It’s Health Literacy month in October, but at The Difference Health Literacy is a priority topic 365 days a year.
Communicating on the right level for the people who need to hear and act on messages demands a different perspective. Some might say it’s the ultimate test for a writer who may be more used to writing that’s designed to impress and persuade peers and professionals.
It takes a lot of experience and skill to produce clear, accessible, accurate and compliant copy that everyone can understand. Making it engaging is an even finer art.
Sally Snow is a talented medical writer and communicator with a track record of taking health literacy communication to that next level for a long list of clients. Here, she explains her approach and shares practical tips for health literacy writing.
Health literacy is a person’s ability to find, understand and act on health information.1 It is widely recognised as a key factor in health equity.2 Leaders in the pharmaceutical industry are increasingly considering health literacy as a critical step in their content creation process. As a result, health literacy reviews now form a substantial part of my work as a Difference Collective Consultant.
In 2022 alone, clients have asked us to conduct health literacy reviews on brochures, websites, videos, disease awareness presentations, question & answer documents and regulatory items like medication guides and patient information leaflets.
How do I approach a health literacy review?
When I start a health literacy review, the first thing I consider is the intended audience. Who are they? What are their information needs? What do they need to do as a result of getting this health information?
Once those fundamental questions are answered, I look at what is standing in the way of understanding and action. In some cases, unnecessary information or irrelevant pictures are making the key points hard to find quickly. It could be that the text itself is too small, or on a busy background that is hard to see. Often, the words themselves are too hard to understand – they are not everyday language for the reader.
A lot of our work involves stripping out detail. Making simple formatting tweaks like menus, subheadings or bullet points. Chunk and check – breaking content into digestible chunks and consolidating understanding before moving on – is a principle that works across audio, video, websites and written content.
At The Difference Collective, I am also lucky to be able to tap into the skill of designers and animators who can use visuals to make key points engaging and memorable.
How do we measure the difference?
It is always nice to see a numerical change to demonstrate a return on investment. Readability scores are a good starting point and they are core tools for our health literacy reviews. Readability is an objective measure of how easy it is for a person to read a piece of text.3
There are several validated readability scores for English language text, typically based on word length and sentence complexity. I think the easiest score to understand is the Flesch Kincaid Grade Level. This provides an estimate of the number of years of formal education a person would need to understand the text. So, grade level 4 would be understood by a person who has completed 4 years of formal education. When producing medical information for a general adult audience, a Flesch Kincaid readability score between 4 and 8 is a good target.4
But caution is needed. The following randomly-generated text has an on-target Flesch Kincaid readability score of 5: “Gallon wash condition is build bars. Regulate other fine has in climate. Coin read flex foxes into pass. Garage society snub. Transport wake member has tender.” So clearly, readability scores have their limits.
Readability scores also need to be validated in specific languages. That means additional health literacy review steps need to be taken in localisation of global patient information campaigns.
A focus on the end user
We don’t just need people to be able to read health information, we also need them to understand what it means. In most cases, we also need people to be motivated and equipped to take action as a result of interacting with the content.
While there are some general evidence-based principles for making content more “understandable” and “actionable”,5 it is an art more than a science. Content (words or images) that resonates with one person will not always resonate with another – particularly people from different cultural backgrounds. To gain that deeper level of cultural understanding, there is no alternative to talking to people in our target audiences.
I recently worked on health literacy optimisation for a disease awareness campaign. The main thing we wanted people to remember was a list of signs and symptoms. The original content included icons to illustrate and highlight these symptoms. This is generally good practice, as pictures can speak louder than words. However, the icons were very medical: the stomach, a pelvis bone, a cross-section of the eye.
We felt it was very important to test the impact of these visuals with people representing the age and ethnicity of the target audience. So, we assembled a small group and conducted some qualitative research with the original images and a selection of alternatives. Even as someone who has been working in patient information for more than a decade, the feedback was enlightening. “That says nothing to me” or “is that supposed to be a hose pipe?” clearly demonstrated that the original icons were detracting from understanding. As a result, we were able to demonstrate a rationale for change and a qualitative improvement in this key aspect of the content.
Behaviour change is the ultimate goal of most health information. Through a combination of evidence-based health literacy principles and user research, it is possible to make content more understandable and easier to act on. When we get a client brief to review health information from a health literacy perspective, we apply a range of qualitative and quantitative assessments. These usually show that a few well-considered tweaks to wording, layout or images will result in measurable improvement.
We are also strong advocates for involving the intended audience in content design and evaluation. Finding people who represent the right age group, cultural background and education level is essential. Properly designed user research takes time and skill, but it is absolutely worth the effort.
The Difference Collective is a group of health literacy experts, communicators and healthcare strategists. Get in touch to discuss how we can help you look at your organisation’s approach to health literacy and help you produce better health information.
1. Centers for Disease Control and Prevention (CDC). Health literacy. Website available at: https://www.cdc.gov/healthliteracy/learn/index.html [Accessed 30 September 2022]
2. Public Health England. Improving health literacy to reduce health inequalities. Practice resource summary: September 2015. Available at : https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/460710/4b_Health_Literacy-Briefing.pdf [Accessed 30 September 2022]
3. Readable.com. Website available at: https://readable.com/readability/ [Accessed 30 September 2022]
4. Oliffe M, Thompson E, Johnston J, et al. BMJ Open 2019;9:e024582.
5. Shoemaker SJ, Wolf MS, Brach C. Patient Educ Couns 2014;96(3):395-403.
Sally Snow, is a medical writer and communicator with over 10 years of experience in the healthcare and pharmaceutical industries. She specialises in translating technical information for lay audiences and has a particular interest in promoting health literacy.