Our rule of thumb is this:  If 10 Deaf people can read it, sign it and
explain it to someone else it is clear. If not, they work together to figure
it out and we use what they say. Some funny examples:
Most healthcare directives will talk about "Choose your healthcare agent."
First, the English word "choose" is translated into decide which is close to
decision and judge...gets people wandering off in the wrong direction. The
result: we changed it to "pick."  "Agent"...what's that?? movie star agent,
basketball agent for Nike's?? We never even bother to say that an "agent" is
a "person!"
So we ended up saying "Pick the person you trust." But as hearing people we
often feel embarrassed to use such simple words...also American Sign
Language is not built on a Thesaurus...there is one sign for pain, there was
no sign for hospice until 5 years ago when someone in Minnesota (A Deaf
person) made one up. All adverbs and adjectives are made with grammatically
governed non-manuals, or facial expressions. They go nuts with the
Wong-Baker pain scale of "smiley faces"... what does a happy face have to do
with pain?

Once at a meeting two hearing people were arguing about the different
between "ensure" and "insure."  A Deaf person asked:  what's it mean??  "to
make sure."  "Well, why don't we just say that!"

The scales are helpful, but if we do not test them with the people we expect
to read them we are continuing to throw money out the door. Also, it is
empowering and word spreads fast in tight-knit communities that they
actually are being consulted. Do a big promo piece on including the
community in developing materials. It has amazing results. Most Deaf people
don't even bother to pick up brochures, regardless how simple we think they
are...after years of everything being written so far over their heads they
just throw up their hands and say "forget it."

We need to let them know that the brochures are different...but we must find
a way to also learn from them about what they don't know or understand...

Nancy


On 10/15/07, seubert.douglas at marshfieldclinic.org <
seubert.douglas at marshfieldclinic.org> wrote:

>

>

> YES. Even the CMS guide I referenced (Writing and Designing Print

> Materials for Beneficiaries) says that the Flesch-Kincaid reading grade

> level score in MS Word is usually 2 grades lower than the actual grade-level

> of the document.  I usually do a SMOG (by hand)when I want a more accurate

> reading.

>

> But using Flesch-Kincaid in MS Word can still be helpful, in that it is a

> tool almost everyone has access to. Our organization is rather large, with

> nearly 750 physicians practicing in 41 (soon to be 47) clinics in the

> northern half of Wisconsin. Each center, each department can purchase or

> create patient education materials. Up until now, most of what was developed

> never went through any evaluation, except to make sure the logo was in the

> right place. Over the past 2 years, we have been working to standardize our

> patient education materials, creating them as companion pieces to our

> evidence-based clinical practice guidelines. While we work on standardizing

> patient education materials, there are still letters, brochures, newsletters

> and other print materials that are sent to patients that are not always

> classified as patient education, but should still be evaluated for health

> literacy.

>

> We're trying to raise awareness of health literacy and provide

> recommendations for improving how we communicate with patients. Even if I

> can show some of our staff how to use Flesch-Kincaid in MS Word, it's a step

> in the right direction, and it gets them thinking about how they write and

> how they can improve their writing. If you aim for a score between 4th and

> 6th grade, your piece will most likely be 2 grades above that. But as I said

> in my earlier post, it may be impossible to get a low score if you have any

> medical terms in your piece. You can rewrite "make modifications in your

> food choices" (11 syllables) to "change what you eat" (4 syllables) and get

> a better score and improve your piece. But there isn't a simpler word for

> triglycerides. And you actually need more words to define it and explain it,

> which can raise the score.

>

> As far as the accuracy of Flesch-Kincaid in MS Word, there are several

> things that can affect the score. Bulleted lists of information often cause

> trouble, especially if there is no punctuation. You can have a list of

> symptoms, for example, and Flesch-Kincaid in MS Word will read the entire

> list as one sentence, and include the next sentence as well, because it's

> looking for the next period and treats everything written between the

> periods as one sentence. As readers, we often put in the punctuation even

> when it is not there. When we read a bulleted list of words (symptoms, for

> example) or phrases (actions steps or safety tips, for example), we process

> them as separate sentences or thoughts, even if there is no punctuation

> (periods) after each item in the list. When you run Flesch-Kincaid in MS

> Word, put in the periods (you can always remove them) after each item in the

> list and you'll get a more accurate reading grade level score. This is just

> one of many tips for improving!

> the accuracy of Flesch-Kincaid in MS Word.

>

> We can't solely rely on a reading grade level score when we evaluate

> written patient education for health literacy. Flesch-Kincaid in MS Word,

> nonetheless, is often still worth doing.

