Be sure the materials and messages reflect the age, social and cultural diversity, language, and literacy skills of the intended users. Consider economic contexts, access to services, and life experiences.1 Beyond demographics, culture, and language, consider the communication capacities of the intended users. Approximately one in six Americans has a communication disorder or difference resulting in unique challenges.2 These individuals will require communication strategies that are tailored to their needs and abilities. Evaluate users' understanding before, during, and after the introduction of information and services.Talk to members of the intended user group before you design your communication intervention to determine what information they need to know and how they will use it. Then, pretest messages and services to get feedback. Test your messages again, after they have been introduced, to assess effectiveness. Refine content when necessary. Use a post-test to evaluate the effectiveness of the information. Acknowledge cultural differences and practice respect.Cultural factors include race, ethnicity, language, nationality, religion, age, gender, sexual orientation, income level, and occupation. Some examples of attitudes and values that are interrelated with culture include:
Ensure that health information is relevant to the intended users' social and cultural contexts.
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For print communication, use captions or cues to point out key information.3 Show the main message on the front of the materials. |
Make written communication look easy to read.3-5
Use at least 12-point font. Avoid using all capital letters, italics, and fancy script. Keep line length between 40 and 50 characters. Use headings and bullets to break up text. Be sure to leave plenty of white space around the margins and between sections.
Remember Refer to the Office of Management and Budget (OMB) Policies for Federal Public Websites for further guidance. |
Many of the elements that improve written and oral communication can be applied to online information, including using plain language, large font, white space, and simple graphics.7 Other elements are specific to the Internet. These include:
Enhancing text with video or audio files
Including interactive features and personalized content
Using uniform navigation
Organizing information to minimize searching and scrolling6
Giving users the option to navigate from simple to complex information
A critical way to make information on the Internet more accessible to persons with limited literacy and health literacy skills is to apply user-centered design principles and conduct usability testing.
Usability
is a measure of several factors that affect a user's
experience interacting with a product, such as a
Web page. These
factors include:
To learn more about usability, visit www.usability.gov. |
Ask questions using the words “what” or “how” instead of those that can be answered with “yes” or “no.” For example, “Tell me about your problem. What may have caused it?”3 Try asking “What questions do you have?” instead of “Do you have any questions?”
Plain English will not necessarily help individuals who do not speak English as their primary language and who have limited ability to speak or understand English. To better ensure understanding, health information for people with limited English proficiency needs to be communicated plainly in their primary language, using words and examples that make the information relevant to their potentially different cultural norms and values.
The “teach-back” method is a technique that healthcare providers and consumers can use to enhance communication with each other. The person receiving the health information is asked to restate it in their own words—not just repeat it—to ensure that the message is understood and remembered. When understanding is not accurate or complete, the sender repeats the process until the receiver is able to restate the information needed.8 Consumers also can be asked to act out a medication regimen.3
Easy-to-read flyer developed by the Centers for Disease Control and Prevention. The flyer was developed in multiple languages.
Tip: Checking
for understanding Summarize what the patient needs to do. Consider using a handout or brochure written in plain language. Explain what each medication is for, along with the dosage and side effects. Make sure the patient knows where the information is written down. Then check for understanding: “I want to be sure I didn't leave anything out that I should have told you. Would you tell me what you are to do so that I can be sure you know what is important?” (Source: Doak CC, Doak LG, Root JH. 1996. Teaching Patients With Low Literacy Skills. JB Lippincott Company: Philadelphia, PA.) |
Encourage colleagues to do the same. Consider organizing a training for health professionals and staff in your organization.
Checklist
for Improving the Usability of Health Information
ϖ Identify the intended users ϖ Use pre- and post-tests ϖ Limit the number of messages ϖ Use plain language ϖ Practice respect ϖ Focus on behavior ϖ Check for understanding ϖ Supplement with pictures ϖ Use a medically trained interpreter or translator |
1National Cancer Institute. Making Health Communication Programs Work. Washington, DC.
2National
Institute of Deafness and Other Communication Disorders.
Improving Health Literacy. Available at http://www.nidcd.nih.gov/
about/what.asp.
3Doak C, Doak L, Root J. 1996. Teaching Patients With Low Literacy Skills. 2nd Edition. JB Lippincott Co.: Philadelphia, PA.
4Plain Language Action and Information Network. Available at www.plainlanguage.gov. Accessed on October 21, 2005.
5American Institute for Research. 1981. Guidelines for Document Designers. Washington, DC.
6U.S. Department of Health and Human Services. Usability Basics. Available at http://www.usability.gov/basics/index.html. Accessed on October 13, 2005.
7Baur CE. 2005. Using the Internet To Move Beyond the Brochure and Improve Health Literacy. In Understanding Health Literacy. Schwartzberg JG, VanGeest JB, Wang CC, Editors. AMA Press, 141-154.
8Schillinger D, Piette J, Grumbach K, Wang F, Wilson C, Daher C, Leong-Grotz K, Castro C, Bindman AB. 2003. Closing the loop: Physician communication with diabetic patients who have low health literacy. Archives of Internal Medicine. 163(1): 83-90.