Key points:

• Consult your audience about their information needs.
• Write in plain English. Avoid jargon and choose words that most people understand and use themselves.
• Write information that is actionable and helps consumers and carers to complete tasks and ask questions.
• Aim for a reading age of Year 6, and never higher than Year 8. Consider your audience’s literacy level.
• Readability calculators can help you write clearly for your audience.
• Test your information with consumers. Ask them if it meets their needs. Be prepared to make changes.

The problem

About 40% of Australian adults can understand and apply health information in the way it is usually presented [i]. This means that six in ten Australian adults are not able to find the information they need to make informed choices about their health, or the care they receive

Almost all patient information – about treatments, self-management, health promotion, disease prevention and using health services – is too complex for most people [ii][iii][iv][v].

Most public information about COVID-19 exceeds the recommended reading level of Grades 6 – 8 [vi]. This means that 60% of the population would find it hard to understand critical information about how to prevent and reduce COVID-19 transmission.

Good health information matters

Good health information helps consumers and carers [vii]:

• Understand their health, their health condition, how their body works and how tests and treatments could affect them
• Make informed decisions about their health and care
• Look after their health and follow advice and instructions, and
• Change health-related behaviours.

Health information covers many topics including:

• Health conditions and their management
• Tests, treatments and medications
• Informed consent documents
• Booking, admission and discharge information
• Signage in health facilities
• Public health campaigns

It can be presented in websites and videos as well as documents including brochures, pamphlets, posters, administrative forms and letters.

What you can do

You can assist consumers and carers to understand health information.

Consider and involve your audience

Begin by identifying your audience. Ask:

• What information do they need?
• What do they already know?
• What format will work best for them?
• Which consumers are not your audience?

Involve consumers and carers in answering these questions.

When consumers are involved in planning, developing and testing health information:

• The information is more likely to be relevant to them, and
• They are more likely to follow the instructions and advice you give.

There are many ways to involve consumers, ranging from informal conversations to working groups, consumer representation and co-design. What method you choose will depend on the resource, your timeframe and your audience. You can get more advice about how to involve consumers from:

• The Guide to Producing and Sourcing High Quality Health Information, by the Centre for Health Communication and Participation
• The Health Care Consumers’ Association

Consider what health information already exists before you start writing. Is there a resource you can adapt or use? Does it meet the need you have identified from consumer input?

Test your resource with consumers. User testing can tell you whether the information meets consumers’ needs. Ideally, test with users at different points in the development of the resource. At the minimum, test with readers once you have a good draft. Be prepared to make changes [viii].

The Centre for Plain Language suggests key questions to ask when user testing.

Write for your audience

Write in plain English. This means using common words that most people understand and use in their everyday life. This makes it easier for every reader to understand. It doesn’t mean oversimplifying. Find out what words your audience uses, and use them.

Consider the reading level of your audience. Write for a Year 8 reading level or lower. Many guidelines recommend aiming for Year 6 reading level.

Use a readability calculator to test the reading level of your document. There are many readability calculators to choose from.  Readability formulas are based on the average words to a sentence and the average syllables per word. They tend to positively rate short sentences made up of short words. Readability tests do not check if your writing is understandable, interesting, or educational.

• There is more information about readability calculators and how they work in the Tasmanian Government’s Health Literacy Workplace Toolkit here.
• Readability calculators like Sydney Health Literacy Lab (SHeLL) Health Literacy Editor and the Hemingway Editor App can help you edit your writing to meet the reading level of your audience.

Accessibility

Consider whether your information is accessible to people with specific information requirements. For example:

• Is the font size large enough for people with partial vision or very low vision to read?
• Is there enough contrast between the font colour and the background?
• Are you sharing information with people with intellectual disabilities or cognitive impairment that could benefit from Easy Read translations?
• Should you translate the document, or modify it for people who speak English as a second language? [ix]

If you are writing a document that will be shared electronically, does it work with screen readers? Microsoft Word has built-in accessibility checking tools you can use.

There is more guidance about writing for consumers with specific information needs in the Tasmanian Government’s Health Literacy Workplace Toolkit.

