AMWA Health Literacy

How to write patient resources that build health literacy - By Sophia Auld

(Sophia Auld is a friendly, reliable and professional freelance health and medical copywriter. She draws on 25 years of healthcare experience to write accurate, compelling, compliant copy to help her clients grow their reputations and revenue, so they can ultimately help more people.)

Ever had something explained to you but you just didn’t get it? This may not matter in many cases—like understanding how a vehicle engine works. But when it comes to health, difficulty comprehending material could have a profound impact, potentially even a life-changing one.

Many people have this experience with health information. Figures show almost 60% of Australian adults, and a similar percentage of New Zealanders, have low health literacy[1]^,[2]. People with low health literacy may have difficulty understanding health materials, acting on the information, and making informed healthcare decisions[3].

As health and medical writers, we can develop patient resources that support health literacy–-and therefore help people make better choices about their health. Before delving into how, let’s look briefly at what health literacy is and why it’s so important.

What is health literacy?

Health literacy is about the way people understand and act on health information. It has two key components[4]:

1. Individual health literacy

This involves an individual’s capacity to obtain, understand and evaluate health information and services—and use them to take appropriate action. It includes the ability to read, listen, comprehend and think critically.

Factors that may affect a person’s health literacy include[5]^,[6]:

• education – higher educational attainment is linked with higher rates of adequate or better health literacy
• disability – people with disability may have functional issues that affect their health literacy, such as intellectual disability or low vision
• language and cultural background – a person’s language and culture can influence how they derive meaning from their experiences. This can impact their understanding of health issues. Difficulty with the English language can also affect an individual’s health literacy. Aboriginal and Torres Strait Islander peoples may be at risk of lower health literacy due to educational and socioeconomic disadvantage. Māori and Pacific peoples have lower rates of health literacy than non-Māori people.

2. The health literacy environment

This includes factors that affect how people access, understand, evaluate and apply health information. Examples include the policies, infrastructure and people that form our healthcare system. For many, the healthcare system can be complex and overwhelming, making it difficult to grasp health information.

Why is health literacy important?

Health literacy matters because research has found links between individual health literacy levels, health-promoting behaviours and health outcomes.

Lower health literacy is associated with[7]:

•          a higher rate of adverse health outcomes
•          higher hospitalisation rates and use of emergency services
•          lower participation in health screening and prevention measures (e.g. flu vaccination)
•          poorer understanding of medication instructions and compliance with treatment
•          less ability to comprehend labels and health messages.

Poor health literacy also places a significant strain on human and financial health system resources[8].

In contrast, higher levels of health literacy are linked with benefits for[9]:

•          individuals – such as better ability to manage chronic health conditions, stick with treatment programs, and take part in health-promoting activities
•          societies – health-literate people are more active in contributing to economic prosperity and their communities.

The benefits of health literacy: some examples

The World Health Organization has some good examples of how health literacy, and materials that support health literacy, can benefit people and societies[10]^,[11].

• .Health literacy plays a vital role in preventing noncommunicable diseases such as diabetes, heart disease and cancer.
• .Health literate mothers better understand how breastfeeding benefits nutrition, thereby improving infant and child health.
• .Picture-based warnings on tobacco product packaging do a better job of alerting people to the health harms of smoking than text-based warnings. They also help overcome literacy challenges, especially in populations with low literacy, children and young people.

Writing health literacy-friendly resources

Effective patient resources can help improve health literacy, empowering individuals to take more control of their health.

Here are some practical tips for writing health literacy-friendly materials.

1. Use plain language

Plain language helps your audience understand the information. Use simple, everyday words instead of technical or medical jargon. For example:

• Instead of: “Administer the medication orally at eight-hour intervals.”
• Write: “Take the medicine by mouth every eight hours.”

If you can’t avoid medical terms, define them in a way that is easy to understand.

Use short, direct sentences and active voice wherever possible. For example:

• Instead of: “It is recommended that the medication is taken twice daily.”
• Write: “Take the medication twice a day.”

