If working in public health has taught me anything, it’s that yes, it’s important to get your message out, but it’s more important to think how your messaging will be taken in. It was an interesting jump moving from the world of public health to pharma. After years of focus on health disparities, accessibility, and cultural competency, I found myself in a world full of promising data, strict language structure, and material that “co-travels.” The bridge between these two worlds has been through health literacy and with a focus that is not just on the patient, but also on the person. Critical standards about reading level, font type, bulleted copy, and so forth are all very important, but they are ingredients in a larger recipe. There is so much more to understand about how to communicate with your reader that goes way beyond what grade level the communication is written at. The person who is reading or consuming health care information is different from a general reader. The process of learning new health information is usually due to a vulnerability in either the life of the reader or someone they care about. So, the reader’s lens—the proverbial lens through which they are reading the health care information—is already a bit blurred by concern and anxiety. That is why health literacy cannot solely be about literacy and comprehension. It needs to include compassion, validation, imagery, representation, and an engaging tone of voice. It needs to be relevant.
Put the Moment Back in Teachable Moment Let’s talk about Lucy. At her appointment, Lucy was handed take-home material about a disease state written at a fifth-grade reading level. The patient received an educational resource? Check. But only one box was truly checked here. A person was provided communication. But did anyone stop and make sure Lucy understood the content? Understood how it relates to her? The easy-to-read “store in refrigerator” tip may be helpful with an image, but does Lucy understand that it has to be returned to the refrigerator after each use? And what if Lucy does not have consistent access to a refrigerator? Lucy works a night shift. Do the materials help Lucy understand what she can do when she doesn’t have the means to keep the medication cold?
Let’s meet Janet. She’s a native English speaker, but is understandably overwhelmed by the news that her cancer has progressed. Janet’s internal narrative is processing intense emotions. If she is handed a packet about the advances of CAR T-cell therapy for her type of cancer, how is the provider matching the moment? While promising treatment can reassure Janet, is this high-science information addressing the questions that a cancer patient may have at this chapter of her journey? Know your audience. Health literacy involves understanding the reader.
For example, while a newly diagnosed patient may be handed compassionate packets of information, this is not always the case for patients who are in treatment and awaiting encouraging news. Focus on how a patient may feel to hear about their disease progression, not just about the new options to fight it. Patients with cancer and their families need to have their feelings recognized and validated, and their energies conserved.
Factor in the Role of Trust with the Rest of the Facts Before we meet Ben, let’s address that the term “clinical trials” itself requires high literacy. So, discussing it at all requires a certain level of attention to the lexicon. Ben is interested in learning more about clinical trials, but truthfully, he doesn’t trust them. He’s heard horrible stories about trials from family members and in his faith community. What good is a poster that just provides the ABC’s of research without acknowledging the reasons why so many people distrust trials and what the field of research has done about it? Ben is not suddenly going to be quizzed on phrases like blind studies, endpoints, or statistical significance—Ben wants to know whether this type of research will help him, whether it’s safe, and who will be there to protect his rights as a study participant.
Bulleted Copy Points Need to Point to Something Meaningful We have all seen healthy living education materials. For instance, “eat a lot of fruits and vegetables and lean protein” is the caption under a photo of a bland piece of chicken. Sure, the bullet is easy to read, but it says nothing about how to best incorporate healthy foods into your diet. If the picture of the chicken does not look appetizing, or if the reader’s culture or religion does not include chicken in their diet, such a picture with this simple caption risks further alienating the reader. Health literacy acknowledges food from different cultures and the ingredients used to season them. If the educational materials do not focus on how to incorporate health behaviors into the reader’s reality, then they might as well be on a different grade level. Does the reader feel they can integrate this knowledge into their behaviors? Make it understandable and realistically actionable.
Case in point, when addressing a need for protein, recommend a non-meat alternative for those who don’t eat meat. If the focus is, indeed, chicken, provide guidance on the types of seasonings, sauces, or marinades that may be healthy to use. If the material is for a specific ethnic audience, share a recipe that shows how the ingredients the reader likes can still be used for cooking. The grade level is truly only one factor in determining if it is health-literate or not. While literacy software can be helpful in converting higher science into plain language, it is a tool in the arsenal. Health literacy is at its most effective when we use these tools to consider the attitudes, emotions, and concerns of every reader, how they perceive the information and how they take it “in”.
