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Bridging the Health Literacy Gap

Health Literacy for Better Public Health

Why It’s So Hard to Stop Writing or Talking Like a….

Categories: Plain language

In The Sense of Style, his most recent book on language and writing, psychologist Steven Pinker argues that all people, and especially highly educated professionals, suffer from “the curse of knowledge.” He defines the curse as “a difficulty in imagining what it is like for someone else not to know something that you know.” Pinker states that the curse “is the single best explanation…of why good people write bad prose” filled with jargon and incomplete or confusing information.

How might the curse help us understand the persistence of health literacy problems even in organizations doing their best? Is the curse perpetuating health literacy problems and could lifting the curse be a major part of the solution? Pinker acknowledges that most people struggle to shake off the curse. He offers four pieces of advice. One, remember there is an audience who doesn’t know as much as you do. Two, recognize the assumptions you make about what your readers or listeners know. Jargon, for example, reflects an assumption that other people know the words you do and share the meaning for those words. Three, ask the people you’re trying to communicate with for feedback. Four, be willing to revise based on feedback.

Pinker’s suggestions should sound familiar to us. The health literacy field has many tools, such as the CDC Clear Communication Index and the Health Literacy Universal Precautions Toolkit, that show health professionals how to write and speak more plainly. A social marketing approach would tell us we need to make sure these tools meet health professionals’ needs if we want much adoption. The adoption challenge is, how easy and fun is it to look deeply at your own assumptions and adjust something like communication style that you may be comfortable with?

The curse of knowledge reminds us that we’re asking our colleagues to grapple with and change deeply ingrained habits that require more than superficial attention. If we aspire to creating organizations that address health literacy as a routine matter, we may need to dig deeper to uncover and correct harmful assumptions.

Are we doing everything necessary to help our colleagues under stand their “audience” and recognize assumptions about communication? Do we need to do even more to help our colleagues practice and refine their ability to adjust their communication techniques? How else can we help a clinician or scientist understand that communication is an iterative process that may involve multiple rounds of checking for understanding?

Please post your comments about how the “curse of knowledge” works in your organization and ways we can help our colleagues “dig deeper” and recognize their assumptions about communication.

Let’s Educate Someone About Health Literacy This Month

Categories: Health Literacy Month

Since 1999, advocates have used October to focus attention on limited health literacy as a widespread social problem. This month, we consider how health professionals can help improve health literacy.

At CDC, we kicked off Health Literacy Month with staff training sessions in plain language and the CDC Clear Communication Index. We know that equipping staff with clear communication skills is a necessary step in the process of creating understandable public information.

Many CDC staff will do at least one thing this month to raise awareness of limited health literacy with their peers, managers, grantees, contractors, and stakeholder groups. Please join us in educating at least one more person or organization about what they can do to improve health literacy in our society. You will find many resources to help you on CDC’s health literacy web site. Let us know what you’re doing by emailing us or posting here on this blog.

Spring Cleaning and the CDC Clear Communication Index

Categories: Clear Communication Index

Spring in Atlanta refreshes the mind and spirit (even while covering us in yellow-green pollen!). In that spirit, we are “spring cleaning” the CDC health literacy Web site and blog.

During the next several months, we’ll freshen up and expand the Web site’s sections and content. We’ll return to regular blog posts, sharing both CDC’s health literacy work and health literacy research and practice in the field.

In the meantime, please take a look at CDC’s Clear Communication Index (Index). We launched the Index In February 2013 at CDC with training classes, examples, and practice sessions. Many CDC programs now use the Index to create new materials and evaluate existing materials, and you can use the fillable score sheet to do the same.

The Index has 4 open-ended questions and multiple scored items. Use the 20-item full score sheet for longer materials such as fact sheets, web pages, and brochures. The 13-item modified score sheet is for social media messages, podcast and call center scripts, and storytelling infographics. The scoring process works the same for both.    

The Index User Guide provides examples for each scored item. We’ll add more examples later this spring, along with a scoring widget. Subscribe to the RSS feed and be the first to know when these go live.

