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Center for Health Literacy Promotion Blog

Promoting Health Literacy-Brief is Best

“Give it to them briefly so they will read it, clearly so they will appreciate it, picturesquely so they will remember it and above all accurately so they will be guided by its light.”
Joseph Pulitzer

Pulitzer is talking about printed information, and so am I. Previously in this space, we said powerful information giving starts with a question along the lines of “Would you like some information?” The question positions the learner as an able information seeker in charge of her own learning; it positions the informer as a non-judgmental resource rather than a know-it-all rescuer. Still, his recipe for clear communication applies to spoken information, too.

Here we focus on keeping the information brief. Brief means short – short words in short sentences in short lines and short paragraphs in short documents. Pulitzer notes that if it is anything other than short, your client is not likely to read it. Assume that the learner is busy, stressed and can use only what is immediately applicable to the problem she has now. Focus on what she needs to do to cope, recover or otherwise solve her current problem. Then give her the critical minimum information she needs to do that.

Use common short words that the learner hears and uses in everyday conversation. This means no medical jargon, no acronyms, no polysyllabic words like polysyllabic – having 3+syllables. (To count the syllables in a word, hold your chin as you say it. Each time your chin moves, that’s a syllable.) Choose materials written in a conversational tone –it should sound like something you would actually say to an individual sitting in front you. The mind is most familiar with conversation, so it can process conversational information most readily.

A short sentence contains about 15 words or less. It expresses only one thought. Short sentences are especially important to persons with low literacy skills. Some would say that is most American adults; our average reading skill is 7th to 8th grade level. An unskilled learner reads or hears one word at a time; so by the time you get to the end of a long sentence like this one, it is easy to forget what it is about. Readers are most likely to recall the last few words in the sentence, so place the context (the part they already know) first and new information second. For example, say “When you have a headache, call the doctor”. The learner will not need to remember the part about the headache, so she can focus on the new information– call the doctor.

Compare These Two Sentences

Smoking during pregnancy can cause prematurity, low birth weight and failure to thrive.

A baby growing in a smoky womb may be born too early or too small to thrive.

The first sentence contains 12 words compared to 17 in the second sentence. But it has more syllables. The first sentence requires a high level of background knowledge and specialized vocabulary. It is concept dense; that is, it contains several complex ideas (smoking, pregnancy,prematurity, low birth weight and failure to thrive.) It focuses on the learners’ bad behavior, so it may invoke resistance. The second sentence uses short common words. It focuses on the learners’ primary interest – the baby. So the second sentence is more informative and more acceptable.

A short paragraph contains two to five sentences about one idea. The break between paragraphs cues the reader to get ready for a new idea. Group two or three related paragraphs under a subhead that expresses the main idea.

We read by starting at the left and moving to the right. At the end of a line of type, the eye moves back to where it started and then down to the next line. This is why it is hard to keep your place and read fluently when the lines are longer than about 35 characters. A character is a letter, punctuation mark or space.

A long document appears difficult or overwhelming. It feels like a hard duty. A short document appears manageable. It makes the tasks described seem doable. It feels like a gift. This is why the Beginnings Guides present pregnancy and parenting information in a series of booklets rather than in a single book. When you present information in short segments it allows the possibility of small successes along the way and encourages the learner to keep going.

Also consider small documents. We presented mothers the first booklet of the Beginnings Pregnancy Guide in two formats: 8.5x11 and 5.5x8.5. Although the larger format used more white space and larger type, the testers chose the small size two-to-one. They said it “looked easier”, and seemed “less like homework.”

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