Pick plain language for patient pamphlets

Solid organization, writing style yield best results

No matter the literacy level of your population, it is wise to develop criteria for selecting or creating educational materials in plain language.

"Whether people are college educated or not, they want information that is easy to read and accessed very quickly. They don’t want to read educational material like it is Gone With the Wind, says Sandra Cornett, RN, PhD, director at OSU/AHEC (Area Health Education Center) Health Literacy Program, Office of Health Sciences at The Ohio State University in Columbus.

Pamphlets can be written in a way that gets a concept across and makes the instructions understandable for people at all reading levels. It’s not cost-effective to create four or five different reading levels of information on one topic because you serve people with varying backgrounds. Patient education managers should try to have one piece of material that would be considered easy to read or plain language that everyone would use, and those individuals that want additional or more in-depth information could be given more materials or directed to the health information center, she says.

"Writers think that if the reading level is low enough, basically they have a good document and that is not true," says Cornett. There are many elements to consider when creating plain-language materials. To make sure that patients will find the pamphlets handed out by nurses and physicians at your health care facility easy to read and understand, include the following criteria in your materials review process:

1. Appearance and appeal

All the design elements, such as the amount of white space, font size, balance of illustrations and text, and use of uppercase and lowercase letters contribute to the appearance and appeal of educational materials.

Titles must be behavior-focused and action-oriented. They should be worded in such a way as to grab the reader and framed from the reader’s perspective, says Cornett. Upper and lowercase letters used for the titles as well as the text makes material easier to read. Use 12- to 14-point font size with column widths of two to five inches. A block of text is daunting to a reader, says Cornett.

To emphasize key points, use bold print, boxes, rule lines, different typeface, bullets, and increased print size. Subheads should help readers unfamiliar with the topic navigate the text. The purpose of illustrations or graphics is to help clarify the text.

Writing style counts

2. Writing style

No matter how carefully the elements of design are followed, they won’t help if the text is poorly written. The best pamphlets are written in second person, active voice with a conversational tone. Technical jargon is eliminated or explained if it must be included, and difficult concepts are explained with good analogies.

"Lots of times we are trying to explain abstract principles, and people — especially those that have limited reading ability or understanding — can’t take abstract principles and interpret them," says Cornett.

Clarity is enhanced when sentences are simple, no more than 10 words, and words should be kept to one or two syllables whenever possible. Terms should be consistent as well.

3. Organized information

Consumers often look at educational materials differently than health care professionals, says Cornett. What is a logical sequence of information to the professional is not to the consumer. Often, the key message is buried in the fourth or fifth page because the health care professional discussed risk factors, described what is normal before describing what is abnormal, and discussed anatomy and physiology before talking about the specific disease.

The consumer may want to know how the disease will affect his or her life, therefore that question may need to be addressed before details on the disease are covered. The text must be structured and sequenced in such a way that readers get the message very quickly and it is logical to them. The key messages need to be up front, action-oriented, and repeated, says Cornett.

"Before time is spent on developing and writing a pamphlet find out from the reader what they want to know and how they think logically," advises Cornett.

Often when pamphlets are field-tested, they are given to consumers after they are written, but before they are sent to the printers. Instead, the consumer should be approached before the writing process is started to determine what it is they need to know about a topic and the logical sequence of the facts from the perspective of the consumer should be noted as well, says Cornett.

[Editor’s note: Cornett recommends a book published by the National Literacy and Health Program, Canadian Public Health Association in Ottawa, Ontario in 1998 — Easy Does It! Plain Language and Clear Verbal Communication Training Manual. For more information, call (613) 725-3769.]


For more information about writing in plain language, contact:

Sandra Cornett, RN, PhD, Director OSU/AHEC Health Literacy Program, Office of Health Sciences, Ohio State University, 218 Meiling Hall, 370 W. Ninth Ave., Colum-bus, OH 43210-1238. Telephone: (614) 292-0716. E-mail: cornett-1@medctr.osu.edu.