Strategies for Effective Written Instructions | Health Literacy Project Module 5

1. In It Together: National Health Literacy Project for Black MSMTraining of Trainers Module 5: Strategies to Effectively Use Written Materials and Improve Written Instructions

2. Welcome • Trainer: Daniel Driffin • Email: hivhealthliteracy@jsi.com • Phone: 404.460.4790 This material was produced by John Snow Inc., under Contract #HHSH25020140037I with the Health Resources and Services Administration, U.S. Department of Health and Human Services.

3. Recap of Module 4 and take-away activity • How did you apply a strategy that you learned to improve your: • listening skills? • spoken communication? • client’s understanding?

4. Training goal • Trainers will increase their awareness of strategies to improve their delivery of written instructions and written material.

5. Goals of this training module • By the end of this training, you will be able to: • Explain how written material can be used to promote health literacy • Identify at least 3 factors to consider when selecting written material • Describe at least 3 tips for creating effective written material • Identify at least two strategies that make prescriptions instructions easier to understand

6. Written Material

7. What is considered written material?

8. What is the value of printed material? • Written information can: • Improve patients' understanding and recall of medical information • Satisfy patients who want more information about medical conditions, treatments, or outcomes • Facilitate adherence to medical advice or treatment

9. What is the value of printed material?

10. What is the value of printed material?

11. What is the value of printed material?

12. Challenge of written material

13. Challenges to providing effective written material • Health communication involves complex topics that can be stressful, upsetting, or overwhelming • Written patient materials frequently exceed the reading ability of the general public

14. Challenges to providing effective written material • Cost • Time ≠ ≠ Behavior Knowledge Information

15. Why, How, When, and Where to Introduce Patient Material

16. Why to use written material • Supports visual learners • Leads to better treatment adherence • Improves patient knowledge of less common information such as precautions, side effects or special directions

17. Why to use written material Studies show that patients have difficulty remembering the information and instructions they receive • 40% - 80% of medical information is forgotten immediately • 50% of the information remembered is incorrect McGuire, 1996, Anderson, Dodman, Kopelman, Fleming, 1979

18. How to use print material • Questions to ask: • Is it the right information for the patient? • Is the message consistent? • Is the information complete and accurate? Hasselkus, 2009

19. How to use print material • Health literate written information should be: • short • clear • visual • level appropriate

20. How to use print material Health professionals can: • Note important information by circling or highlighting it • Personalize the materials • Confirm patient understanding of the material • Provide tailored information

21. Use print material during clinical encounter Use during or when approaching pivotal care points Reinforce specific, important points about care and treatment Refer to printed material in future visits When to use printed material

22. In a private area Lack of privacy inhibits willingness to take or use information Waiting rooms are appropriate places for material that is interesting/appropriate to the general population Waiting room material examples: material about health insurance, healthy eating, and physical activity Where to offer print material

23. Selecting effective written material

24. What to look for when selecting materials • The material should clearly state: • What the client needs to do • Whythe client needs to do it • When the client can expect results • What warning signs (if any) does the client need to watch for • What to do if a problem occurs • Who to contact with questions or concerns

25. What to look for when selecting materials Select materials written at or below a 6th grade reading level • Focus of material should be patient’s experience of the condition Select material rich with visual images and graphs • Infographics and Pictographs promote recall Show me an infographic!

26. Examples of pictographs 36% of American adults have limited health literacy Image credits (clockwise from left): 1) John Snow, Inc. , 2) https://s-media-cache-ak0.pinimg.com, 3) www.biorad.com

27. Examples of pictographs 36% of American adults have limited health literacy Image credits (clockwise from left): 1) John Snow, Inc. , 2) https://s-media-cache-ak0.pinimg.com, 3) www.biorad.com

28. How to assess printed material • Clinical Assessment • Educational Assessment • Technical Assessment • Appeal Assessment

29. GROUP EXERCISE-SELECTING MATERIAL

30. Group Exercise: Material Selection Considerations • Clinical Assessment: Is the information current, accurate, and sufficient for its purpose? • Educational Assessment: Is the material presented in a way that maintains the interest and attention of the reader? Is the information organized appropriately? Are technical terms or acronyms identified? Is the reading level at a 6th grade level or below? Is there unnecessary information? • Technical Assessment: Are illustrations simple and easy to understand? Do illustrations enhance or compete with the text? Are headings used? Are main points easy to find and understand? Are sentences short (10-15 words or less)? Are paragraphs short and simple (2-3 sentences)? Are lists used? Is there adequate white space? • Appeal Assessment: Is the tone positive? Is there stereotyping? Are there commercial product promotions?

