Overcoming Attachments

Attachments

No, we're not talking about email attachments. We're talking about source language attachment and how it affects Plain Language Writing.

There are various reasons why someone would push back on to terminology that our writers need to use in favor of the source language. Often, this pushback unnecessarily inhibits Health Literacy and Plain Language efforts.

Here are 4 source language attachments that affect Plain Language:

1. Legal Attachment

Copy that is created by your Legal Division creates a strong attachment because it is written by legal experts and often serves an important corporate need. If the legal copy is about understanding legal rights, those legal concepts should be written in Plain Language.

Remember: Legal copy should not inhibit readability and understanding.

2. Emotional Attachment

Certain forms of push backs exhibit an emotional attachment to the negative associations with the terminology. A strong example of this is the word "drug" as opposed to "medication" or "medicine." There is fear that the term will negatively impact the brand even though that is the term that many use at the 4^th grade level.

Remember: Plain Language uses terminology that is understood and used by the target audience.

3. Information Attachment

Separating the "nice to know" from the "need to know" is harder than you may think. Writers and Health Experts have a hard time letting go of information that may not benefit the reader as much as they think it would. It may also be information that is based on a medicalized approach and stops the reader from going forward with interest. The organization of information is also affected by what the writer knows is important medical information, but doesn't always promote the information that drives the behavior.

Remember: Information in Plain Language is only good if it affects behavior.

4. Design Attachment

A polished design may look good, but is not always effective in driving behavior. Plain Language Design concepts do not always promote the design concepts that are embraced by the Marketing Department, but serve a vital need in understanding concepts and behaviors. See our presentation on what "good" looks like for design.

Remember: Design is one of the tools to affect behavior as well.

There is nothing wrong with being attached to the source language. It can foster a healthy debate over terminology. If you ask yourself why you have a need for certain terminology and consider alternative ways to address these terms in Plain Language, you will more likely get the result that you need from your healthcare communications.

The importance of the Introduction in any Plain Language writing

The initial introduction of any document can be so very important.  The reader's first perception on the task is influenced by the way that the topic is introduced and presented.  This may be a deciding factor in whether or not the reader will even pay attention.....so really put time into the introduction with that in mind!

Give the most important first

 

To quickly engage the audience:

• Give the most important information first
• Tell them what actions to take
• Explain it is important

The example below is the Intro to a book we wrote on Diabetes Management for a Managed Health care plan.  A warm welcome section at the beginning tells the reader "HOW" to use the book.  A limited literacy reader does not read from start to finish or cover to cover.  Good Health Literacy materials allow the reader to skim (subheads at the top of every page or section).  Click on it to enlarge.

We were recently advising on content that was targeted to Hispanic employees of a company that had a health promotion program.  What can you do in the intro when targeting this population with this kind of program? Consider using a culturally and linguistic approach that respects cultural values, beliefs and practices of the intended audience.  

Hispanics are collectivists - health values, beliefs and practices of the individual are linked with those of the family and community.  The intended audience for health promotion efforts may need to be the family or community rather than solely the individual.  Care must also be taken to define family and community in ways that are in line with the culture of the recipient.  

Consider emphasizing cultural diversity with the Hispanic population when conducting health assessments and promotion activities.  Subgroups of the Hispanic population such as Mexicans, Puerto Ricans, and Cubans differ in their lifestyles, health beliefs and health practices.  Don't be tempted to make generalizations here.  Those beliefs, values and attitudes are very local in nature.  

An example of doing so would be addressing the health disparities of the different groups. 
Health Literacy writing also incorporates educational models in the writing.  You could research those and that might help you to seek for further answers and incorporate them in your writing.  Two models to research would be "self efficacy" and "locus of control." 


We know that as a general rule with the Health Belief Model that people will respond best to messages on health promotion or prevention when they:

 

1. Perceive that they are susceptible (at risk) and that the risk is serious.  
2. They will receive benefits from a change in their behavior - this is the motivation to change that behavior.
3. The barriers (pain, cost, etc.) to changing their behaviors are not too great.  They can do it.  Show them they can do it and have small successes (education model of self efficacy).

So how do you build in those factors of self efficacy or self confidence?  In the writing, you need to emphasize that the task is doable.  Relate it to another similar type task that they already do. Find the similarity in the tasks.  Test the reader's perception or experience and make sure they perceive that the task is doable.  Cite testimonials from others who have done it!

Another strategy to use would be to partition the task into smaller, easier to do subtasks.  This allows for small successes.....and it also helps with the perception that the task is doable!  See how that worked.

This all comes back to the Introduction.  Make the writing clear and quickly engage your target audience but know your target audience and use an approach that is tailored for them.

Healthcare Engagement

Healthcare engagement is a hot topic in the healthcare industry. Healthcare communications become more personal and topics in healthcare marketing are more focused to specific needs of members. We've looked at our services and defined how these services can can connect stakeholders in healthcare to achieve better health outcomes.

