THE NEED FOR PLAIN LANGUAGE PATIENT EDUCATION MATERIALS By Lauren Davison

PRESENTATION OVERVIEW The goal of the medical writer is to present patients with usable patient education materials Plain language follows certain standards that make it easier for the layman to understand Health literacy is the ability to interpret and navigate the healthcare system Patients need plain language documents to understand medical information There is a gap between the layman’s reading level and the level at which patient education materials are written There are ways to improve patient education materials and increase health literacy

REACHING THE GOAL In order to reach this goal, medical writers should strive to provide patients with patient educational materials written in plain language that can be understood by people with varying health literacy skills To provide patients with patient education materials that deliver usable information that allows a patient to improve their quality of life by making health behavior changes GOAL OF THE MEDICAL WRITER

WHAT IS PLAIN LANGUAGE? “Plain Language is communication that an audience can understand the first time they read or hear it. It is clear and concise, and uses short sentences and simple words. It keeps to the facts and is easy to read and understand. Plain language is simple and direct but not simplistic or patronizing” (Wicklund and Ramos 178) Plain language is most commonly discussed from a legal perspective, but medical writers can use it to better communicate with patients

WHAT IS HEALTH LITERACY? Health literacy is: “Having the specialized vocabulary, knowledge, and skills to manage one’s own health Using multiple information formats in multiple locations to accomplish tasks (e.g. reading food labels in a supermarket, medicine instructions at the pharmacy, safety regulations at work, consent forms in the hospital, etc.) Mastering the arcane American health insurance and health delivery systems … Overcoming high levels of stress and anxiety associated with health decision-making” (Stableford and Mettger 73)

WHY DO PATIENTS NEED PLAIN LANGUAGE? Health literacy is a global issue because most people have limited health literacy skills When patients receive treatment or research conditions, they have to navigate through the healthcare system and understand their conditions Plain language helps patients to understand their health because it provides usable information by avoiding jargon and verbose wording. Patients’ health literacy skills are limited

THE READING LEVEL GAP “Patient education materials, informed consent documents, patient package inserts, and medical directives are often written at reading levels associated with college or graduate school reading skills and do not match the reading skills of the people for whom they are designed” (qtd. in Rudd et al 196) Impact Information Plain Language Services suggests writing public health and safety information at the 5 th grade level, based on the results from the National Adult Literacy Survey (NALS)

In 2003, approximately 14% of people tested at the “Below Basic” level. These people are unable to do the following things: Understand the instructions on a medicine container Read the safety instructions for operating machinery Compete effectively for today's jobs (“Know Your Readers”) Comparison of literacy levels in 1992 and 2003 (“Know Your Readers”).

This gap between the grade level patient education materials should be written at and the grade level at which they are actually written is problematic because if patients cannot understand the information with which they are provided, they cannot make informed decisions about their healthcare “Adults with diabetes, asthma, and heart failure who cannot follow self-care instructions are hospitalized for complications. Patients who take the wrong dose of medicine may end up in an emergency room or the hospital” (Stableford and Mettger)

SUGGESTIONS FOR IMPROVING PATIENT EDUCATION MATERIALS Before this issue can be fixed, the reality of the issue must be realized The Office of Disease Prevention and Health Promotion, Agency for Healthcare Research and Quality, and Health Resources and Services Administration (“Federal Agency Links about Health Literacy”) are working to improve health literacy; these agencies need to do something more public to communicate the serious issue that limited health literacy presents Perhaps with more publicity significant improvements could be made; agencies could offer help to those with low health literacy skills (e.g. Make it easier to receive healthcare system training)

Improve patient education materials by writing in and designing with plain language: Write content that is well-organized and easy to understand in a short amount of time Avoid jargon (or technical wording) to improve readability Use a conversational tone instead of a formal one while maintaining accuracy of all scientific information (Stableford and Mettger 79) Consider the audience while preparing content Design for usability (e.g. headings, white space, use of color, etc.)

Below are a few additional suggestions from Rudd et al: “Substitute everyday words for multi-syllabic and unusual terms Re-write all complex sentences and, where needed, substitute two or three sentences Re-write all sentences in an active voice Insert words such as “we” and “our” to maintain a collaborative and personal voice Assess all tables, charts, and graphs for complexity Simplify complex tables, charts, and graphs Substitute two or three simple charts in place of one complex chart Consider use of color coding for more complex tables, charts, or graphs Construct a glossary of terms for needed bureaucratic or scientific language Conduct a readability assessment of the text and of the documents within the text Pilot test: engage panels of reviewers. Include members of the intended audience as key reviewers Modify the report as needed to meet the needs and suggestions of members of the intended audience and other reviewers” (199)

GOALS FOR MEDICAL WRITERS Increase the usability of patient education materials through plain language documents to improve patients’ perceived control over their health conditions and increase their level of satisfaction with their health situation If people feel in control of their health, they will want to continue to feel that way and will try to stay on track with their treatments Medical writers have a responsibility to their audience to provide them with documents that can help them understand their condition. Understanding leads to better decisions, which has the potential, in this case, to save a life

PRESENTATION SUMMARY The goal of the medical writer is to present patients with usable patient education materials Plain language follows certain standards that make it easier for the layman to understand, such as avoiding jargon and wordy language Health literacy is the ability to interpret and navigate the healthcare system Patients need plain language documents to understand medical information There is a gap between the layman’s reading level and the level at which patient education materials are written Patient education materials can be improved through the use of plain language and health literacy can be increased by awareness and improved communication

REFERENCES “Federal Agency Links about Health Literacy.” Plain Language. Plain Language, n.d. Web. 7 May “Know Your Readers.” Impact Information. Impact Information Plain Language Services, n.d. Web. 7 May Rudd, Rima E., Kimberly Kaphingst, Tayla Colton, John Gregoire, and James Hyde. “Rewriting Public Health Information in Plain Language.” Journal of Health Communication 9 (2004): Communication & Mass Media Complete. Web. 22 January Stableford, Sue, and Wendy Mettger. “Plain Language: A Strategic Response to the Health Literacy Challenge.” Journal of Public Health Policy 28.1 (2007): Academic Search Complete. Web. 22 January Wicklund, Kimberly, and Kathryn Ramos. “Plain Language: Effective Communication in the Health Care Setting.” Journal of Hospital Librarianship. 9 (2009): Ebscohost. Web. 22 January 2014.