteracy.com/2015/04/22/health-literacy-from-a-to-z-second-edition-practical-ways-to-communicate-your-health-message/
Podcasts
>>>Health Literacy Out Loud
Several podcasts on important health literacy topics such as speaking clearly, culture and older adults.
http://www.healthliteracyoutloud.com/
>>>10 Minute Tech (University of Alabama at Huntsville)
Jan. 13, 2016 (11 minutes)
https://www.stitcher.com/podcast/uah-technical-writing/10minute-tech-comm
Checklists/tools/detailed guides
>>>SAM – Suitability Assessment of Materials developed by Cecilia and Leonard Doak and Jane Root in 1993 (10 pp)
A tool to evaluate health information for readability and comprehension.
http://aspiruslibrary.org/literacy/sam.pdf
>>>A link to various checklists to help you write more clearly.
https://www.plainlanguage.gov/resources/checklists/
>>>Best practices for creating nutrition education materials (USDA’s MyPlate)
https://www.choosemyplate.gov/best-practices-creating-nutrition-education-materials
>>>CDC’s Clear Communication Index
A research-based tool to assess and develop communication materials includes a user guide, score sheet and other materials.
https://www.cdc.gov/ccindex/index.html
>>>CDC Simply Put: a guide for creating easy-to-understand materials (44 pp, 2009)
https://www.cdc.gov/healthliteracy/pdf/Simply_Put.pdf
>>>Writing and testing plain language
Before/after examples – pp. 4 – 7
https://msktc.org/lib/docs/KT_Toolkit/MSKTC_Plain_Lang_Tool_508.pdf
Readability formulas
>>>Advantages & disadvantages of using readability formulas
Readability formulas have their use and misuse. You are likely to get a wide variety of results when using different formulas. Using formulas can help guide your writing.
http://www.readabilityformulas.com/articles/advantages-and-disadvantages-of-readability-formulas.php
>>>How to prepare your text to help readability formulas calculate an accurate grade level
Punctuation and titles can impact your readability analysis as sentence length is part of readability analysis.
http://www.readabilityformulas.com/articles/how-to-prepare-your-text-for-readability-formulas.php
>>>Readability tools including online options and software
https://medlineplus.gov/etr.html
There are many formulas, here are more about some of them:
SMOG
http://www.readabilityformulas.com/smog-readability-formula.php
>>>Fry graph
http://www.readabilityformulas.com/fry-graph-readability-formula.php
>>> Cloze test (tests comprehension not just readability)
https://www.nngroup.com/articles/cloze-test-reading-comprehension/
>>>Kansas WIC uses Fog Index
http://www.kansaswic.org/manual/NED_03_04_00_Evaluation_of_Nutrition_Education_Materials.pdf
Other resources
>>>Health Literacy Innovations
Slides from a series of webinars on health literacy.
https://healthliteracyinnovations.com/resources/webinars
>>>CDC Health Literacy training
6 online health literacy training courses (some provide completion certificates)
https://www.cdc.gov/healthliteracy/gettraining.html
>>>Other online health literacy, plain language, culture and skill-building training
https://www.cdc.gov/healthliteracy/non-cdc-training.html