 

Better healthcare outcomes: Health Literacy and Plain Language Writing

Helping to drive behavior in patients from the thinking stage, to the action stage.

Health Literacy writing and design has proven to benefit low literacy populations to take action and drive behavior. However, health literacy strategies are designed to benefit anyone who wants to access health information.

 

We see that Health Literacy Writing as a core competency of being able to provide healthcare related communications that will drive better health outcomes:

• Plain Language / Grade level (re)writing is used for Medicare and Medicaid communications and provides information using terms that can be understood.
• Health Literacy Design employs about 300 design rules to not only organize information for better engagement (not to distract), but it also looks at the use and intent of images to showcase behavior.
• Health Literacy Writing uses techniques to separate the nice-to-know from the need-to-know. Health Literacy Writing employs many strategies designed for the demographic of the intended audience, using risk assessments from trials and literature to write about the issues and needs in a way that engages the patient to take appropriate action.

Empowering patients with information: Accurate and relevant translations

Helping foreign language speaking patients' understanding of healthcare related information.

 

Translations is more than just translating words. We convey concepts in a meaningful way for foreign language speaking members.

 

One example of how we help patient understanding is to assess their access to healthcare information and how this influences the translation. A good example is access to drug information. While a Spanish speaking patient may be more familiar with Spanish drug labels and names, those members who live in the US will have to be knowledgeable about the drugs and ingredients in English as well. Keeping the patient in mind and their environment by providing bilingual translations can provide more meaningful information that a patient can use.

 

The foreign language speaking population in the US is quite diverse. Even among Hispanics, you will find that not only are there regional language differences, there are also generational differences between first generation Spanish speaking persons and second generation Spanish speaking persons. Their healthcare experiences can vary quite differently between generations.

 

Taking into account your target audience when translating documents means that you should take into account the healthcare experience of that population and what information they may be familiar with, but also the information that may help them to access healthcare and health information in the United States.

Writing in Plain Language for different cultures

The idea of changing some of your English messaging for different cultures is to adapt the writing and messaging to consider other cultural beliefs.  The overall objective is to move the patient behavior to action.  Consider some of these cultural beliefs that may change the content of your English Plain Language Materials.  It's important to note that strategies to improve health literacy for low-literate individuals are distinct from strategies for culturally diverse populations.  In order to adapt your message, you must be aware of the cultural barriers that may exist.

Hmong Culture

The Hmong language lacks words that correlate directly with Western words for disease processes. Consequently, interpretation in health care settings sometimes requires lengthy explanations and is sometimes impossible. The Hmong may have difficulty comprehending illnesses or diseases they have never encountered before, and some Hmong find chronic illnesses, such as diabetes and hypertension, particularly challenging to comprehend because of the concept of a controllable but not curable condition (Cha, 2003; Johnson, 2002).

HEP B and the Asian Community

Asians are at greater risk because to begin with, there are more Asian people infected with

hepatitis B than non-Asians. Although hepatitis B is not an "Asian disease", it certainly affects
hundreds of millions of Asians. The HEP B Smart campaign was created and targeted to the Asian populations primarily in the California area. This campaign was also translated into a variety of Asian languages: http://www.hepbsmart.com/en/default.aspx

Russian culture

Russian patients lack a concept of "chronic disease" based on their experiences with Soviet health care.  When writing for this population, strategies should be used to help this population understand that they need to continue with their diabetes or hypertension medications even though they may begin to feel better.

Where do I start with my communications?
Before you begin to adjust or create new communications for different cultural audiences, add qualitative pre-testing to explore diverse patients' understanding of instruments you are going to consider using. 

HIPAA and HITECH compliance for healthcare communications

One of our main areas of expertise in Plain Language and in multilingual communications is healthcare and life sciences.  In addition to building trust with our clients, we also make compliance a top priority.


LSI is HIPAA compliant and our Translation Management Portal, FLOW is HIPAA compliant as well.  All of our employees go through HIPAA/HITECH training and training on our corporate policies which are also displayed in our locations.  All of our translators and interpreters are required to sign a business associate agreement. 

According to HIPAA for 2013, all Business Associates must be compliant by September of 2013.  We have been proactive on this front as many of our clients are healthcare plans and managed healthcare providers and being the "process heads" that we are, we have ensured that our policies are sound, we perform regular audits, we train regularly and we have contingency plans in place.  If you build it, the trust will come.......

What does good Health Literacy Writing and Design look like?

This presentation gives you an overview and examples of design and writing standards for health literacy materials. Wondering what interactives are in a brochure or booklet? How are the selection of images important? Where does the organization of material fit in your priority list when getting ready to write clear and concise patient information?

These principles are now applied to not only healthcare communications but also legal, financial, consumer awareness and other areas that are striving for Plain Language. 

We work in the total lifecycle of the content and this gives us a greater understanding of the development of material and concepts so that when you are also ready to translate it into another language, we know the key objectives and work with our translators on the cultural aspects of health literacy.