2. Structure information logically

A clear structure helps make patient materials accessible. Use headings and subheadings to break content up and aid scanning. Use bullets or numbered lists to draw attention to key points.

You can also use bullets instead of long sentences in some cases.

Here’s an example based on diabetes management.

Instead of: "Managing diabetes involves monitoring your blood sugar levels each day, eating a healthy diet, and exercising regularly."

Write: You can manage diabetes by:

•          monitoring your blood sugar levels each day
•          eating a healthy diet
•          exercising regularly.

3. Focus on key information

Avoid overwhelming people with information. When deciding what to include, consider what is:

•          essential
•          non-essential but helpful
•          too much.

Include the most important details at the top of the piece. You can also highlight key information with text boxes or visual aids, such as icons. Provide actionable instructions where appropriate.

4. Consider your audience

Your audience may be made up of people from diverse cultural, educational, and socioeconomic backgrounds. To ensure patient resources are accessible to most readers, they  should be written at a 6th-8th grade reading level.

Use readability tools like the Flesch-Kincaid Grade Level or the Hemingway App to check the complexity of your text and adjust as needed.

Additionally, consider cultural sensitivity when crafting materials. If people from a different  cultural background to your own will be using the resources, get someone from that background to review them.

5. Use visuals

It can sometime be better to present information using visuals rather than words. Visual aids can also support written information and aid scanning.

A diagram showing people how to use an EpiPen, for example, can help them understand a written or verbal explanation.

Visuals that might be helpful include:

•          diagrams
•          charts
•          tables
•          photos
•          infographics
•          icons.

6. Use tools to check your content

You can use different tools to help ensure your content is appropriate for your audience.

1. SHeLL Editor – this online tool from the Sydney Health Literacy Lab gives you feedback about how easy your content is to understand. It points out uncommon words, jargon, passive voice, and acronyms.
2. CDC Clear Communication Index – is a tool designed to help public health professionals create clear and effective communication. It includes a checklist of essential factors, such as audience understanding and appropriate use of visuals.
3. Readable – this online readability analyser assesses the complexity of text and gives you suggestions for simplifying language.

Helpful resources

NSW Government | Plain and inclusive language

Australian Government Style Manual | Plain language and word choice

The Royal Children’s Hospital | Guide to writing in plain language

Australian Clinical Trials Alliance | Writing in plain language

Envision Pharma | PLS of Publications Toolkit

The Health Literacy Place (NHS) | Toolkit

Health education England (NHS) | Health literacy ‘how to’ guide

Office of Disease Prevention and Health Promotion (US) | Health Literacy Online

References

[1] Australian Institute of Health and Welfare. Australia's health 2018: health literacy. Available at https://www.aihw.gov.au/reports/australias-health/australias-health-2018/contents/indicators-of-australias-health/health-literacy. Accessed 4 Oct. 24.

[2] Health Quality & Safety Commission New Zealand. Background information about health literacy. Available at https://www.hqsc.govt.nz/assets/Consumer-hub/Partners-in-Care/Publications-resources/health-literacy-background-info-Sep-2013.pdf. Accessed 8 Oct 24.

[3] Australian Commission on Safety and Quality in Health Care. Health literacy. Available at https://www.safetyandquality.gov.au/standards/nsqhs-standards/partnering-consumers-standard/health-literacy. Accessed 4 Oct. 24.

[4] Ibid.

[5] Ibid.

[6] HQSCNZ. Background information about health literacy.

[7] ACSQHC. Health literacy.

[8] World Health Organization. Health literacy: the solid facts. 1 October 2013. Available at https://www.who.int/europe/publications/i/item/9789289000154. Accessed 5 Oct 24.

[9] Ibid.

[10] Ibid.

[11] World Health Organization. Health Promotion: Health literacy. Available at  https://www.who.int/teams/health-promotion/enhanced-wellbeing/ninth-global-conference/health-literacy. Accessed 5 Oct. 24.