1. Making Health Information More Accessible Yvonne Kellar-Guenther, Ph.D. March 16, 2011

2. What Is Health Literacy? Capacity to Obtain, Process, and Understand Basic Health Information Verbal Health Literacy Written Health Literacy

3. Why Is Knowing Health Literacy Important? People With Low Literacy Skills Are Less Likely To Follow Through With Treatments. Misunderstanding Medical Directions Can Put a Person’s Health at Risk.

4. What Contributes to Health Literacy? Individual Capacity Reading Fluency Prior Knowledge Health Care Environment Baker, DW (2006). J Gen Intern Med; 21: 878-883.

5. Making Health Information More Accessible

6. Fatigue is a feeling of tiredness that can keep you from doing the things you normally do or want to do. Fatigue is very common among people receiving cancer treatments. Factors such as cancer itself, low blood counts, nutritional problems, and sleep problems contribute to fatigue, but the exact cause (50 words) is not known. How many words are 3 or more syllables? How many sentences in the 50 words?

7. Number of syllables per 50 words – 78 so about 150 per 100 words Number of sentences - 3 for 50 words so 6 for 100 x

8. Tips for Making Written Information Accessible How Is Reading Level Determined? Number of syllables Number of words in a sentence Hard words are those with more than two syllables. To Get To Fourth-grade Reading Level Average sentence length of eight words; and/or No more than 1 out of 50 words having three or more syllables

9. Tips for Reducing Reading Level If The Title Of Something Will Not Be Clear Even When It Is Spelled Out, Use The Acronym Avoid Complex Sentences One idea per sentence Minimize the use of compound sentences

10. Rewrite Paragraph

11. Tips for Reducing Reading Level Pronoun Reference Should Be Clear Use the noun first, then the pronoun when possible Have pronoun as close to noun as possible Make Sure A Concept Has Been Introduced First If Another Concept Has To Build On It. Start with an overview of task/procedure/etc.

12. Tips for Reducing Reading Level Avoid Passive Voice Putting Things In A List (Even As Complete Sentences) Makes Reading Level Lower Numbered steps are helpful Do periods after bulleted clauses

13. Example There are other things you can do for your. These treatments are ___________. You may choose not to get treatment. Talk to your doctor about other treatments. If you stop being in the study you can use other treatment. Before you choose to be in the study you should understand all your choices. (4.8 for section) There are other things you can do for your. These treatments are ___________. You may choose not to get treatment. Talk to your doctor about other treatments. If you stop being in the study you can use other treatment. Before you choose to be in the study you should understand all your choices. (3.8 for section)

14. Another Exercise Acute and Chronic disease: What is the difference? Acute disease is a short-term illness that comes on rapidly and has distinct symptoms. Examples of acute diseases are childhood illnesses, Tonsillitis, Appendicitis, Earaches and infectious diseases like a cold, flu or strep throat. (12.9)

15. One Way I Re-wrote It Acute disease is a short-term illness. This disease comes on quickly. It usually also has distinct symptoms. An acute disease does not usually last more than 3 months. Examples of acute diseases are: Childhood illnesses. Tonsillitis. Appendicitis. Earaches. Infectious diseases like a cold, flu or strep throat. (7.8)

16. Tips for Reducing Reading Level If Introduce Jargon, In Same Sentence Provide Definition Do not use the term in the definition There should not be a break between the term and the definition Use Common Words

17. Game Time Come up with as many different names for the following words as you can: Red meat Nauseate Ambulate Medical Procedure

18. Tips – Clear Health Communication White Space Is Helpful To The Reader Use white space between steps so that they stand out Avoid References In Parentheses (e.g., Another Name, Etc.). Use Examples That Relate To Client’s Personal Experiences Answer Question “What If” Tell Translator You Are Aiming for Less Experienced Readers. Keep it interesting. Food doesn’t have to be boring. Try wraps and rice cakes, crispbreads and chapattis, tortillas, naan and corn cakes and, as an alternative to white breads, consider sourdough, multigrain, rye bread, pocket bread and fruit bread.

19. Tips- Clear Health Communication Strategy Variables How do you engage the reader? Task Variables What is the mode of presentation? What is the rate of the presentation? Reader Variables What vocabulary are they used to? What is experience do they bring to interpret?

20. Tips- Clear Health Communication Know your intended audience If your audience is “general population”, write to the lowest reading of understanding within the group. Use common type-faces Times-New Roman, Century School-Book ALL CAPS and bold focus attention Use sparingly

21. Tips – Beyond the Written Word Account for Different Learning Styles Visual Auditory Experiential Ask for Demonstrations Ask Open-Ended Questions

22. Tips –Beyond the Written Word Consider Alternative and Multiple Modes Of Giving Message Use Universal Symbols Whenever Possible

23. Tips for using Flesch-Kincaid to Check Reading Level Flesch-Kincaid formula does not like large numbers or phone numbers. Check your reading level without these. Remember, ultimately this is a computer program. Use this only as a guide.

24. Contact Information Yvonne Kellar-Guenther, Ph.D. Yvonne.kellar-guenther@ucdenver.edu