When designing materials, go to the source
When designing materials, go to the source
Choosing a long-distance carrier and making health care choices have many similarities. Both are complex and require the ability to take in information and make an informed choice. But making the right choice about long-distance calling and health care have very different and far-reaching consequences, too.
That was the point Robert Friedland, director of the National Academy on an Aging Society of Washington, DC, made at the National Academy for State Health Policy conference in Bloomington, MN, in August. Similar skills are used for making both decisions, he said, but with about 40% of the population suffering a lack of literacy skills problems, and 21% functionally illiterate, the cost of health care soars.
There are expenses, he explained, as simple as having health care workers spend time making sure patients understand instructions for taking their medication properly. The cost, overall, he said, goes into the billions annually.
Reaching this population is tough. Some experts in the field contend that it is hard to tell when people have trouble reading or retaining information because they have developed skills over the years to mask their deficiencies. Functional illiteracy, Mr. Friedland said, is not necessarily tied to education. It also can result from aging, when reading and retention skills of an educated person can drop, for instance, following retirement. Locating the enemy can often be as tough as combating it.
The best way for health care workers to fight the problem is to go directly to the source, the patients, said Jeanne McGee, president of McGee & Evers Consulting Inc. in Vancouver, WA. Her company prepared a writing and designing guide for the Health Care Financing Administration (HCFA) last year so that workers could design materials to reach those with literacy problems. (To order guide, see box, at left.)
"There are a combination of ways to communicate," Ms. McGee said. "We rely heavily on feedback from readers."
Ms. McGee created a six-step model for helping health care workers develop and test their print materials:
1. Identify goal and intended audience.
2. Research to learn about audiences and issues.
3. Develop and test materials.
4. Distribute materials.
5. Assess effectiveness.
6. Use feedback to make further improvements.
She cautioned about using formulas when creating printed materials, especially formulas for determining the grade level of the intended reader.
"Be cautious because it’s hazardous to take it too seriously," she said. "They are based on words and sentences, short words vs. long words and sentences. It’s mechanical and the assumption is the reader is mechanical, a robot. [Formulas] don’t take into account what they bring to the material. Short sentences are not always the best."
It is humbling to find out that people do not understand your materials, no matter how simple and readable you thought they were, Ms. McGee added.
Ms. McGee suggested that the best way to approach judging the readability of materials was to be patient and invest in staff education, training, and development.
Use audience research by learning about the various cultures of potential readers, and take the time to use the proper graphics. Find graphics, she said, that will attract and hold readers’ attention and allow them to focus on the main points. Next, make a mock-up of the document and test it by interviewing potential readers.
The interviews should identify whether the material is appealing, culturally acceptable, easy to understand, well-organized, and if readers can actually put the information to use. Several rounds of testing are important, Ms. McGee added.
Her tips for successful testing include:
• Explain the purpose and process to participants to encourage candor.
• Ask questions in a way that allows and encourages people to say what they think without feeling pressured or inhibited.
• Suspend your assumptions; be sure to ask about reasons why.
• Be nondefensive; it’s a rewarding if humbling experience.
Daniel Rubin, health policy coordinator, of the Office of Policy, Legislative, and Constituent Relations of Olympia, WA, said using emotional material is another way to get a point across to readers. His example was a comic book showing the hazards of smoking that was created for young readers. He said drawings and characters are often more accessible and understandable to readers instead of straight text.
Mr. Rubin also suggested that creators of health care materials keep in mind that their potential audience is not always future patients, but also health care management and policy-makers.
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