Use Inclusive language

​​Using inclusive language and images is critical to ensure that your message is engaging and appropriate to all audiences. Inclusive language aims to avoid expressions that include or imply ideas that are sexist, racist, or otherwise biased, prejudiced, or denigrating to any particular group of people.

Some principles of inclusive language are that it:

• Keeps it gender-neutral – Gendered language is often used when it is not relevant. This type of language can incorrectly assume a consumer’s identity or exclude those who are nonbinary, intersex or transgender. Try to use gender neutral pronouns (they/them/theirs) and terms (e.g. parent, partner).
• Is person-centred – for example, ‘people with diabetes’ rather than ‘diabetics’, ‘person with disability’ rather than ‘disabled person’. See the PWDA Language Guide: A guide to language about disability for more tips.
• Respects a person’s values, including cultural, spiritual, emotional and religious beliefs.
• Demonstrates respect for how individuals describe who they are and what is important to them (relationships, gender, abilities, and identities). This may be different to the standard language used in your service’s forms and policies.
• Focuses on a person’s strengths and assets and what they can do, not their limitations or deficits or what they can’t do.

Tips for clear writing

Content

• Present the most important information first.
• Leave out information that is not essential, even if it’s interesting.
• Use the words your audience uses.
• Use medical terms and complex terms when you need to. Define them when you use them, with examples.
• Focus on actions the reader needs to take. Break complex actions into steps. Dot points and checklists can help.
• Give information that helps consumers and carers ask health professionals questions. For example, consider including a “Questions to Ask” section.
• Patient correspondence should include contact details for questions.
• Suggest places where they can find additional information that is trustworthy and accessible, some people will want more.

Expression

• Write short logical sentences – about 20 words.
• Use short paragraphs of about five sentences.
• Use short words wherever you can. Can you replace words of three syllables or more with a shorter word?
• Avoid jargon, abbreviations and acronyms.
• Aim for a conversational tone.
• Use active voice – “take your medication after meals” not “medication must be taken after meals”.
• Address readers as “you”. Refer to your service as “we”. This makes your information more relevant to the reader.

Layout

• Use dot points for lists of 4 or more.
• Use headings, colour and font to group information and highlight what is most important.
• Use white space to break up sections of information.
• Use images. Drawings, photos and simple diagrams can help people understand the text [x].

Remember not all health information is written. Use different formats – text, video, images and conversations – to meet different people’s information needs and preferences. Use written information to reinforce key messages and support what you say in discussion.

Resources

The Australian Commission for Safety and Quality in healthcare has produced a fact sheet on Writing health information for consumers.

Health Literacy Northern NSW has a Checklist for designing consumer-friendly health information.

The Tasmanian Government Department of Health’s Health Literacy Workplace Toolkit has fact sheets on writing clearly.

The US Centre for Plain Language’s Five Steps to Plain Language are easy to follow.

The Centre for Health Communication and Participation’s Guide to Producing and Sourcing Quality Health Information is a step-by-step guide to information governance, partnering with consumers, supporting health literacy and sharing resources. It includes a self-evaluation toolkit. It was written by Louise Walsh, Tamsin Waterhouse and Sophie Hill in 2019 for the Centre for Health Communication and Participation at La Trobe University with support of Safer Care Victoria.

The Connecting through inclusive communication practices Guide  from the Eastern Sector Development Team (ESDT) contains information, tools and good practice examples that you can use when developing new material or when reviewing existing material. It focuses on inclusive language and communication practices and will support person-centred approaches that reflect diversity.

The United States Agency for Healthcare Research and Quality (AHRQ) Universal Precautions Toolkit, second edition, includes information and tools to improve written communication with patients, consumers and carers as well as examples of health literate patient information:

The United States Centre for Disease Control and Prevention hosts Everyday Words for Public Health Communication – a database of medical terms and jargon with suggested plain language synonyms, and examples of how these words can be used in plain English sentences.

The Plain English Campaign in the UK has a guide on How to write plain English.  The guide begins with ‘So what’s plain English?’  and then looks at the main ways to make writing clearer.

