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Step by Step Writing Guide for Developing Plain English Consumer Information

Revision 5 September 2013 of 17

Contents

What is plain English and why use it? ..................................................................................... 3

Plain English – before and after .............................................................................................. 4

Step 1: The Planning Stage .................................................................................................... 5

Step 2: Writing your Consumer Resource .............................................................................. 6

Step 3: Design and Layout ...................................................................................................... 7

Step 4: Checking and testing your resource ........................................................................... 8

Step 5: Getting your Resource Approved and Published ....................................................... 9

Checklist for Developing Posters ............................................................................................ 9

Consistent Features .............................................................................................................. 11

Words and Phrases to Avoid ................................................................................................ 12

Everyday words ............................................................................................................. 12

Concise words ............................................................................................................... 14

Medical Terms ............................................................................................................... 15


What is plain English and why use it? Plain English is a style of presenting information that helps consumers understand health information the first time they read or hear it. It is a more efficient way of writing. This guide will help you to produce plain English resources for your patients, clients and carers. To write in plain English you need to first put yourself in your reader’s shoes. When you use plain English you:

write in clear language, give relevant information in the right order, and help consumers to find this information quickly.

By providing plain English health information, we can help to make sure that consumers:

arrive on time for their appointments properly prepare for procedures or operations; remember what their health care provider has told them. (Many consumers,

due to stress or language difficulties are unable to remember medical information and/or instructions) ;

make informed decisions with confidence, giving them time to go away, read the information that is relevant to them, and think about the issues involved;

are involved in decisions about their condition and their treatment; and have an overall positive experience of the ISLHD.

In this document, you will find checklists to guide you step-by-step through the planning, writing, design and layout through to the testing and final review of your consumer information resource. We recommend you work through each stage of the checklist as this way you will produce a high quality patient resource which is in plain English and which meets the needs of your consumers. A printing guide is also available to guide you through the steps of getting your resource ready for printing. Click here to access the ‘Step-by-Step Printing Guide for Plain English Consumer Information’ or find the guide in the Patient Information Portal (PIP) tool kit page.


Before

Mammography Patient Information Women in the three high risk categories-age 50 or more, age 40 or more with a family history of breast cancer, age 35 or more with a personal history of breast cancer- may consider an additional routine screening method….Mammography uses radiation (x-rays) to create an image of the breast…It can reveal tumors too small to be felt by palpation….

Readability Consensus Based on 8 readability formulas, we have scored your text:

Grade Level: 14 Reading Level: difficult to read.

Reader's Age: 21-22 yrs. old (college level)

After

What is a mammogram and why should I have one? A mammogram is an x-ray picture of the breast. It can find breast cancer that is too small for you, your doctor, or nurse to feel. Studies show that if you are in your forties or older, having a mammogram every 1-2 years could save your life.

Readability Consensus Based on 8 readability formulas, we have scored your text:

Grade Level: 6 Reading Level: easy to read.

Reader's Age: 10-11 yrs. olds (Fifth and Sixth graders)

Plain English – before and after

Using plain English can make a big difference; have a look at these ‘before’ and ‘after’ examples which have been reviewed using a readability formula to calculate how difficult the information is to read. Use this readability formula as a broad guide, but remember it can only check the difficulty of the language, not the content.


Now it’s time to start producing your consumer information resource. You can contact the Health Literacy Ambassador in your service / ward, or the Patient Information Team in the Clinical Governance Unit if you need assistance.

Step 1: The Planning Stage

Planning Checklist

√ Work out who will coordinate the development of the consumer information resource in your service or ward, for example, an identified individual, or perhaps an established committee will be taking the lead.

Identify the need for specific information from consumers, carers and clinicians and other health staff as appropriate.

Don’t reinvent the wheel - check what other relevant information already exists in your service or in the organisation by checking on the ISLHD Register of Consumer Information, or from other outside sources such as the Multicultural Health Communication Service or non-government health organisations, such as the Heart Foundation or Diabetes Australia.

Consider how the resource will be distributed. Will it be available on a display rack, handed, posted or e-mailed to the consumer? Also, which service / team / ward, etc takes responsibility for this?

Identify funding (if needed, for example for printing) –it may be more cost-effective to arrange for printing of your resource rather than photocopying, and the quality is better. This printing guide will help you through this process


Step 2: Writing your Consumer Resource

Plain English Principle

Guidelines

√

1. Keep your sentences short:

An average sentence should contain no more than 15 to 20 words.

2.Use everyday words

Use words the reader will understand – this does not mean use simple words. Try to avoid acronyms or jargon.

