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Center for Health Literacy Promotion Blog

Promoting Health Literacy-Simple Is Not Always Clear

“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

Previously on the blog we said before you give information, offer it. This keeps the learner in charge of the learning. Next, we said to keep it brief, focus on the critical minimum information the client needs to solve a problem she has now. Now we discuss giving it to them clearly so they will appreciate it.

George is a wiry 50-year old firefighter who runs to keep fit. Today he is being re-admitted to the hospital Heart Center. In medical staff parlance, he is a CABG (say cabbage). He had a coronary artery bypass graft a few weeks ago after he had a heart attack at a fire. When George was discharged last week, his doctor told him to “take it easy”; so yesterday George ran three miles instead of his usual five.

Jack, a 47-year old salesman who has not exercised since he graduated from high school, also is being readmitted to the Heart Center. Jack had a heart attack and surgery about the same time as George. The surgeon told him to “take it easy”, too. He has not been out of bed for three weeks and now his systems are shutting down.

George and Jack are both native English speakers. They are both high school graduates with responsible jobs. The surgeon gave them brief post-surgery instructions in plain language; he told them to “Take it easy.” Still, neither George nor Jack interpreted the instruction the way the surgeon meant it. Does that mean they have low health literacy? No. It means the instruction was unclear.

When Pulitzer says Give it to them clearly, he means make it clear to the learner, and not subject to interpretation. When he says, so they will appreciate it, he does not expect them to be grateful, although they will be when you give them clear instruction. Rather, he means so they will understand what you say. In this case, the surgeon made a common fatal assumption that all English speakers understand Take it easy the same way that he does.

The reader/listener must make a judgment based on his or her personal experience to make specific meaning from the word. Since each person has unique experience, Take it easy means something a little different to each person. To George, the runner, it means take a shorter run. To Jack, the couch potato, it means Stay in bed.

To avoid this communication error, the doctor needed more knowledge of his patients and time to reflect on what his words might mean to them specifically. Perhaps it was just not possible to get to know George and Jack as well as he would like. In that case, and in every case, it pays to be specific and to check-back for understanding. A more effective instruction might be some like this: Start regaining your strength by walking each day. Walk two blocks on flat ground at an
easy pace. If you feel short of breath, stop and rest, then go on. Do this each day until I see you again. To check-back with your client/patient you might say something like this: “This is important so I want to be sure I am being clear. Tell me what you are going to do to get your strength back when you start feeling better in a few days.”
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