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Updated Jun. 2012

Rx for Better Health Care:
Plain Language

- by Maria Mindlin

When the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) launched a campaign to introduce its Universal Protocol to Prevent Wrong Site, Wrong Procedure and Wrong Person Surgery, they turned to plain language as a solution. Aimed at stopping surgical errors, the plain language Universal Protocol is written at the average American’s reading level (6th grade) and uses words most readers can easily read and understand. Here’s an excerpt:

Mistakes happen during surgery. Doctors sometimes do the wrong surgery or operate on the wrong part of your body. Or, they operate on the wrong person.

In contrast, most healthcare materials are written at the 10th grade level. The gap between document sophistication and consumer literacy skills is a growing concern in the health field.

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Low Health Literacy

The ability to obtain, comprehend and use information to make appropriate medical decisions is called “health literacy.” Research conducted by the National Adult Literacy Survey estimates “90 million Americans – half of all adults – may struggle with low health literacy.” Older adults, minorities, immigrants, and people with low income are especially at risk for low health literacy.[1]

Low health literacy has both human and financial costs. It can decrease the quality of patient care making it difficult for health organizations to function efficiently. According to the Harvard School of Public Health, there is a strong correlation between patients with low health literacy and:

  • poorer overall health,
  • hospitalizations,
  • misunderstood treatment explanations, and
  • inability to follow medical regimens.[2]

The American Medical Association reports, “Individuals with low health literacy incur medical expenses that are up to four times greater than patients with adequate literacy skills, costing the health care system billions of dollars every year for unnecessary doctor visits and hospital stays.”[3]

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Plain Language Solution

Using plain language to make sure patients can read and understand printed information is part of the solution. For example, a new DHS flyer on Flu Vaccinations uses the key features of an effective plain language document.

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Plain Language Features:

Sample of plain language health document: Who Should Get Flu Vaccine?
Click to enlarge

Transparent Title
The title conveys what the reader will learn: there is a shortage, and who can get vaccinated.

Limit the scope of information
Say why this information is important and what you want the reader to do. And, always provide resources where readers can find more information if they want it.

Register and grade level
This text uses conversational language and is written at the 4th grade level.

Style
Readers respond best to direct address (you) and succinct phrasings. For example, instead of “Criteria to Determine Eligible Populations for Flu Vaccinations,” it says “Who should get a flu vaccine?” Active voice is better than passive. And paragraphs, sentences, and words made short are best.

Subheads & Bullets
Easy-to-understand subheads followed by short paragraphs are a staple of plain language documents. Bullets break up the text and highlight important points. Use five or fewer bullets. If you use more, most readers will skip items in the middle.

Font type
San serif system fonts – such as Arial – are best. Unlike serif fonts, they stand up fairly well to photocopy, faxing, online display, and low-resolution printing.

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Field-testing

A document that is not field-tested on typical consumers is, at best, an educated guess. Conduct field tests at clinics, or local health branches and improve your document before you go to print.

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Translation

Plain language documents have less text and more white space – they are an ideal platform for translation into other languages, which generally expand by 25%.

Plain language translations are more accessible to people who have low literacy skills in their native language as well as in English. And plain language lowers translation costs, since translation agencies charge by the word.

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Plain language is contagious

Most public and private health organizations have specific readability goals for their documents. WIC (Women, Infants and Children) produces its materials at the 3rd–5th grade level. Other DHS branches set goals of 5th–7th grade.

Mario Gutierrez of the DHS Immunization Branch says internal research shows plain language forms are more effective. Since the department moved to plain language, there is greater consumer demand for the forms and higher levels of vaccination. Mr. Gutierrez noted, “[Since] one of our missions is to reach and educate every community, ethnicity and gender… Plain language is very important to all of us here in the health industry… I think it will become even more widespread and mandatory.”

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References and Notes

[1] Center for Health Care Strategies, Fact Sheet #2
[2] Harvard School of Public Health, Health Literacy: A prescription to end confusion
[3] Health Literacy Studies, American Medical Association

For more information on Readability and plain language call Transcend at 530.756.5834.

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