31. Creating CLIENT material

32. Tips for creating great written materials • Consider how the material will be used • Make it immediately appealing • Create a clear and obvious path for the eye to follow • Maintain a consistent style and structure • Select font that is 12 point or larger • Use fonts that are easy to read (Times New Roman, Arial, Calibri) • Left-justify margins • Keep right edge ragged Indian Health Service, and Centers for Disease Control and Prevention, 2009

33. Tips for creating great patient handouts • Try to use: • Simple words with 1 or 2 syllables • Short sentences: 10 to 15 words • Strong, vivid words, including verbs • Words or phrases familiar to the audience • Avoid passive voice • Passive voice: The results of your lab work will be sent to you • Active voice: We will send you your lab results

34. Tips for creating great written material • Things to avoid: • ALL CAPITAL LETTERS, • Italicized or underlined text • Acronyms and contractions • Technical words or jargon

35. Tips for creating great patient handouts • To emphasize, use a large or bold font • Use headings and subheadings to group (chunk) text • Use strong, vivid verbs • Be aware of cultural sensitivities

36. Tips for creating great patient handouts • Consider other formats Remember - I may read your handout with my smart phone.

37. Reading level assessment tools • Readability measures generally count the number of words in the sentence and the number of letters or syllables per word. • Flesch Reading Ease • Fry Graph Readability Formula • The SMOG Readability Formula

38. Clear language tools • The Centers for Disease Control and Prevention’s Clear Communication Index • The Centers for Medicare and Medicaid Services’ Toolkit for Making Written Material Clear and Effective • The Agency for Healthcare Research and Quality’s Patient Education Materials Assessment Tool

39. Creating Health Literate Prescriptions, intake forms and consent documents

40. Promoting health literacy in written prescriptions • Factors influencing client understanding of label: • Low and marginal literacy • Expressions of time periods, time intervals and times of day • Absence of review of instructions with provider or pharmacist

41. Promoting health literacy in written prescriptions We expect patients to... • Read • Listen • Describe • Ask questions • Track experiences • Demonstrate numeracy

42. Tips for writing prescriptions to promote health literacy • Be specific about actions and times • Frame the prescription to answer the question, “What do you want me to do?”

43. Tips for writing prescriptions to promote health literacy • Write all numbers (1, 2, 3, etc.) • Provide visual descriptions or images • Do not group medication instructions • Avoid acronyms

44. Tips for improving the usability of intake forms and informed consent • Test forms with intended users and revise as needed based on the results of your testing • Provide plain language forms (in multiple languages if appropriate) to all clients • Provide clear information about eligibility for public assistance • Train staff to answer client questions and help clients complete forms

45. Recap • Today we learned: • How written material can be used to promote health literacy • Why, how, when and where to introduce patient material • How to select effective written material • Tips to use to create effective patient material • Strategies that make prescription instructions, intake forms and informed consent documents easier to understand

46. Recap pulse check • Identify 2 design elements in written material that hinder health literacy • Identify 2 design elements in written material that promote health literacy • Provide 1 tip for writing prescriptions that promote health literacy

47. Take home • Over the next week, review an example of written health material • Come prepared to discuss how the material did, or did not support health literacy principles

48. Next steps • In Module 6, participants will explore the digital landscape and identify social media platforms that they can use to engage Black MSM.

49. Thank you! • Trainer: Daniel Driffin • Email: hivhealthliteracy@jsi.com • Phone: 404.460.4790 This material was produced by John Snow Inc., under Contract #HHSH25020140037I with the Health Resources and Services Administration, U.S. Department of Health and Human Services.