Resources/Referral/Follow Up

Developing Written Materials

Another way to reinforce your patient’s learning is through written resources. These resources may be in the form of patient letters routinely used by genetic counselors, fact sheets about specific conditions or procedures, information about support groups, or internet resources. However, it is essential that these resources also be easy-to-read and understandable, since they may be referred to as a permanent record of the oral conversation in the future. Additionally, nearly half of Americans read below an eighth grade reading level, while the general health education material is written above a 10th grade reading level (OSU, “Write it in Plain Language”). In general, when creating or reviewing resources, begin by brainstorming what your patient wants and needs to know about the topic. Think about the following topics:

• How might my patient use this information?

• Who needs to know this information and why?

• When will they need to know this information?

• What do I expect the reader to know and do after reviewing this information?

After getting a general idea of what your text should include, there are two ways to more specifically assess the readability of health resources: using formal readability formulas and informal readability checklists.

Readability formulas, such as the simple SMOG and FRY readability formulas (see links below), measure both vocabulary difficulty and sentence length. These formulas are generally easy to use and are useful in predicting the general reading difficulty (plus or minus one grade level). Readability formulas can also help you analyze how word choice and sentence length affect the difficulty of the resource. That being said, readability tests cannot speak to the clarity of the writing, the complexity of the ideas, the factual correctness of the information, the organization of the content, the level of vocabulary, the design of the resource or the cultural sensitivity of the resource (Cornett, 2005). Therefore, readability formulas are helpful in giving a specific grade level if needed (e.g., for informed consent documents), but they cannot ensure that a resource is appropriate for an individual with low health literacy.

SMOG:

FRY:

Alternatively, when examining the overall readability of a document, the following checklist may be useful in guiding the selection and development of documents appropriate to individuals with low health literacy (adapted from Cornett, 2005 and Maine AHEC Health Literacy Center’s “Checklist for easy to read materials”):

  • Appearance/Appeal: The piece “grabs” the reader and looks easy to read.

    • Design elements (size, shape, color, pictures, and text layout) work together to attract attention.

    • Cover or masthead includes a title and behavior-focused core message framed from an audience perspective.

    • Page layout and illustrations draw in/engage the reader.

      • Layout:

        • Looks uncluttered. Has ample white space, generous margins, short line length (2-5 inches).

        • Balances white space with words and illustrations. All 3 elements are proportional to each other.

        • Uses highly visible subheads (section titles) that are concrete and informative, to guide readers unfamiliar with the context.

        • Emphasizes key points with restrained use of boxes, rule lines, bolding, different typeface, and/or increased print size. Does not use all capital letters or italics.

        • Uses upper and lower case letters in 12-14 point serif typeface.

      • Illustrations:

        • Attract attention, reinforce key points, and are appropriately located close to the text.

        • Are culturally suitable and meaningful for the target audience.

        • Include captions when needed.

        • Are simple, without adding unnecessary clutter.

    • The piece is interactive. It actively engages the reader by using creative formats—story, dialogue, check list, self quiz, etc.

  • Organization: Text is structured and sequenced so readers can “get the message” quickly.

    • Key messages are action-focused, up front, and repeated.

    • Major points are limited (3-5). “Need to know” information is stressed; “nice to know” information is limited.

    • Information is sequenced and presented in a way that is logical to the intended user.

    • Paragraphs and/or sections are short, visually distinct, appropriately labeled with subheads, and stick to one point.

  • Writing style: Strong, clear, concrete nouns and verbs create visual images the reader can remember.

    • Writing style uses active voice, conversational style, pronouns and friendly tone. Do not be afraid to use a personal, conversational style, even it means using the pronouns “you”, “we”, and “I”.

    • There is little or no technical jargon, and when necessary, it is explained. Terms are used consistently throughout the piece.

    • The piece emphasizes concrete examples rather than abstract principles. Common words/analogies explain difficult concepts.

    • Provide context before presenting new information. Words and sentences are short and simple, but not to the point of being choppy. Important information is not hidden in complex sentence construction. Lists are bulleted and short.

    • Instead of using medical generalizations (e.g., “premature births and newborn illnesses are decreased by getting early pregnancy care”), give concrete recommendations for action (e.g., “make an appointment to see your doctor as soon as you can.”).

For more information regarding health literacy, please review the many excellent articles on the Ohio State University’s Health Literacy Program’s website. We also suggest reviewing “Tools for Assessing Readability and Quality of Health-Related Web Sites,” which provides multiple online resources (Shedlosky et al., 2008).

Exercise:

Use the pointers in this section to begin developing a new patient educational material. Decide on the focus based on prevalence of conditions on which you counsel, as well as specific needs of the patients served in your center. Consider developing a brochure, a fact sheet, or a web-based resource. Outline the content and design of the new material and develop an evaluation checklist. Use the checklist results to revise the content and or design as needed. Ask a colleague to use the checklist to evaluate the item. Pilot the evaluated materials with several patients, and re-revise. Share your final educational product with your colleagues.

 

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