Health Literacy: Guidelines for Comprehension

Providing health education through written materials is a common method of patient communication. However, medical concepts can be difficult to grasp. According to a paper in the Journal of Psychology, Health and Medicine, much of the material written for patients, in the areas of informed consent, illnesses and their investigation and treatment, and lifestyle advice, is too difficult for many of them to understand. Most healthcare agencies have recommended readability of patient education materials at a sixth-grade level or below. It is important to note that even people with literacy skills above a sixth-grade level may find understanding healthcare information is a challenge.

Welocalize Life Sciences has compiled several tools and recommendations to assist medical writers with health literacy for patient comprehension. The following are based on over 20 years of experience preparing patient-facing material and input from the EU’s Summaries of Clinical Trial Results for Laypersons, U.S. Centers for Disease Control, the Fernandez-Huerta Formula and the World Health Organization,

  • Reduce technical jargon. Don’t copy text from the technical summary. Instead, rewrite it and explain technical terms in simple language. Note: translation into some languages may increase the number of words and result in longer documents.
  • Text should be understood by people with a low to average level of literacy. According to “Summaries of Clinical Trial Results for Laypersons,” the average proficiency level in Europe is 2 -3. A proficiency level of 2 is defined as being able to identify words and numbers in a context and being able to respond with simple information. In the U.S., most health agencies recommend material written for an audience no higher than 6th grade reading level.
  • Avoid long and complex sentences,  that include many clauses. These can be difficult to understand.
  • Consider font style. Choose fonts that are easy to read. Avoid fancy scripts and all-caps. Limit your use of italics and underlined words, however do use bold-faced font to call attention to critical terms.

Localization Tip: Font selection and usage. Font style also matters when translating your materials. Matthew Reiner, Senior DTP Specialist at Welocalize Life Sciences, recommends trying to choose fonts that cover a wide variety of writing systems when designing source file content. Fonts that support Unicode characters are best, also staying away from very complex, artistic fonts as these font styles typically do not support special characters.

  • Use vocabulary that will be familiar to non-medical persons. Avoid jargon, technical or medical language. For example, use the phrase “high blood pressure” rather than the medical term “hypertension.”
  • Reduce the number of unnecessary words. And, remove what could be considered complex words. For example, “use” rather than “utilize”.
  • Consistent and specific. Be consistent in the use of terms and words throughout the document, and then define them. In addition, avoid ambiguous words and phrases. For example, “felt badly” can be subjective and have different meanings from one person to another.
  • Use images and symbols. Visuals can improve your communication materials when used correctly. Pictures help grab an audience’s attention and help tell a story. The CDC provides several examples of how (and how not) to incorporate symbols and images. It also points out that many symbols are not universally understood. It also recommends testing visuals to ensure they are appropriate for the intended audience. Access the CDC library for a variety of images related to public health.
  • Test for readability. There are several readability tools writers can use to determine a document’s readability (how easy it is to read). For English text, using Microsoft Word, you can test the readability by using the Flesch Reading Ease Test or the Flesch-Kincaid Grade Level Test based on counting syllables and sentence length. This can be helpful in multi-country studies where summaries are first drafted in English and then translated into other languages. The Flesch Reading Ease Test assesses readability on a scale from 1 to 100. Anything that scores 70 and above is easy to read.

Here is the step-by-step guide for testing readability in Word:

    • Click the File tab, and then click Options.
    • Click Proofing.
    • Under When correcting spelling and grammar in Word, make sure the Check grammar with spelling check box is selected.
    • Select Show readability statistics.
    • After you enable this feature, open a file that you want to check, and check the spelling. When Word finishes checking the spelling and grammar, it displays information about the reading level of the document.

Contact Welocalize Life Sciences for information on translation of summaries of clinical trial results for laypersons and other patient-facing medical and clinical documents.