The Plain English Campaign has also produced a resource to help you to write in plain English – The A – Z of Alternative Words. This guide gives hundreds of plain English alternatives to the formal words and phrases that are common in official writing. On its own the guide won’t teach you how to write in plain English but using everyday words is an important first step towards clearer writing.

References:

[i] Australian Commission on Safety and Quality in Health Care. 2014, National statement on health literacy. Sydney: ACSQHC;

[ii] Rowlands G, Protheroe J, Winkley J, Richardson M, Seed PT, Rudd R. A mismatch between population health literacy and the complexity of health information: an observational study. Br J Gen Pract. 2015;65(635):e379–86

[iii] Comings JP, Garner B, Smith CRudd RE, Anderson JE, Oppenheimer S, et al.(2007) in Review of adult learning and literacy. Volume 7, Health literacy: an update of medical and public health literature, eds Comings JP, Garner B, Smith C (Lawrence Erlbaum Associates, Mahwah, NJ), pp 175–203

[iv]Stone, Louise & Waldron, Russell. (2019). Great Expectations and e-mental health: The role of literacy in mediating access to mental healthcare. Australian family physician. 48. 8-12. 10.31128/AJGP-11-18-4760.

[v] Cheng C, Dunn M. Health literacy and the internet: A study on the readability of Australian online health information. Aust N Z J Public Health 2015;39(4):309–14. doi:10.1111/1753-6405.12341

[vi] Mishra V, Dexter JP. Comparison of Readability of Official Public Health Information About COVID-19 on Websites of International Agencies and the Governments of 15 Countries. JAMA Netw Open. 2020;3(8):e2018033. doi:10.1001/jamanetworkopen.2020.18033

[vii] Deering MJ and Harris 9 1996 in Louise Walsh, Tamsin Waterhouse and Sophie Hill, 2019, Guide to producing and sourcing quality health information: Guidelines to support high-quality health information for consumers and carers in Victoria. Centre for Health Communication and Participation, La Trobe University, Victoria. Accessed 20/10/2020 at: https://www.latrobe.edu.au/__data/assets/pdf_file/0005/1029362/CHCP-HEALTH-INFORMATION-GUIDELINES_APRIL-2019.pdf

[viii] Five Steps to Plain Language, The Centre for Plain Language. Accessed 22/10/2020 at: https://centerforplainlanguage.org/learning-training/five-steps-plain-language. Louise Walsh, Tamsin Waterhouse and Sophie Hill, 2019, Guide to producing and sourcing quality health information: Guidelines to support high-quality health information for consumers and carers in Victoria. Centre for Health Communication and Participation, La Trobe University, Victoria. Accessed 20/10/2020 at: https://www.latrobe.edu.au/__data/assets/pdf_file/0005/1029362/CHCP-HEALTH-INFORMATION-GUIDELINES_APRIL-2019.pdf

[ix] Tasmanian Government Health Literacy Workplace Toolkit – Use Plain Language, accessed 20/10/2020 at: https://www.dhhs.tas.gov.au/publichealth/health_literacy/health_literacy_toolkit/use_plain_language, Assessing readability, at: https://www.dhhs.tas.gov.au/publichealth/health_literacy/health_literacy_toolkit/assessing_readabilit and People with Additional Information Needs at: https://www.dhhs.tas.gov.au/publichealth/health_literacy/communications_and_health_literacy_workplace_toolkit

[x] Five Steps to Plain Language, The Centre for Plain Language. Accessed 22/10/2020 at: https://centerforplainlanguage.org/learning-training/five-steps-plain-language. Louise Walsh, Tamsin Waterhouse and Sophie Hill, 2019, Guide to producing and sourcing quality health information: Guidelines to support high-quality health information for consumers and carers in Victoria. Centre for Health Communication and Participation, La Trobe University, Victoria. Accessed 20/10/2020 at: https://www.latrobe.edu.au/__data/assets/pdf_file/0005/1029362/CHCP-HEALTH-INFORMATION-GUIDELINES_APRIL-2019.pdf, and Tasmanian Government Department of Health Health Literacy Workplace Toolkit, accessed 20/10/2020 at: https://www.dhhs.tas.gov.au/publichealth/health_literacy/communications_and_health_literacy_workplace_toolkit