When using acronyms, such as CEC(Clinical Excellence Commission) spell them out the first time you use them

Present your information in a logical order

3.Be personal - use “you and “we”

Use “you” and “we” to keep sentences short, clear and personal

For example: “you must send us” and “your appointment is on…’, and ‘please bring with you…’

4. Be consistent Be consistent with terms or words. For example, if you use the word ‘test’ use this term throughout your document - it can be confusing if you use the word ‘check’ or ‘evaluate’ for the same thing.

4.Be positive For example, “Give yourself plenty of time to get to the bathroom safely - rushing may cause you to fall’

5.Use the active voice

The active voice is more personal and direct and makes it clear who’s doing what. For example: ‘We will send the results to you…’ rather than ‘the results will be sent …..’

6. Avoid nominalisation

Nominalisation refers to the use of verbs or adjectives as a noun. Say:

‘complete instead of ‘the completion of’ ‘arrange' instead of ‘the arrangement of’ ‘provide’ instead of ‘the provision of’

7.Use lists/questions

This is a good way to break up long sentences, for example:

‘This is what do you need to bring to your next visit:

Your Medicare card Your birthing plan, etc


8. Give direct instructions

“Tell your nurse if you have had gestational diabetes (high blood sugar) with another pregnancy”, or “our service is located….enter via Crown Street and take the lift to….”

9. Consider the diversity of your consumers

Translations - it may be appropriate to make your resource available in different languages - contact the Health Care Interpreter Service for assistance / guidance, or click here to find out more about translating health information.

When providing contact details, make sure you give consumers appropriate options, eg: Interpreter Service number, SMS or email for Deaf patients.

Step 3: Design and Layout


Guidelines

√

1. White paper is best

White paper makes information easier to read

2. Use the right size font and casing

Use at least 12-point font size, Arial or Times New Roman - any smaller than this and the text becomes difficult to read.

Lowercase letters are easier to read, although uppercase is always required for the first letters of names and sentences.

3. Use bold or larger print to emphasize

Do not use all capital letters (upper case), italics, underlining or red to make points stand out. AS YOU CAN SEE FROM THIS EXAMPLE, THEY CAN BE DIFFICULT TO READ AND MAKE IT SEEM LIKE YOU ARE

SHOUTING AT THE CONSUMER. Use bold type or a bigger size to make important points stand out.


4. Divide and ‘chunk’ your text

Question and answer format will help you to divide your text.

Bulleted or numbered points will help you to break down complicated information, and will help consumers to digest it.

Small blocks of text using headings and paragraph breaks help to divide your information up.

5. Use numbers correctly

Use numbers as words from one to nine because they are easier to read as words. From 10 onwards however, represent these as numbers.

6. Use images carefully

Diagrams and pictures can be very effective for illustrating and enhancing text.

Clearly label all individual pictures and diagrams, but avoid printing over them.

Avoid using clip-art, as this can detract from a professional image.

Contact ISLHD Communications Department for assistance with sourcing and using images.

7. Use ISLHD standard templates

Standard ISLHD templates for all patient information resources are available in both Word and Publisher formats – you will find all the templates in the Tool box.

Step 4: Checking and testing your resource


Guidelines

√

Test your document

Testing your resource will help you to check that people will understand it quickly and easily. The best way to do this is to: ask your colleagues or team to review the resource -

Give a final draft to everyone who is interested and set a short deadline for them to respond; and

test the resource with some of the people who are likely to use it – use this Consumer Information Feedback Tool to guide you through this process and this Consumer Information Feedback Log to record the feedback you receive.


Step 5: Getting your Resource Approved and Published


Guidelines

√

Follow the correct process

Once you have made any final changes after receiving feedback from testing your resource you will need to follow the steps for approval and publishing which are outlined in the ISLHD Procedure for the Development, Approval and Publishing of Consumer Information. Follow the steps outlined in the Flowchart at the back of the Procedure document.

Checklist for Developing Posters

Title Fonts √

Is the title banner readable from 2 metres away?

Is the font simple and easy to read?

Is the title in bold and all caps?

Have you used plain text, with no bold or mixed upper/lower case?

Is the body of the poster readable from about 2metres away (about 96 point size – or 48 points enlarged 200%)?

Are the Dept /authors names printed smaller? Acknowledgment of partners can be smaller, at about 36 – 48 points)

Use of Colour

Have you used muted colours, or shades of grey - these are best for the background. Use more intense colours as borders or for emphasis, but be conservative – overuse of colour is distracting

Have you limited the colours to two to three? (including the background)

Have you used a light background with darker photos and vice versa?


