writing consumer health information

Associate Professor Anne Johnson

2010

Background information How do you assess information? Resources you can use Suggestions for how to write more

clearly and effectively

Patient-centred care is about sharing the management of an illness/condition between patient (and significant other) and practitioner.

It is in contrast to the traditional, didactic “Medical model” approach to the practitioner-patient interaction which focuses on the disease rather than the person with the disease and the power and knowledge rests with the practitioner.

Degree Participants’ Action

High Have control

Have delegated

Plan jointly

Advise

Low Are consulted

Receive information

None

Enabling an open exchange of information between health professionals and consumers is essential in the provision of appropriate and effective patient-centred care.

It is a right of consumers to have access to up-to-date, accurate, relevant and understandable information on which to base informed choice and informed consent. Written information is one approach to the provision of this information.

75% of oral communication is ignored, misunderstood or quickly forgotten (Bolton 1986).

Quality written information as a communication tool greatly enhances learning and retention of information, increases confidence, decreases unnecessary contacts with health professionals and increases consumer satisfaction.

The Cochrane Review, “Written and verbal information versus verbal information only for patients being discharged from acute hospital settings to home”, found that the knowledge and satisfaction of

patients and/or significant others appears to improve when a combination of verbal and written health information is provided compared to verbal information only.

(Johnson A, Sandford J, Tyndall J, 2003, Issue 4, The Cochrane Library)

0%

10%

20%

30%

40%

50%

60%

70%

TV newspapers, magazines

packaging, labelling

family/ friends

specialist books

doctors Consumers advice

services Internet free phone

n°

Poland Spain Germany Hungary Denmark

Health literacy is: The degree to which individuals have the capacity

to obtain, process, and understand basic health information to make appropriate health decisions.

Health literacy has a direct influence on people’s access to crucial information about their rights and health care, whether it involves following instructions for care, taking medication, comprehending disease-related information, what services/programs are available for them to access, or learning about disease prevention and health promotion

(Rudd et. al.1999).

Health care and maintenance Health promotion Health protection Disease prevention Systems navigation

Shows that 59 per cent of the Australian population aged 15 to 74 years did not achieve health literacy skill level 3 (out of 5) or above, which is the minimum required for individuals to meet the complex demands of everyday life and work in the emerging knowledge-based economy.

Australian Bureau of Statistics, Health Literacy, Australia, 2006, Catalogue No. 4233.0,

Australian Bureau of Statistics, Canberra, 2006.

At each higher level of self-reported level of overall health, adults had higher average health literacy than adults in the next lower level.

Excellent health = average score 262 Very good health = average score 254 Good health = average score 234 Fair health = average score 207 Poor health = average score 196

Lower percentages of adults with Below Basic health literacy than adults with Basic, Intermediate, or Proficient health literacy reported that they got information about health issues from any written sources.

20% of adults with Below Basic health literacy got information about health issues from the Internet. This compared to 42% with Basic health literacy, 67% with Intermediate and 85% with Proficient.

.

Higher percentages of adults with Below Basic or Basic health literacy than adults with Intermediate health received a lot of information about health issues from radio literacy and TV.

Adults with Proficient health literacy were least likely to receive a lot of information about health issues from those same non-print media sources.

Consumer information Citizen information Choice information Coping information Community health promotion

information

Educational resources as part of an education program

Health/illness information Procedural and medication information Service information Health information for the community

This is mine! What do other staff think of this? Let’s do it as a department/team! Let’s forms a committee! What do consumers think should be

included? The consumer(s) want to do it and want us

to help!(Johnson A, 1998, Reorienting a health service to become more

health promoting. PhD thesis, Flinders University)

Where consumers and health professionals work collaboratively.

Most common flaw is where health professionals ask consumers to comment on the design and content of an existing draft (Coulter et. al. 1999)

When you look at consumer health information what criteria do you use to make your judgment about whether you think it is is any good or not?

