Consider the following questions as you develop and
deliver health information:
- Is the information appropriate for the users?
- Is the information easy to use?
- Are you speaking clearly and listening carefully?
the information appropriate for the users?
The information below is a summary of best practices
in health communication that can aid in improving health
literacy. Many of these concepts are discussed in depth
in the National Cancer Institute's Making Health
Communication Programs Work (a.k.a. the “Pink
Book”) and in the Centers for Disease Control and
Prevention's tool CDCynergy.
Identify the intended users of the health information
Identify the intended users based on epidemiology (who
is affected?), demographics, behavior, culture, and attitude.
This is known as segmentation.
These principles also apply if you are using existing
resources. Be sure to select materials that are accurate
and appropriate for the intended users.
Be sure the materials
and messages reflect the age, social and cultural diversity,
language, and literacy skills of the intended users.
Consider economic contexts, access to services, and life
Beyond demographics, culture, and language, consider
the communication capacities of the intended users. Approximately
one in six Americans has a communication disorder or
difference resulting in unique challenges.2
These individuals will require communication strategies
that are tailored to their needs and abilities.
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Evaluate users' understanding before, during,
and after the introduction of information and services.
Talk to members of the intended user group before you
design your communication intervention to determine what
information they need to know and how they will use it.
Then, pretest messages and services to get feedback.
Test your messages again, after they have been introduced,
to assess effectiveness. Refine content when necessary.
Use a post-test to evaluate the effectiveness of the
Acknowledge cultural differences and practice respect.
Cultural factors include race, ethnicity, language,
nationality, religion, age, gender, sexual orientation,
income level, and occupation. Some examples of attitudes
and values that are interrelated with culture include:
Accepted roles of men and women
Value of traditional medicine versus Western medicine
Favorite and forbidden foods
Manner of dress
Body language, particularly whether touching or
proximity is permitted in specific situations1
Ensure that health information is relevant to the intended
users' social and cultural contexts.
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the information easy to use?
Limit the number of messages,
use plain language, and focus on action.3,
Keep it simple. The number of messages will depend
on the information needs of the intended users. As a
general guideline, use no more than four main messages.
Give the user specific actions and recommendations. Clearly
state the actions you want the person to take. Focus
on behavior rather than the underlying medical principles.
Use familiar language and an active voice. Avoid long
or run-on sentences. Organize similar information into
several smaller groups.
Many of the same plain language techniques that make
the written word understandable also work with verbal
messages, such as avoiding jargon and using everyday
examples to explain technical or medical terms the first
time they are used.
For more information on plain language, visit www.plainlanguage.gov.
Supplement instructions with pictures.
Individual learning styles differ. For many people,
visuals are a preferred style, especially for technical
line drawings can help users understand complicated or
abstract medical concepts. Make sure to place images
in context. When illustrating internal body parts, for
example, include the outside of the body.
Use visuals that help convey your message. (Don't
just “decorate,” as this will distract users.)
Make visuals culturally relevant and use images that
are familiar to your audience.
| For print communication,
use captions or cues to point out key information.3
Show the main message on the front of the materials.
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Make written communication
look easy to read.3-5
Use at least 12-point font. Avoid using all capital
letters, italics, and fancy script. Keep line length
between 40 and 50 characters. Use headings and bullets
to break up text. Be sure to leave plenty of white space
around the margins and between sections.
Improve the usability of information on the Internet.
Studies show that people cannot find the information they
seek on Web sites about 60 percent of the time.6
This percentage may be significantly higher for persons
with limited literacy skills.
Refer to the Office of Management and Budget (OMB)
Policies for Federal Public Websites for
Many of the elements
that improve written and oral communication can be applied
to online information, including using plain language,
large font, white space, and simple graphics.7
Other elements are specific to the Internet. These include:
Enhancing text with video or audio files
Including interactive features and personalized
Using uniform navigation
Organizing information to minimize searching and
Giving users the option to navigate from simple
to complex information
A critical way to make information on the Internet more
accessible to persons with limited literacy and health
literacy skills is to apply user-centered design principles
and conduct usability testing.
is a measure of several factors that affect a user's
experience interacting with a product, such as a
Web page. These
- How fast can the user learn how to use the
- How fast can the user accomplish tasks?
- Can the user remember how to use the site
the next time he or she visits?
- How often do users make mistakes?
- How much does the user like the site?
To learn more about usability, visit www.usability.gov.
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Are you speaking clearly and listening carefully?
Ask open-ended questions.
Ask questions using the words “what” or
“how” instead of those that can be answered
with “yes” or “no.” For example,
“Tell me about your problem. What may have caused
it?”3 Try asking
“What questions do you have?” instead of
“Do you have any questions?”
Use a medically trained interpreter.
Plain English will not necessarily help individuals
who do not speak English as their primary language and
who have limited ability to speak or understand English.
To better ensure understanding, health information for
people with limited English proficiency needs to be communicated
plainly in their primary language, using words and examples
that make the information relevant to their potentially
different cultural norms and values.
Check for understanding.
The “teach-back” method is a technique
that healthcare providers and consumers can use to enhance
communication with each other. The person receiving the
health information is asked to restate it in their own
words—not just repeat it—to ensure that the
message is understood and remembered. When understanding
is not accurate or complete, the sender repeats the process
until the receiver is able to restate the information
needed.8 Consumers also
can be asked to act out a medication regimen.3
Easy-to-read flyer developed by the Centers for Disease
Control and Prevention. The flyer was developed in multiple
Summarize what the
patient needs to do. Consider using a handout or
brochure written in plain language. Explain what
each medication is for, along with the dosage and
side effects. Make sure the patient knows where
the information is written down.
Then check for understanding:
“I want to be sure I didn't leave
anything out that I should have told you. Would
you tell me what you are to do so that I can be
sure you know what is important?”
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Participate in plain language and cultural competency
Encourage colleagues to do the same. Consider organizing
a training for health professionals and staff in your
for Improving the Usability of Health Information
ϖ Identify the intended users
ϖ Use pre- and post-tests
ϖ Limit the number of messages
ϖ Use plain language
ϖ Practice respect
ϖ Focus on behavior
ϖ Check for understanding
ϖ Supplement with pictures
ϖ Use a medically trained interpreter
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