Health Literacy Making Your Health Materials Understandable for All

1. Health LiteracyMaking Your Health Materials Understandable for All Paul D. Smith, MD Associate Professor University of Wisconsin Department of Family Medicine Paul.Smith@fammed.wisc.edu

2. Topics today • How to plan written materials • Testing readability • Other factors to consider

3. Reading Levels 20% of American adults read at or below the 5th grade level. Most health care materials are written above the 10th grade level.

4. Why is it so hard? • Complexity of information • Big words and medical jargon • Navigating the system • Insurance • Forms • Locating services

5. Why is it so hard? • Other barriers • Stress • Pain • Language

6. Why is it so hard? • Other barriers • Fatigue • Time constraints • Visual impairments

7. Planning Steps • Define the audience • Limit the objectives • Limit the message • Writing and production • Pre-testing

8. Define the Audience • Age • Gender • Culture

9. Define the Audience • Literacy level • Readiness to learn • Include audience in planning and writing

10. Limit the Objectives • Behavior change • Health belief model • Steps completed in a specific order • Procedural model • Gain attention • Story model

11. Limit the Message • Short and sweet • “Must include” information only!

12. Writing and Production • Select format • Description • Story • Questions and answers • Use examples

13. Writing and Production • Decide how to include interaction • Ask reader questions • Taking a quiz • Test readability

14. Written Materials- Common Mistakes • Too much detail • Hard words are not explained • Pictures do not reinforce the message • No examples

15. Written Materials- Common Mistakes • Readability level is too high • Long sentences • Reader not asked to interact with material • Use of passive voice

16. Take your medicine with your meals. The nurse will bandage your arm. Passive vs. Active Medicine should be taken at mealtimes. Your arm will be bandaged by the nurse.

17. Exercise regularly Don’t lift anything heavy Get adequate rest Exercise 3-5 days per week for 40 minutes Don’t lift anything over 10 pounds. Get at least 7 hours/night Value Judgment Words

18. Readability • Review materials for reading level • 5th – 6th grade reading level • Flesch-Kincaid grade level • Flesch Reading Ease • SMOG-Simple Measure Of Gobblygook

21. Objectives • Acquire an understanding of the definition of literacy, health literacy and the magnitude of the problem in Wisconsin. • Identify people at increased risk of low literacy • Acquire an understanding of specific activities they can do to improve verbal communication with all patients, especially low literacy adults • Identify the important issues to address when developing educational documents for low literate adults Flesch-Kincaid Grade Scale: 12

22. Objectives • Acquire an understanding of the definition of literacy, health literacy and the magnitude of the problem in Wisconsin. • Identifypeople at increased risk of low literacy • Acquire an understanding of specific activities they can do to improve verbal communication with all patients, especially low literacy adults • Identify the important issues to address when developing educational documents for low literate adults Flesch-Kincaid Grade Scale: 12

23. Topics today • General health literacy information • How to recognize people with low literacy • How to improve communication • Factors to consider when creating documents Flesch-Kincaid Grade Scale: 12

24. Topics today • Health literacy. • Finding people with low literacy. • How to improve communication. • How to make things easier to read. Flesch-Kincaid Grade Scale: 7.1 (talking for communication = 5.1)

25. Written Materials • Look on the internet. • Print as is. • Use as a place to start. • Rewrite as necessary.

26. Written Materials • Use short sentences • 10-15 words • Simple language • Monosyllable words

27. Written Materials • Be consistent with words and terminology. • Define technical or difficult words.

28. Written Materials • Important concepts first • Use bulleted lists instead of blocks of text • Use headings and subheadings

29. Written Materials • Use a readable type style—usually one with serifs—the little “feet” on the bottoms of the letters that you see in this type. • Arial • Helvetica • Times New Roman

30. Written Materials • Use 12-14 point type for text. • Use 16-18 point bold type for headings. • Use upper case and lower case for the text. ALL CAPITALS ARE HARDER TO READ

31. More hints…. • Have a 50/50 blend of white space and type. • Use summary techniques. • Do not justify the right margin • Use columns : 50-60 characters wide. • Use pictures.

32. Diabetes Pamphlet Example

33. Beyond handouts • Pictures and models • Audiotapes and CDs • Videotapes and DVDs • CD-ROM • Internet

34. Group Exercise • Review a patient handout • Rewrite underlined passage • Pick a recorder • Rewrite at 5th grade level • Bring up front when done

35. Group Exercise • Critically appraise the handout • Recorder will summarize for group • Identify appropriate techniques used • Identify things that could be done better

36. Summary • Readability matters, but is just the beginning • Plan carefully • Activate the reader • Test with the audience

37. More Information • Health Literacy Resources.doc • On your Summit CD

38. Keep in Mind • Health Literacy Definition • The degree to which individuals have the capacity to obtain, process, and understand basic information and services needed tomake appropriate decisions regarding their health. • Universal Design

39. Contact Information Contact me if you want the Power Point file for this presentation Paul.Smith@fammed.wisc.edu