Today we are continuing with our Suitability Assessment of Materials using the SAM
instrument to evaluate Beginnings Guides suitability for promoting maternal health
literacy in US mothers, including those with limited resources and limited literacy.
We’ve already discussed factors related to content. Now we are considering factors
that determine literacy demand, that is the number and difficulty of literacy tasks
required to make meaning from the information. The literacy demand of any health
related information is unavoidably high; the health communications challenge is to
reduce the literacy demand and facilitate meaning making and application in real
So far in the category of literacy demand, we have considered readability,
writing style and sentence construction. Today’s topic is vocabulary.
Choose common, explicit words
Almost always, the need for health information emerges due to something painful,
scary, “weird” or otherwise stressful, so that learning capacity is reduced. Health
information should not be a vocabulary test. Parents and patients cannot be
expected to know the specialized vocabulary of medicine. Health professionals must
be expected to use plain ordinary short words in conversation with the rest of us.
Plain talk is empowering to patients, and may be challenging to those whose power
comes from status.
What’s clear to you is clear to you
To check that you are using plain language, note the mental picture your words
create. Watch out for categories like poultry (chicken, turkey, goose, duck,
pigeon, dove, pheasant...). One mother told me, “I eat chicken; the doctor said
to stay away from poultry.”
Watch out for concepts that require a judgement.
Two men had heart surgery. On discharge, the surgeon told each of them to
“take it easy”. But the doctor’s mental picture of taking it easy was not the same
as the images his words created in the patients’ minds. Two weeks later both men
arrived at the ER by ambulance and were readmitted. The first man was a runner;
he ran two miles instead of five. The other man was a couch-potato; he had not
been vertical in weeks, his systems were shutting down. What question (s) could
you have asked these men to learn how to frame take it easy’ in way that would
facilitate their making meaning and taking recovery-promoting action?
My favorite: familiar words that mean something else
In a medical context, common familiar words often take on a new meaning. Stool
is one that often baffles new mothers. While the nurse is talking about what’s in
Baby’s diaper, the mother is wondering what a 3-legged thing to sit on has to do
He is complying to the letter. And he is
about to overdose. “Cap”
brings to his mind his hat; experience
tells him he can drink out of it in a pinch.
But in the writer’s mind, a “cap” goes
on a medicine bottle and measures a dose.
Photo Credit: "Life According to Carp"
From Smith S. (2000) Patient Education and Literacy in Laubus and Lauber (Eds)
Preventive Medicine and Patient Education. Philadelphia, Saunders, 266-290
When you cannot avoid a technical or judgement term...
Instead of excess mucus, which requires a judgement of what is excess and
interpretation of medical jargon (mucus), say it the regular way: runny nose.
Sometimes there is no plain term. In those cases explanation, example and
illustration reduce literacy demand and facilitate meaning-making.
Culture matters In testing the Beginnings Pregnancy Guide, we asked mothers
how to talk about urination, since no one actually says urinate. English speaking
moms wanted to say “go to the bathroom”. Spanish speakers seemed surprised
by the question; they said, “We know what orino means.”
Final note: no one says healthcare provider. Mothers said a provider is one who
puts a roof over your head. While they know there are physicians and nurses and
therapists and receptionists, most used the term doctor to refer to anyone they met
in the medical encounter.
Bottom line: Short plain words that create an unambiguous mental picture
Next: Road Signs