At CDC, the Index helps scientific subject matter experts and communicators discuss key communication issues early and answer “who is the primary audience?” and “what is the main message?” even if they don’t score every item. Everyone on a team may think they know and agree on audience and message, yet misunderstandings and disagreement can surface late in the development process. The Index is helping teams be explicit and clarify sooner rather than later.   

We invite you to try the Index and use the comment section to let us know how the Index works for you. Happy Spring!

Promote Plain Language

Categories: Plain language

Many of us speak plain language every day, but we know plain language isn’t often the everyday language of government, business, law and healthcare.  The Plain Writing Act of 2010 requires federal executive branch agencies to use plain language communication with the public. How can large, complex organizations like government agencies make plain language everyday practice?

One way is through the power of communication. Although agencies must tell their staff about the law’s requirements, we all know how easy it is for broadcast emails, memos and other notices to get lost in the workday flow of information. To get employees’ attention, the CDC Office of Communication created 4 materials – a checklist and 3 messages – to remind staff of key plain language techniques.

The plain language checklist is based on the training slides from PLAIN, the network of federal plain language trainers. The 3 messages focus on specific issues in our public communication. We encourage employees to eliminate jargon and unnecessary details and highlight main messages. These materials are free and available for anyone to use.   

Organizational practices won’t change until the people inside the organizations change. Communicating expectations and specific action steps should be part of every organization’s plain language strategy. Please share your stories of how you’ve created a plain language culture in your organization. And please let us know if our materials helped you.

Health Literacy Month Twitter Chat

Categories: Health Literacy Month

The Department of Health and Human Services’ Office of Disease Prevention and Health Promotion (ODPHP) invites you to the 3rd annual health literacy Twitter Chat on October 25, 2012 at 3 p.m. EDT.

Using the hashtag #healthlit, please join @healthfinder, @HHS_DrKoh, @AHRQNews, @HealthLitMo and others to discuss IOM’s recent paper on the 10 Attributes of Health Literate Health Care Organizations. Share your ideas on how organizations can help people navigate, understand, and use information and services to take care of their health.

If you have health literacy resources that you’d like to share, either about this issue or related to other health literacy topics, please tweet those before the chat using the hashtag #healthlit. Following the chat, ODPHP will collect those resources and post them to

If you have any questions, please email Join our discussion on October 25th and add your ideas to the conversation.

Kicking Off Health Literacy Month

Categories: Health Literacy Month

Today is the first day of Health Literacy Month, an idea proposed by health literacy consultant Helen Osborne. Many organizations and individuals now use October as a chance to raise awareness of health literacy and promote their projects.

What are you doing for Health Literacy Month? Check back often as we report on health literacy activities throughout the month.

Health Literacy Around the World

Categories: International Health Literacy

On September 24, the Institute of Medicine Roundtable on Health Literacy (Roundtable) convened health literacy leaders from the United Nations and a dozen countries to discuss activities and progress around the world.

There was general agreement that educational systems have not provided the majority of people with the literacy skills they need to find, read, listen to, analyze, understand and use health information and access health services. Participants also agreed that health care systems – public and private – are not prepared to address the low levels of health literacy skills in the populations they serve.

Dr. Ilona Kickbusch of Switzerland noted that the population data on health literacy skills show how poorly we have done around the globe with our health promotion programs. According to Dr. Kickbusch, if our health promotion efforts had been more successful, our populations would be better prepared to access and use health information and services. She proposes that people are empowered when they have choice, control and skills. (An audio recording of all the speakers is on the Roundtable page under the webinar link.)

Despite common problems, each country has its own approach to health literacy improvement. In Australia, health literacy work is part of the national Commission on Safety and Quality in Health Care. Canada has a long history of connecting health literacy with health promotion and the public health sector leads the health literacy work. Ireland’s health literacy activities are linked to the country’s adult literacy agency and its efforts to improve the population’s literacy skills not only in health but also in family literacy and workforce readiness.

The U.S. National Action Plan to Improve Health Literacy has influenced some countries’ approaches. For example, Canada’s “inter-sectoral” approach echoes the multi-sectoral approach in the U.S. plan. Participants expressed interest in the U.S. Action Plan as an example of a comprehensive framework for health literacy work.

If you attended the meeting (in person or by webinar), which developments were most interesting to you? If your country wasn’t represented at the meeting, what health literacy activities are happening where you live?

Plain Language is Essential in Public Health Emergencies

Categories: Plain language

This week, Dagny Olivares from CDC’s Emergency Communication team blogs about plain language and public health emergencies.

September is National Preparedness Month. Across the country, it’s a time to take stock of how prepared we are to withstand and respond to emergency situations that affect us, our families, and our communities. At CDC, we make sure that we are prepared to protect the nation’s health from whatever threatens it, be that natural disaster, disease outbreak, or emerging hazard. To do that, we are working to ensure that plain language is a part of our emergency communication planning. Steps we are taking include

  • Training staff to understand and use the principles of plain language when developing and reviewing emergency communication  materials;
  • Prioritizing plain language along with such message characteristics as accuracy, timeliness, and consistency; and 
  • Working with subject matter experts to review our existing emergency materials so that we can make them more understandable and accessible.

The updated  CDC 2012 edition of the Crisis and Emergency Risk Communication (CERC) manual states, “Technical language and jargon are barriers to successful communication with the public. In low-trust, high-concern situations, empathy and caring carry more weight than numbers and technical facts.” Public health professionals must make plain language a core tenet of their emergency and risk communication strategies because people need to be able to understand and act upon health information quickly in times of stress and uncertainty.

What are you doing in your organizations to make plain language a part of your preparedness planning? What challenges are you facing in undertaking that mission? We’d love to hear about your experiences, tips, and lessons learned.

Clear, Main Messages – We all Need One

Categories: Plain language

The main message of this week’s post is that every health material needs a clear, main message.

The power of a main message is that your readers or listeners can almost immediately say, I know what this is about. When you state your main message clearly AND put it at the beginning, you help your readers or listeners know what is most important. 

Perhaps you think this point is obvious. Of course every health material has a main message, you say.

Let’s put this idea to the test with a main message challenge: Go to any health web site, randomly select a web page, download a brochure or report, or listen to a podcast or video on the site. Try and find the main message in the first paragraph, first set of key points, or first few sentences of the audio or video recording.  Can you easily and clearly state the key point this organization or person is trying to communicate to you?

Once you’ve taken the challenge, send in your results, and we’ll post them in the comments section.  Let’s do our part to improve health messages!

Health Literacy Basics: Who is the Audience and What is the Purpose?

Categories: Public health practice

In his book The Checklist Manifesto, Dr. Atul Gawande argues that people, even experts, often skip basic, critical steps that can determine success or failure in a project or task. He proposes that people use checklists to increase the accuracy and consistency of their performance.  Checklists draw our attention to all the elements in a process, not just a selective few that we remember or feel most comfortable doing.  

Last week’s health literacy workshop at the National Conference on Health Communication, Marketing and Media illustrated how often we overlook basic, critical steps in public health communication. Workshop participants used a health literacy checklist to evaluate 2 public health materials. Although the checklist had almost 3 dozen items, the first 2 items – audience and purpose – took up the majority of the discussion period in the exercise.

Participants identified multiple audiences and purposes for each piece. Without a clearly defined audience and purpose, it was difficult, and in some cases, meaningless to go through the rest of the checklist. For example, you can’t decide if a material is filled with jargon if you don’t have a clearly defined audience. Jargon for one audience might be everyday language for another.  Or, you can’t determine if you’ve included the correct health behaviors if you don’t know audience and purpose.

If you want to try a full checklist, see CDC’s plain language manual, Simply Put, Appendix A . Whether you use a checklist or not, try using these 2 questions when you plan, review or revise your next health material.

1)      Who is the primary audience?

2)      What is the primary purpose of this material?

Do you agree these are the 2 most important questions? Can you think of other, equally important questions that have made a difference in your materials?

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