NHMRC (1999) How to present the evidence for consumers: preparation of consumer publications.

http://www.health.gov.au/nhmrc/publications/synopses/cp65syn.htm

Victorian DHS (2000) Well written health information: A guide.

http://www.health.vic.gov.au/consumer/downloads/dhs1074.pdf

Health Consumers’ Council WA (1997) Best Practice Guidelines for Developing Patient Information.

http://www.hcc-wa.asn.au/

Plain English Campaign, How to write medical information in plain English, UK

http://plainenglish.co.uk/medicalguide.html

Better Information and Communication Practiceshttp://fahcsia.gov.au/sa/disability/pubs/policy/Documents/cds/bicp/default.htm

Communication Rights Australia (CAUS) – communication tool for people with speech and communication difficultieshttp://www.caus.com.au

Communicating Positively. A guide to appropriate Aboriginal terminology.http://www.health.nsw.gov.au/pubs/2004/pdf/aboriginal_terms.pdf

What is the purpose? Who is the information being written for? What is the information that needs to be

covered? Have you reviewed existing material on

the subject? Have you discussed the project with your

department head and secured support?

Whom else needs to be involved? How best to involve consumers and

others? What format best suits the information? What is the cost of the proposed

project?

In your writing style have youKept sentences short and to the point?Expressed only one idea in each sentence?Used simple grammatical structures?Written in the active versus the passive voice?Used the second person YOU instead of the third

person such as ‘the patient’ or ‘individuals’

Limited the number of words containing three or more syllables?

Tried to keep the eye span to no more that 60-70 characters?

Used adequate spacing to provide the eyes with a rest?

Used font size of suitable size (11 or 12) and Times New Roman or other easy to read font.

NOT USED ALL CAPITAL LETTERS?

Have you taken the following into account when writing?Does the information address the message

you want to convey as well as what the target group want to know?

Can the information be supported by current research?

Is the information consistent with your organisations standards/policies?

Is the content organised so that the “must know” information comes before the “nice to know” information?

Is the content organised so it flows well?Where appropriate have you used

illustrations to convey the message more clearly?

Is the content free from jargon and abbreviations?

Have you used consistent terminology?

Would the message be more clearly communicated through the use of: Question and answer format? Headings? Point form where appropriate? ‘Remember’ boxes which contain the most

important points/action steps?

Have you remained gender neutral, or it it a gender specific topic?

Is the information respectful towards the target group?

Have you identified your department and organisation and provided a contact number and address?

Is the publication dated? If necessary, have you placed © on it?

Has the draft been analysed to ensure clarity, accuracy and appropriate reading age?Reading age dependent on target group.

Standard is usually grade 8 reading level.Objective feedback from someone with

good writing skills.Final copy edited for printing errors.

Step 1: count 10 consecutive sentences near the beginning, middle and end of the material (total of 30 sentences). A sentence is any list of words ending in a full stop, question mark or exclamation mark.

Step 2: count every word of three or more syllables in the 30 sentences. Count repetitions of words.

Step 3: Obtain the nearest square root of the number of three or more syllabled words.

Step 4: Add three to the square root. This gives you the SMOG Grade

Step 1: 10 sentences beginning, middle and end (= 30 sentences)

Step 2: 212823Total 72

Step 3: 64=8 Step 4: 8 + 3 = 11th grade

College reading levelwith the onset of nausea, diarrhoea or other

gastrointestinal disturbances, consult your physician immediately.

12th Grade Reading Level If you experience nausea, diarrhoea or

other stomach or bowel problems, call your physician.

8th Grade Reading Level If you start having nausea, loose bowel

movements or other stomach or bowel problems call your doctor immediately.

4th Grade Reading Level If you start having an upset stomach, loose

bowel movements or other problems call your doctor right away.

Have you planned your evaluation process for the publication?

How would you evaluate?

Effective health information is developed with the people who will be using it.