Health Literacy 101: How You Write Matters!

by Ally Gallop, RD, CDE and Claire Whitney, RD, LD

Health literacy. Ever heard of it? Well, there’s a 99.9% chance you’ll stumble upon it in your future career. You will need health literacy if you want a population or an individual to comply with your suggestions, be it to eat more vegetables or exercise daily. Over the winter break, Tufts University’s Public Health and Professional Degree professor Sabrina Kurtz-Rossi led an eye-opening course in health literacy (HCOM 509). We were shocked by our carelessness! So where are we, as future communicators, going wrong?

At Friedman, students tend to have the freedom to select a topic for an assignment or paper. We conduct the research and revise multiple drafts, and after a final self-edit, an end product is produced. Often, these papers are intended for our professors or other health professionals. Beyond the classroom, writers for the Friedman Sprout select a topic of interest, peer-edit, and unleash the finished articles to the world.

However, some of these and future projects require writing for children or the general public, groups that require a shift in writing style and word choice. After making any appropriate edits we default to Microsoft Office to verify our changes with its readability option. Readability considers the number of words in each sentence and the number of syllables each word contains. Based on this assessment, a grade level is assigned.

But then what? Do we ever consider the impact of our message on our target audience? Do we accept an eighth grade reading level as being easy to read from the perspective of that audience? Aren’t we as health communicators forgetting something?

Left out of the readability formula is health literacy. Health literacy is not only a person’s ability to read, but it also considers

  • Layout and formatting of the text
  • Words chosen when verbally communicating health messages
  • Inclusion of technology (e.g., the internet)
  • Learning ability of an individual
  • Cultural appropriateness

Together, these factors clarify messages being delivered by health providers. Purity in message delivery increases one’s ability in making informed decisions about their health.

How do people find and process health information?

The flow chart below presents the Calgary Charter on Health Literacy’s logic model that follows how an individual finds information and puts it into action. When providing health information as a communicator, a break in the chain is a break in your ability to deliver a message and implement behavior change.

Screen Shot 2016-01-30 at 5.11.04 PM

Revised from The Calgary Charter as a framework for health literacy curriculum development and evaluation. Presented by Andrew Pleasant at the 2013 IHA Health Literacy Conference in Irvine, CA. May 2013.

Major takeaways from HCOM 509 for nutrition communication writers

In relation to written communication, the key concepts learned from Professor Kurtz-Rossi’s class include:

  1. Assume that everyone is health illiterate

Why does health literacy even matter? Lacking health literacy is linked to poor health outcomes and knowledge about health, increased medication errors and health care costs, and under-utilization of health care services. Individuals often hide reading, writing, and comprehension difficulties, which makes it hard for communicators to assess whether their messages have gotten through.

The Program for the International Assessment of Adult Competencies 2012 (PIAAC) measured the literacy (which it defines as “understanding, evaluating, using and engaging with written text to participate in society, to achieve one’s goals and to develop one’s knowledge and potential”), numeracy, and problem solving in technology-rich environments among American adults. PIAAC found that only 12 percent of those aged 16 to 65 years met the highest literacy score, which is significantly below the international average. Another measurement by the U.S. Department of Education reports that 9 out of 10 American adults have less than proficient health literacy scores.

It does not matter if your intended audience is lawyers, athletes, or even those with a science degree; you cannot assume that they understand health and medical messaging.

Solution: No matter how educated your audience is, assume they lack health literacy. Speak and write in plain language by defining essential medical words and replacing jargon with living room language. This is not condescending; it is respecting the individual receiving the message.

  1. Readability formulas are not the gold standard

Readability formulas, like Microsoft Office’s Flesch-Kincaid Grade Level, do not measure health literacy. Formulas may still be used, but not in isolation. A similar comparison is only using body mass index (BMI) in determining a patient’s health—even though it only considers height and body weight. Although BMI is one measurement tool it should be used in concert with others (e.g., blood cholesterol panel, waist circumference, a patient’s self-evaluation, etc.).

Measuring your writing’s readability should also be applied to blogs, emails, and any other technological means. Combing through blogs by dietitians, we found an average reading level of grade 10!

Solution: You could still use readability formulas as a starting point, but try supplementing those scores by evaluating the writing’s layout, spacing, and format. Other options you may want to try out include the Fry Readability Formula.

  1. Gain input from your target audience. And then ask for feedback again and again and…

When first setting out to write, how often do you think about the target audience? Do you consider their age or socioeconomic status? Do you evaluate what they want to know about the topic?

Although you may have a peer or an editor review your work, remember that they are likely not your target audience. Your article means nothing if your audience cannot understand it and use the information. Reaching out to intended readers at the beginning, during draft writing, and in finalizing the piece are vital in ensuring that your writing is relevant.

Solution: From topic selection to the final copy you need to gain feedback from your target audience. This includes what valuable information is included (i.e., the “need to knows”), the article’s format (e.g., dense text, bulleted lists, images, and article length), and if the delivery of the message persuades one to change a behavior.

Going forward

When writing for the public, stop wasting your time writing an article that interests only you. Think about the audience you are writing for and how well they understand and interpret your message. As health communicators, if people are going to take the time to read your work then ensure they are able to understand and implement it.

Ally Gallop, RD, CDE is a second-year nutrition communication and behavior change student focusing in U.S. food and nutrition policy. She now uses readability formulas solely as a starting point.

Claire C. Whitney, RD, LDN is a second-year nutrition communication and behavior change student with an interest in Food Business and Communication. Being dyslexic, she understands first-hand the importance of plain language and readability.

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