Communicating In Plain Language: Application for Community Nutrition

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Communicating In Plain Language Application for
Community Nutrition

• Stephany Parker, PhDNutrition Education Asst.
  Specialist and Adjunct Assistant Professor,
  Oklahoma Cooperative Extension Service and the
  Department of Nutritional Sciences, Oklahoma
  State University

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True or False?

• Most people with limited literacy are poor,
  immigrants or minorities.
• Most people with limited literacy have low IQs.
• People will tell you if they have problems
  reading.
• The number of years of schooling is a good
  general guide to determine literacy level.

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Dont fit a stereotype

• Many people with inadequate literacy
• Are born in USA (75)
• Are white (50)
• Hold full or part-time job (40)
• Finished high school (25)

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Health Literacy

• Health literacy is an individuals ability to
  read, understand and use health care information
  to make effective health care decisions and
  follow instructions for treatment.
• Healthy People 2010. Office of Disease Prevention
  and Health Promotion. Available at
  http//www.healthypeople.gov/
• Does your patient, participant, or group
  understand what you are telling them?

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What does it feel like?

• Your naicisyhp has dednemmocer that you have a
  ypocsonoloc. Ypocsonoloc is a test for noloc
  recnac. It sevlovni gnitresni a elbixelf epocs
  into your mutcer. You must drink a laiceps
  diuqil the thgin erofeb the noitanimaxe to naelc
  out your noloc

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So, what are the colonoscopy prep orders?
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Why is Health Literacy Important to Community
Nutrition?

• Limited ability to read and understand
  information translates to poor health outcomes.
• Single best predictor of health status.
• Less knowledge of their medical conditions,
  self-care and dietary instructions.
• Exhibit less healthy behaviors.

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Risk Factors
People with Chronic Diseases Visual
impairments Learning disabilities (i.e.
dyslexia) Low Income Unemployed
Weiss BD. Health Literacy. A manual for
clinicians 2003. AMA Foundation.
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Schillinger article Association of Health
Literacy with Diabetes Outcomes. JAMA. 2002
288(4) 475-482.
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What is plain language?

• Requires use of plain language in all new
  documents written for the public, other
  government entities and fellow workers.
• Writing that is clear and to the point helps
  improve communication with the public since clear
  material takes less time to read and understand.
• Use plain language for all documents,
  presentations, and electronic communications

http//execsec.od.nih.gov/plainlang/intro.html
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Four steps to developing quality educational
materials

• Assess the needs of your target audience
• Evaluate the materials
• Pretest with your audience
• Use your material effectively

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Evaluating Materials
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Written Materials Review

• Reading Comprehension
• Content
• Design Quality
• Review Summary

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Developing or Reviewing Client Education Materials

• Consider needs of target audience
• Define purpose / objectives
• Write clearly
• Use simple and familiar words
• Use words consistently
• Define terms
• Use active verbs
• Limit sentences 25 words
• State info positively
• Use you
• Give reader info they can apply

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Reading Comprehension Level

• Readability testing
• Other comprehension factors

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Assessing Reading Level

• Most pamphlets at 10-12th grade level

• Informed consents at 14.316th grade

Recommended Reading Level Type of
Information
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Calculating reading level

• Flesch-Kincaid Grade Level formula
• SMOG
• Many others

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Quick SMOG

• Identify 10 consecutive sentences at beginning,
  middle, end
• In these 30 sentences, count number of words with
  3 or more syllables
• Look up approx. grad level on the chart

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Quick SMOG

• Words 3 syllables
• 0-2
• 3-6
• 7-12
• 13-20
• 21-30
• 31-42
• 43-56
• 57-72
• 73-90
• gt91

• Approx Grade
• 4
• 5
• 6
• 7
• 8
• 9
• 10
• 11
• 12
• College

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Readability Tests Cant Tell You.

• How complex ideas are
• How well or poorly material is written
• Whether grammar is correct
• Whether the vocabulary tone are appropriate
• Whether there is discriminatory language

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Readability Tests Cant Tell Whether

• There is any bias
• Information is presented in a sequence that makes
  sense
• Readers can find the information
• The design makes the piece inviting easy to read

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Comprehension Factors

• Clear purpose
• Appropriate word usage
• Appropriate sentence structure
• Appropriate paragraph structure
• Appropriate overall organization
• Appropriate tone

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Simple, Clear Words

• Fruits contain fiber
• Fruits have fiber
• Purchase whole-grain foods to help meet your
  daily fiber requirements
• Buy whole-grain foods to help get enough fiber
  every day.

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Practice!

• A deficiency of calcium can increase your
  possibility of getting osteoporosis.

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Technical Terms

• It is fruitless to become lachrymose over
  precipitately departed lactate fluid.

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Active Role

• Passive
• Calcium pills should be taken at meals.
• Active
• Take calcium pills with meals.

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Practice!

• Food can be kept safe by always washing hands
  before food handling.

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Overall Organization

• Appropriate number of concepts
• Headings identify topics and concepts
• Key ideas are highlighted, repeated, or summarized

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Tone

• Dont give your baby juice or other sweet drinks
  in a bottle ever!
• Offer juice from a cup, not a bottle

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HANDOUT Guidelines

• Is it simple? (The Rule of 3 3 major points with
  3 supporting points for each OR a maximum of 5 -
  7 points)
• Is  it interactive? (Is there a place for the
  learner to write on the handout or circle foods
  they will eat?)
• Is it tailored to different cultural groups?
  (Messages may vary by cultural group)
• Are there quotes from "real people" ?(This
  personalizes the information and helps learners
  to see that others find the information useful).

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Handouts

• Use font size appropriate for target audience
• Limit to one or two fonts
• Break up long blocks of text with headings,
  indentations, extra spacing, bullets or columns
• Right justification is easier to read
• Full justification sometimes has strange spacing
• Use spell checker, then proofread.

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Handouts, contd

• Pictures and drawings add to the meaning of
  text, draw attention to important points
• Lettering large enough for target audience to
  read easily (12 pt, 14 or 18 for elderly)
• Layout on page use headings, lots of white
  space
• Pilot test material with target audience

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Content

• Accurate, credible information
• Appropriate information
• Useful information
• Appropriate recipes

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Participatory Formative Evaluation

• Review all materials and use a consistent check
  list
• Engage members of the intended audience in a
  critical review process
• Re-work the materials based on reviews
• Pilot materials with members of the intended
  audience
• Re-work materials based on pilot test findings
  and solicited suggestions

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Resources

• Dalton C. University of Virginia School of
  Medicine. Health Literacy. Recognition and
  Treatment of a Hidden Problem. Available at
  http//www.healthsystem.virginia.edu/internet/som-
  hlc/Lecture.cfm
• Health Literacy Studies (HLS). Department of
  Society, Human Development and Health at the
  Harvard School of Public Health. Available at
  http//www.hsph.harvard.edu/healthliteracy/index.h
  tml
• Health Literacy Web page at University of
  Washington . Available at http//students.washing
  ton.edu/wcurioso/literacy.htm
• NIH. Plain Language Initiative. Available at
  http//execsec.od.nih.gov/plainlang/guidelines/ind
  ex.html
• Reed D. and Shuster E. Recipe Checklist A Tool
  to Aid Development of Recipes for Audiences with
  Limited Resources. Available at
  http//www.joe.org/joe/2002december/tt4.shtml