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Bridging the Health Literacy Gap

Health Literacy for Better Public Health


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?

Health Literacy Sessions at National Conference on Health Communication, Marketing and Media

Categories: Public health practice

This week marks the Sixth National Conference on Health Communication, Marketing and Media in Atlanta, Georgia. Each August, health communicators, educators, social marketers, media specialists, and other public health professionals discuss the state of the science in communicating about health.  

Once again, the conference includes a 3.5 hour workshop on health literacy as part of a social marketing strategy. Health literacy and social marketing approaches put the end user or “customer” at the center of exchange and focus on creating useable products and services.

Although social marketers will tell you information is not a product, information is a critical component of how people make decisions that can affect their use of products and services.  When we design information that reduces the demand to understand information about symptoms, for example, we can positively affect people’s use of medicines and visits to healthcare providers.

In addition to the workshop, a breakout session includes four presentations on health literacy. One previews a new tool for CDC staff to evaluate health messages and materials. Another reports findings of a content analysis and consumer interviews on public messages about H1N1 pandemic influenza. A third presentation describes changes to CDC’s immunization campaigns based on parents’ feedback. The fourth presentation describes how a manual for health professionals was revised using plain language. 

For the first time, parts of the conference will be streamed live. You can watch the plenary sessions and a limited number of special and breakout sessions. To register, visit

Health Literacy Outcomes and Public Health

Categories: Public health practice

How do we know that focusing on health literacy makes a difference?  The passing of Len Doak, co-author of the classic text Teaching Patients with Low Literacy Skills, places this question in a personal context. The question is also relevant for health research, evaluation and policy. Policymakers, managers, project funders, and professional and administrative staff want to know if paying attention to health literacy makes a difference.

Len and Ceci Doak and Jane Root wrote the book on health literacy practice in clinical settings. They were tireless advocates and made a difference by explaining health literacy and engaging others in the work.  The large number of people drawn into health literacy because of their book and gracious mentorship is one type of difference.

But, decisionmakers typically want evidence of a different kind. They want measurable outcomes aligned with organizational or policy requirements to know if a change or intervention is worthwhile.  Quality, cost and access are typical healthcare outcomes of interest. The two systematic reviews of evidence along with many single studies suggest that limited health literacy decreases healthcare quality and access and increases costs.

Defining outcomes for health literacy practice in public health is equally important. If we aim to reduce illness and death on a large scale, how can attention to health literacy help us get better public health outcomes? 

For example, many different organizations provide health information to the public. Sometimes they use highly visible mass media campaigns directed at millions of people; other times they may use a web site and targeted promotion to a very specific audience.

The outcomes for mass media campaigns might include reach (did we reach the audiences we intended to reach?), recall (does the audience recall seeing our messages and do they recall specific messages?), and attitude change (did our messages change their attitudes?). Web site metrics might include most popular features, time spent on pages and number of downloads of site products.  How might these outcomes help us learn about health literacy?   

As we think about the many types of public health work that could benefit from health literacy insights, we should also think about the outcomes we want. Please share your ideas about outcomes you already address and outcomes you’d like to address from a health literacy perspective.

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