How to's for creating easy-to-read materials

Organization, style, and appearance important

Although many in the field of health care think only the poorly educated fall into the category of low health literacy, that is not necessarily the case. Even well-educated people can have low health literacy; it has nothing to do with their ability to read but with their ability to understand very complex material that is unfamiliar to them.

"A simple definition of low health literacy is the ability to read, understand, and act on health information to make health decisions," explains Sandra Cornett, RN, PhD, director of the OSU/AHEC Health Literacy Program at The Ohio State University in Columbus.

What keeps people from understanding health information? Often the material is written poorly with lots of jargon and poor logical sequencing. The message is hidden in complex sentence structures making it difficult for those who do not have the context or frame of reference to understand.

In order to make sure people of all educational levels will understand health care material it must be written in plain language, says Cornett.

"Studies have shown that even well-educated persons prefer easy-to-read material when reading health information. I often tell workshop attendees that we all have a degree of low literacy, depending on what it is we are reading," she explains.

An easy-to-read piece is well organized. "The message needs to have as much structure built in as possible because less able readers organize information poorly," says Cornett.

In a well-organized piece the actions or desired behaviors the reader is to take should be immediately evident. Key points are limited with the "need to know" information stressed and the "nice to know" information either not included or not stressed. Headings and summaries aid organization and provide opportunity for repetition.

The information needs to be sequenced in a way that is logical to the reader; the author should know something about how the intended audience perceives things.

"It is absolutely essential when developing low literacy materials to know who you are writing for and why. Gather information about the target audience through personal knowledge, focus groups, colleagues, and journals. Knowing your audience helps focus more clearly on the material to be covered," says Cornett. Cultural diversity issues would be considered at the time the audience is being evaluated.

In addition, the cover needs to indicate the core content and the intended audience so people know what to expect when they pick up the material.

Conversational style best

Cornett says writing style can make all the difference in making a pamphlet or handout easy to read. "If the message is friendly with familiar words and short sentences, it is more likely to be read," she explains.

Easy-to-read material is written in conversational style, using active voice with vivid nouns, verbs, and pronouns. In addition to vivid language the material should have lots of examples or analogies making it more interesting and easier to remember. The use of pronouns makes it personal.

Technical jargon should be used only if absolutely necessary and if a term is unfamiliar to the reader it should be explained in the text.

Sentences should be kept short but not to the point of being choppy and whenever possible words should be no more than one or two syllables.

Use bullets for lists to help organize a series of items under one heading. A well-organized list with a descriptive heading can be remembered more easily than if the important information is embedded in a complex paragraph. Lists of more than five to seven items will not be remembered.

Appearance and appeal of the material complement organization and style and are just as important when creating an easy-to-read manuscript.

The layout should look uncluttered with ample white space and generous margins. White space, words, and illustrations should be proportional to each other. Also, the design elements should work together including the size, shape, color, pictures, and layout of the text.

Subheadings that are highly visible, written as questions or statements, and are concrete and informative guide a reader who is unfamiliar with the context. Key points can be emphasized by using boxes, bold print, rule lines, increased print size, underlining or highlighting. Capital letters should never be used for emphasis, says Cornett.

Don't try to write to different grade levels but rather write to one standard level, which for an easy-to-read guide is sixth through eighth grade, preferably sixth. One knows what grade level a piece of material is by doing a reading index or formula, preferably by hand. Two of the most widely used are the Fry Index and the SMOG.

"You decrease reading difficulty by increasing the number of sentences and decreasing the number of syllables in words. However, simply doing this and getting a low reading level does not make a piece easy to read. All the criteria including organization, writing style and appearance need to be addressed.

To ensure that pamphlets and handouts are user-friendly set up a review process of different disciplines and use the criteria for easy-to-read materials as a guideline.

Cornett advises health care systems to create standard criteria for the appearance, layout, design, illustrations, font size, and type so authors don't have to consider these aspects.

"The best way to ensure clear, easy-to-read materials is to field test them with the target audience. This is the gold standard," says Cornett.


For more information about writing easy-to-read materials, contact:

  • Sandra Cornett, RN, Ph.D., 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: