While guides and resources for the creation of understandable health information materials exist and should be used more, their writers and developers should take a page from web developers: test with end users.

Working from the premise that "If the information does not fit the learner, it cannot increase her ability to use information and services in ways that promote health", the Beginnings Guides blog has created a multi-post series on assessing health literacy materials that is a valuable read for anyone trying to help expectant and new mothers effectively care for their child's health. As of this writing, there are six installments on different aspects of creating, designing and evaluating health literacy materials:

1. Does the info fit the learner? In other words, make the purpose of the information and the steps necessary clear, and repeat or review this information at the end of the handout or materials.
2. Readability: write in a conversational tone using active voice, common words and personal pronouns.
3. Writing style and sentence construction: provide a context the mother can relate to, not in an abstract manner but in a voice you would use when talking to someone.
4. Vocabulary: word choice is critical. Use common, explicit terms instead of medical jargon (what's a better word for "stool"?), and avoid category words (say "chicken" instead of "poultry").
5. Road signs: use short, simple sentence subheadings that include a verb to "break up a sea of type".
6. Cover graphics: graphics that are friendly and clearly indicate the materials' purpose are more likely to catch her attention amidst the deluge of information in her daily life.

These recommendations are based on the Suitability Assessment of Materials (SAM), developed in 1993 by Leonard and Cecilia Doak and Jane Root under the Johns Hopkins School of Medicine project, “Nutrition for Education in Urban African Americans” funded by the National Institutes of Health.

Need a way to quickly check new or existing materials for readability? A number of software programs exist to assist in this process:

• Health Literacy Advisor (Add-on to Microsoft Word)
• InText (Public domain software for Windows, English and German); commercial version available as TextQuest
• Readability Plus (Windows and Mac)
• Readability Studio (Windows)
• Stylewriter (Windows and Mac)
• UNIX commands to help identify readability and style issues ("How to Write Easy-to-Read Health Materials", MedlinePlus 2012 )

And even if all of these steps and tools are utilized, patient compliance may not be as full as we'd like. Why?

While it is essential that these steps be taken in developing materials, no amount of software-based or writer-based editing and evaluation of health literacy materials can substitute for feedback from end users. Usability testing is central to the development of an effective website and web presence: if visitors don't like the site within a few seconds, they will leave. Readers of health literacy promoting materials may read a bit longer, but if they don't understand, they won't use them. Funds need to be made available to recruit the kinds of patients that these materials are designed to reach.

A website usability test involves hiring a few (8-12) potential end users of a site, sitting them down in front of a computer, and asking them to complete a series of tasks. Recordings of their reactions and on-screen activities are used to evaluate links (road signs), layout and more. This provides concrete feedback that will help developers make the site easier to use.

Why not recruit low-income and/or non-English speaking patients to read and provide feedback on health literacy promotion materials? It would need to be an outside group, not the healthcare provider and its staff: patients are uncomfortable challenging their physicians. Couple this with some sort of health outcome based statistics, and it would help demonstrate what really works in creating informational materials.

Have you created materials to increase your patients' health literacy? How did you evaluate its effectiveness? Tell us at the fireside!

Reference

Doak, C Doak, L, and Root J. Teaching Patients with Lowe Literacy Skills 2nd Edition, Philadelphia: Lipincott 1996.

MedlinePlus. How to Write Easy-to-Read Health Materials. Retrieved December 6, 2012, from http://www.ncbi.nlm.nih.gov/pubmed/