Health Literacy

Two Simple Strategies for Engaging Patients With Writing

There’s one thing on which most patient advocates agree: the quality of written communications can help motivate patients to participate in their own care and improve their health literacy. In my post last month, I discussed how to do this with written materials. I try to build each document around three pillars: audience, purpose, and input. The first two—audience and purpose—drive the choices I make when creating the document, while the last pillar— input—helps me revise and finalize.

But I’m often asked, then what? What are some other strategies for creating clear content in documents? In this post, I’ll explain two things I do to help people find what they are looking for and understand what they find in any document I create.

Tip #1 – Create informative headings.

Headings and subheadings don’t get enough appreciation, particularly in formal documents, such as consent forms. Yet informative headings are critical to helping people navigate documents and find answers to their questions. When you read an insurance form or fill out a document, do you read it from front to back, like you would a novel? I doubt you do. I don’t. Rather, I look at the document through a task-based lens; How do I fill this out correctly? I then jump around the document as needed to figure out how to complete the task. The same is true with consent forms, patient education materials and other forms of technical writing. When we read consent forms, for example, we often look at them with questions in mind: What are the risks? What will my recovery be like?

Because we tend to use questions to navigate these documents, I use question-style headings to help readers find what they are looking for. For example, the heading “Coverage” may help someone find a broad section in an insurance document, but “What prescriptions does my plan cover?” is much more informative. It speaks to readers, and it will help them find the specific section or subsection they need. Plus, if your headings ask and answer questions that readers are already asking, navigating the document doesn’t seem as daunting. They may not feel like they are “reading” at all.

Tip #2: Explain technical terms you cannot avoid using.

One of the myths of plain language is that it means to “dumb” things down. Naysayers think plain language means taking things out and not trying to explain them. But that misses the point of plain language. The goal of plain-language writing is to discuss sophisticated concepts that people need to know in clear, understandable ways. That is not easy, and it involves so much more than just taking content out.

Of course, it is useful to remove any medical or legal term or any other jargon that is not essential to the patient’s needs. There’s no need for information overload if terms are unnecessary. And even though it is tempting to use the medical or legal term to “be precise,” that precision is lost on the vast majority of patients. So it is best to use simpler terms such as “low blood pressure” instead of “hypotension.”

But this doesn’t mean that you can’t use plain language if you have to use a medical or legal term like “colonoscopy” or “indemnify.” Rather, if you must use a medical or legal term because the patient needs to know it, then do patients a favor and explain what that term means in clear language. In these situations, I often use the technical term and then explain what it means in a sentence or parenthetical phrase right after that term. People will appreciate it.

In fact, in a 2012 study I conducted on public preferences in legal writing, I asked participants 11 questions that contained two versions of content. One version included traditional language and the other used plain language. In all but one of these choice-of-language questions (as I call them), the shorter version prevailed. But there was one question where the longer version prevailed. Here were the two options for that question (participants were asked which version they would prefer to read in a legal document):

  • If you do not respond, the court will issue a default judgment.
  • If you don’t respond, the court will issue a default judgment. That means you will lose, and the court will give the plaintiff what he is asking for.

Surprisingly, the results weren’t particularly close: 78% preferred the longer version with the explanation. Even more surprising, both versions were clear and understandable. It wasn’t like the shorter version was unintelligible, which made the longer version the clear choice. Plus, I asked that same question in a follow-up study that will be published later in 2018. The results were the same: a little over 80% preferred the explanation. From this, it is clear that people know what they want; they want to understand, even if it takes a few more words to do so.

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Christopher Trudeau, JD Christopher Trudeau, JD, has a dual appointment as an associate professor in the UAMS Center for Health Literacy and as an associate professor of law at the UALR Bowen School of Law. Chris is an expert on health literacy, plain language and the law. His views are his own; they do not necessarily represent those of his employers. He may be reached at ctrudeau@uams.edu.

Christopher Trudeau, JD has 6 post(s) at EngagingPatients.org

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2 Comments

  • The classic book by Doak, Doak, & Root says some folks with poor literacy skills stop reading when they see a term like, ‘“default judgment.” Authors say to put the plain language definition first, then give the term.
    “If you don’t respond you will lose, and the court will give the plaintiff what he is asking for. This is called a default judgment.” This makes it even easier to read.

  • Chris Trudeau says:

    Thats a great point. I wonder if that’s been validated. I’ll have to test that difference with users and write an article about the results. Thanks for the heads up.

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