Field-test materials to gauge effectiveness

Create focus group or one-on-one evaluation

Health care educators know that easy-to-read materials are a must for patients with limited literacy skills but also work best for skilled readers.

There are many elements that distinguish an easy-to-read booklet including writing style, the organization of information, and an uncluttered layout.

However, the only way to be sure the material has met its goal of being easy to read is to field-test it.

Material can be field-tested in focus groups or in one-on-one interviews. For best results the intended audience must be used to determine if the material works.

During the field-testing phase recruit individuals who have similar characteristics as the target audience in knowledge, attitude, skill, and accessibility, says Sandra Cornett, RN, PhD, director of the OSU/AHEC Health Literacy Program at The Ohio State University in Columbus.

"The more specific you make your criteria the more specific your audience is the better you will be," says Aracely Rosales, president of Rosales Communication in Philadelphia, a company that specializes in plain language and culture, and a member of The Clear Language Group.

When Rosales field-tested material on breast cancer via focus groups, the target audience was women who had been affected by the disease and their caregivers.

Rosales recommends asking focus groups who should be asked to review the material. The groups providing information on breast cancer suggested spouses since they are involved in the treatment process. So some of the groups Rosales field-tested the material with were mixed, patients and spouses, and some were only partners of breast cancer survivors.

To find the appropriate people for focus groups or one-on-one evaluation contact community based-organizations or hire a company that has expertise in recruitment. Rosales says if the piece is bilingual make sure the focus groups are bilingual.

To recruit a focus group for a booklet targeting pregnant women Rosales partnered with organizations in the community that work with pregnant women such as family-planning clinics.

"There are many ways to recruit. You can approach organizations directly, partner with organizations, distribute flyers as well as advertise in the newspaper," says Rosales.

Test clear language individually

Wendy Mettger, MA, president of Mettger Communications in Takoma Park, MD, a consulting firm that specializes in health literacy and plain language projects and a founding member of The Clear Language Group, checks to see if materials are truly easy to read by working with adult learners.

"In making sure the materials you are preparing are attractive and appealing and understandable to many different individuals we have found that working with adult learners is a great way to measure that because these are people who have marginal skills and are struggling to learn how to read and write effectively," she explains.

Mettger likes to work with individuals from this group because one-on-one field-testing provides people with limited literacy skills an atmosphere of confidentiality and safety.

To find adult learners contact local literacy programs, she advises.

Teachers can identify the appropriate students, and recruiting can take place during class. One of the key advantages of adult education programs is that the students have undergone a reading assessment to determine their reading level. If the material to be tested is at a sixth-grade reading level the appropriate students can be identified.

It's important not to give people material in advance but have them read it during the focus group or one-on-one evaluation. In this way it is possible to observe the participants discretely to see how quickly they read through the material and if they seem to be stuck on any pages. Often people who are learning to read will read the material out loud so it is easy to see if they struggle with any of the words or skip words they can't pronounce.

Mettger has a script she reads through before getting started that explains the process of letting people know there are no right or wrong answers, and it is their opinion she wants so the more honest they can be the better.

The testing process, whether one-on-one or in focus groups, should help identify areas that are problematic. Look for patterns, says Mettger. For example, during field-testing of a pamphlet on Alzheimer's disease it was clear that people with low literacy skills struggled with the words. So a phonetic guide was inserted into the text.

Generally about 10 interviews are appropriate. If the pamphlet is on a specific disease, such as diabetes, Mettger might do half with people who have diabetes and the other half with adult learners.

With focus groups Rosales recommends running about four groups with a trained facilitator. Always work with prepared questions that help determine if the point of the pamphlet is understood, such as accessing treatment for cancer.

"When you see a pattern in the beginning focus groups when people have trouble with content or a specific piece of information make sure to review this with other focus groups," she advises.

Once all the information is collected it is often clear what changes need to be made. Rosales says she prefers to make the changes and test the material one more time just to make sure the changes are right on target.


For more information about field-testing contact:

  • Sandra Cornett, RN, PhD, director, OSU / AHEC Health Literacy Program, The Ohio State University, 206 E Atwell Hall, 453 W. 10th Ave., Columbus, OH 43210. Phone: (614) 293-7396. E-mail:
  • Wendy Mettger, MA, president, Mettger Communicaitons, 129 Grant Avenue, Takoma Park, MD 20912. Phone: (301) 270-2774. E-mail:
  • Aracely Rosales, president, Rosales Communication, Philadelphia, PA. Phone: (215) 849-0545. E-mail: