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.

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.