>

> Doug Seubert

> Guideline Editor

> Quality Improvement & Care Management

> Marshfield Clinic

> 1000 N Oak Avenue

> Marshfield, WI 54449

> (715) 387-5096 (1-800-782-8581 ext. 75096)

> seubert.douglas at marshfieldclinic.org

>

>

> ------Reply Message------

> From:   "Janet Sorensen" <Jsorensen at afmc.org>

> Date:   Mon Oct 15, 2007 -- 01:45:04 PM

> To:     "The Health and Literacy Discussion List" <healthliteracy at nifl.gov

> >

> Subject:        [HealthLiteracy 1346] Re: simple information

> ondiabetesandhypertension

>

> I have heard this as well. More recently someone told me it's a little

> better now but I have not checked. But it's always a good idea to do

> some kind of formula the old-fashioned way when it really matters. It's

> not that hard.

>

> -----Original Message-----

> From: healthliteracy-bounces at nifl.gov

> [mailto:healthliteracy-bounces at nifl.gov] On Behalf Of Rebecca Metternich

> Sent: Monday, October 15, 2007 12:06 PM

> To: 'The Health and Literacy Discussion List'

> Subject: [HealthLiteracy 1344] Re: simple information on

> diabetesandhypertension

>

> Several years ago when I attended IHA's Health Literacy Conference, we

> were told that the Flesch-Kincaid in M/S Word is not reliable.  The

> results are approximately two grade levels lower than the actual

> grade-level of the document.  Since then, if I use it, I keep this in

> mind.

>

> Rebecca Metternich

> Central Illinois Adult Education Service Center Western Illinois

> University Horrabin Hall 5B Macomb, IL 61455

> Phone: 800-572-9033 or 309-298-2285

> Fax: 309-298-2288

>

> -----Original Message-----

> From: healthliteracy-bounces at nifl.gov

> [mailto:healthliteracy-bounces at nifl.gov] On Behalf Of

> seubert.douglas at marshfieldclinic.org

> Sent: Monday, October 15, 2007 11:23 AM

> To: healthliteracy at nifl.gov

> Subject: [HealthLiteracy 1342] simple information on diabetes

> andhypertension

>

>

> I'm new to the list, but I've been reading a lot of the discussions and

> thought it was time I start contributing.  I work for Marshfield Clinic

> (www.marshfieldclinic.org) in Marshfield, Wisconsin. My main

> responsibility is working with a team of physicians and providers to

> write and publish clinical practice guidelines. I also help write

> patient education materials as companion pieces for our evidence-based

> guidelines.

>

> Marshfield Clinic is currently one of ten sites participating in a

> physician group practice CMS demonstration project. We developed

> extensive clinical practice guidelines for the management and treatment

> of chronic disease (hypertension, heart failure, diabetes, and

> dyslipidemia) within the primary care setting. Corresponding patient

> education resources were developed on these topics. Each is about a

> 30-page booklet, but they can also be printed as a series of individual

> handouts.

>

> Because this is part of a CMS demonstration project, we closely followed

> the recommendations in the CMS guide "Writing and Designing Print

> Materials for Beneficiaries."  By now, most of us interested in health

> literacy are familiar with the recommendations for choosing fonts,

> writing shorter sentences, using plain language, etc. By following these

> recommendations, we were able to produce patient education books divided

> into 4 main areas:  1) an overview of the chronic condition (what is

> high blood pressure? how is it treated? what do my numbers mean?), 2) an

> extensive section of lifestyle modification (including DASH diet, tips

> for reducing sodium, and stressing the importance of physical activity),

> 3) a shorter section on pharmacologic therapy (overview of medicines to

> manage high blood pressure, safety tips for taking medicines, "my

> medicines" work sheet, etc.), and 4) self management tools and resources

> (how to take your blood pressure at home, tips for purchasing a blood!

> pressure monitor, home blood pressure monitoring log, etc.). Each of

> the four books follows this structure.

>

> We did use a lot of information from NIH, but rewrote much of it. Our

> final products average a Flesch-Kincaid reading grade level score of

> 7.7. We used the word "hypertension" in the beginning section because we

> feel it's important for patients to see and hear that word (because

> their doctors use it often), but we made sure it was clear to the

> patient that hypertension and high blood pressure mean the same thing.

> In our medication section, we explained the different classes of drugs

> (ACE1, ARBs, diuretics) and provided the generic names of drugs, again

> because we felt it was important for patients to have this information.