Have you used a neutral background (grey) to emphasize colour in photos?

(white can reduce the impact of coloured photos)

Sequencing content - The poster should use images, figures and tables to tell a story

Is the information presented in a logical sequence?

Has the information been organised into sections (eg: Situation, Action, Outcome and Evaluation)?

Check that the poster does not rely on your verbal explanation to link together the various sections

Edit Ruthlessly – check that:

There is not too much text in the poster

The sentences are short

The layout is around 20% text, 40% graphics and 40% empty

You have used the active voice when writing the text – ‘It can be seen’ becomes ‘the data shows’

All redundant references and filler phrases such as see Figure are deleted

All graphs and figures have explanatory captions (and therefore no need to label the graphic with figure 1 etc)

you have avoided using jargon, acronyms etc

Illustrations

the images are self-explanatory

A minimal amount of text is used to support and reinforce the images

That areas of empty space are used between the sections of the poster to differentiate between these sections

Images are visible easily from a minimum of 2 metres away


Consistent Features

There are certain design features that must be applied consistently and correctly across all ISLHD materials. The Patient Information Coordinator will make sure the following features are applied after you have tested your resource and it is ready for publishing:

Front cover

ISLHD logo – will be placed on your document once it has been checked and approved by the Patient Information Coordinator.

Resource title – for example: ‘Warfarin and Surgery’. Department or facility name where appropriate – for example, ‘Endoscopy

Unit, Women’s Health’.

Back cover

Contact details (phone, email, address, website address, etc). PIP website address PIP Logo Date of publication Resource code (Clinical Governance Unit will assign a tracking number to

each plain English consumer information resource). ISLHD copyright note (will be inserted by the Clinical Governance Unit where

appropriate)


Words and Phrases to Avoid We have included some common complicated words and phrases and suggested alternatives.

Use everyday words as much as possible, this is not ‘dumbing down’, adults prefer easy to use and easy to read information, especially in health situations which can often be stressful and rushed.

Everyday words

Instead of: Consider:

accompany join

alternatively or

ascertain find out

audit review

avail of take up, take

benchmark standard

beneficial helpful, useful

bi-annually twice a year

calculate work out

cease end, finish

commence start, begin

confiscate take from

consequently so

constitute make up, form

demonstrate show

determine check

disseminate share, spread

endeavour try


eventuality situation

facilitate make easier, help, enable

Fundamental basic

herewith with

in lieu of instead of

incremental gradual, little by little

inter alia among other things

interim temporary, meantime

irrespective regardless

locality place

modification change, alteration

operational working

optimum best, greatest, most

participate take part

particulars details

persons people

quarterly every three months

resident, residing living

terminate end, finish

utilise use


Concise words


adequate number of enough

adjacent to beside

as a result of because

at the present time now, currently

by means of by, with

come to the conclusion conclude

draw to your attention point out, show

during such time while

excessive number of too many

for the duration of during, until the end

for the purpose of to

give an indication indicate, signal

give consideration to consider, think about

hold discussions, meetings discuss, meet

in conjunction with with

in possession of have, own

in proximity to near, close to

in receipt of receiving, getting

in reference to about

in respect of about, for


Medical Terms


acute sudden and severe

administer give

antenatal before birth

anterior front

audiology hearing

benign harmless

biopsy studying tissue to check for disease

cardiology studying and treating the heart

catheter tube

central nervous system brain and spinal cord

chemotherapy treating cancer with drugs

chronic long-lasting, slow to change

coagulate, coagulation clot, clotting

congenital from birth

contagious spreading easily

contraindication reason not to take

contusion bruise

diagnosis identifying a health condition

dosage how to take

elective optional

epidermis skin

excise cut out


gastroenteritis stomach illness

haemophilia severe bleeding

hypertension high blood pressure

immunise protect

incision cut

inhalation breathing in

intravenous through a vein

lateral at (on) the side

malignant harmful, cancerous

mammogram breast x-ray

medication tablets, injections (specify)

monitor keep track of

myopia short-sight

negative (test results) you do not have, you are not

normal range as it should be

oesophagus gut

ophthalmic eye

physician doctor

positive (test results) you have, you are

post-operative after the operation

prognosis likely outcome, chance of recovery

renal kidney

respiration breathing

rheumatology muscles and joints

symptoms signs of a sickness


therapy treatment

trachea wind pipe

ventricle lower chamber of the heart

(Source: National Adult Literacy Agency (NALA), Stanford Lodge, Stanford Close, Ranelagh, Dublin 6 IBSN 078-1-907171-12-3, 2011)

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