> We worked hard to write simple explanations of how each medication

> works.

>

> We print 1500-2000 copies at a time (we have our own in-house print shop

> and Graphic Arts department) and in between each printing, we work on

> each section and always find one or two sentences here and there that

> could be improved.

>

> My point is, you may never find that one perfect piece of patient

> education that includes all of the information you want to give to your

> patients, and be written at an appropriate reading grade level. The

> information from the NIH is a good place to look., but you may need to

> rewrite some of it.

>

> Don't just rely on a reading grade level score either. If you work hard

> enough, you can get any piece of education down to 5th or 6th grade

> level.

> It may require taking out all medical terms and names of medications to

> do it, but I think that can sometimes be a bad choice. An effective

> education piece explaining high cholesterol and how read the results of

> a fasting lipoprotein panel, for example,  should include the words

> cholesterol, low-density and high-density lipoproteins and

> triglycerides. They just need to be explained and defined as simply as

> possible. All patients, no matter what their reading level, appreciate

> clear, simple explanations. It may not result in a piece that scores at

> 6th grade when you run a SMOG, but that doesn't mean it's not a good

> piece to use with patients.

>

> Doug Seubert

> Guideline Editor

> Quality Improvement & Care Management

> Marshfield Clinic

> 1000 N Oak Avenue

> Marshfield, WI 54449

> (715) 387-5096 (1-800-782-8581 ext. 75096)

> seubert.douglas at marshfieldclinic.org

>

>

> ------Original Message------

> From:   "Steinbacher Mikal" <Mikal.Steinbacher at lwtc.edu>

> Date:   Mon Oct 15, 2007 -- 09:47:11 AM

> To:     "The Health and Literacy Discussion List"

> <healthliteracy at nifl.gov>

> Subject:        [HealthLiteracy 1341] Re: Need hel with teaching

> advocates

> &clientsmedication co

>

> Barbara,

>

> I scanned several of the high blood pressure documents and found them

> written at too high a level for even intermediatel 'ESL learners.   I

> will

> review the diabetes site later.

>

> Thanks for sharing this info.  I will share it with the RN we have on

> campus, who sees a lot of our ESL students and also comes to our ESL

> classes to talk about how to get the most out of doctor visits, and low

> cost/free medical care.  She's a gem!

>

> Mikal Steinbacher

> Instructor, ABE/ESL/English

> Lake Washington Technical College

>

> ________________________________

>

> From: healthliteracy-bounces at nifl.gov on behalf of Barbara Gordon

> Sent: Fri 10/12/2007 3:42 PM

> To: The Health and Literacy Discussion List

> Subject: [HealthLiteracy 1336] Re: Need hel with teaching advocates

> &clients medication compliance,chronic disease education

> tools(asthma,diabetes and

> hypertsion) very simple

>

>

>

> For simple information on diabetes and hypertension, check out the

> National Institutes of Health's web site(www.nih.gov and select health

> topics A-Z list).

>

> They offer a limited literacy diabetes education series in both English

> and Spanish. You can also order a certain quantity of printed

> publications for free, or a nominal charge, by calling NIH's National

> Diabetes Information Clearinghouse at 1-800-860-8747.

>

> Barbara Gordon, RD

>

> Public Health Consultant

> HealthComm Solutions

> www.healthcommsolutions.net

>

>

> --- Gae <gae at everestkc.net> wrote:

>

> >  I am located in a health service agency which is in a church & I am

> > the only clinical component.  My mission includes working with

> > advocates, clients & safety net clinics.  I will be working with

> > several chronic diseases starting with diabetes & hypertension. 60% of

>

> > the population speak Spanish & many can not read. Looking for very

> > simple info on diabetes & hypertension, info on taking meds, use of

> > chronic disease model in such an area and any experience on group

> > brown bag clinics (to go over medications). The agency has no forms or

>

> > anything; therefore, I am starting from scratch.  I am seeing

> > patients, setting up a clinical area and inservicing advocates. Do you

>

> > have anything that would help me?

> > Would appreciate your help! Thanks.

> >

> > George Ann Eaks ARNP, CDE, BC-ADM

> > Riverview Health Services

> > 722 Reynolds

> > KC. Ks. 66101

> > E-mail: gae at everestkc.net

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >

> > George Ann Eaks ARNP, CDE, BC-ADM

> >

> >

> >

> >

> >

> >

> >

> >

> >

> > George Ann Eaks ARNP, CDE, BC-ADM

> > >

> ----------------------------------------------------

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>

>

>

>

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>

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