Communicating Public Health & Safety

How can we reach Healthy People 2020 goals for healthier and safer people, workplaces and schools?

The Problem

Most health information and education is not tailored to fit most consumers’ abilities to read, listen to, understand and use the information. This is true of pamphlets, fact sheets, websites, lessons …

Concepts and content are so often too technical and complex. Often materials and messages assume that readers have a solid science foundation. Materials prepared with such assumptions often tend to be complex instead of being engaging.

Simplified health and medical information is often too watered down for most consumers to really learn anything. Sometimes, the “complicated” information is what the consumer needs most to grasp the meaning and the message.

The Solution

We focus on achieving the balance between unnecessarily complicated information and overly simplified information.

We start with credible scientific and health information, adapt it to be conceptually accessible, linguistically appropriate and in a format or medium that makes sense to a wider audience / to a wider set of consumers.

Why Do I Need A Lab To Help Me Communicate?

  • We all use language all day long. Internally we talk to ourselves. Externally we communicate with others. But our skills can vary greatly, from one communicator to another. I might be a great teacher of communication, but may lack the verbal skills and ingenuity to negotiate a lower price at a flea market.

  • Mostly we don’t even notice the language we use unless it’s exceptionally beautiful (poetic), or dramatic, or…..when comprehension is breaking down.

    • “Were you listening to a word I just said?”
    • “Let me put it another way”
    • “This is the third time I’m calling to cancel my subscription
  • Unlike solving a math problem or identifying the year the British invaded the Falklands, there is often no one right way to say, or write or display anything. This versatility is one of the most amazing and special things about human language.

    • Example 1:
      Direct and Indirect Request:
      “John, could you close that window for me please?”
      (looking directly at John)
      Gee it’s cold in here.
    • Example 2:
      1 out of 3 people is likely to develop diabetes by 2050
      The number of American with diabetes is project to double or triple by 2050
  • Context is a big part of how we understand language

    • Example
      Context 1:
      Juan came to school as usual today.
      Who is Juan?
      Answer: a student
    • Context 2:
      Juan came to school as usual today.
      But when he arrived the principal asked him to teach an extra class.
      Who is Juan?
      Answer: a Teacher

Readability: Or , What We Call, The Simplicity Complex

We at the Health Literacy Lab are perfectly clear about our concept of readability formulas. For us they have been way overused and really have VERY LIMITED USE.
The requirement to use x or y grade reading level can really sidetrack you from focusing on two important part of reading comprehension:

  1. what really makes a text/or message hard to understand. HINT it’s often the concepts, not the word or sentence length;
  2. what type of writing or communications will actually be understandable and actually advance someone’s health literacy and health.

Readability formulas were never meant to drive regulation and policy. Way back in 1974, Flesch, a developer of the Flesch-Kincaid, stated that he hoped users “won’t take the formula too seriously and won’t expect from it more than a rough estimate.”

What Flesch and others recognized is that short words are not always easy to understand and long sentences aren’t always hard to understand. The word “waive” as in “We will waive your premium” counts exactly the same on a Flesch test as “we,” “will,” and “your” (Redish & Seizer, 1985, p. 4). Way back in the 70s and 80s readability experts understood that reading is much more complex than processing rows of words and sentences. It’s why most textbook publishers don’t use readability scores anymore.

When we’re required to write to meet grade level/ readability criteria we’re caught in a Catch-22. And we often wind up gaming the system – artificially dividing sentences and using sentence fragments (Ancker, 2004; Redish & Seizer, 1985, p. 4). So if we ad the very words or sentences that would make the text really more comprehensible ( understandable) we wind up unhappily increasing the readability score of the material. And the regulators don’t like that, so we write what scores better – often short sentences, without much cohesion, seldom introducing the vocabulary and concepts people need to truly understand, learn and use health information. Ancker (2004) convincingly demonstrates this with the clever example: “Be prepared to die next month,” scores lower (easier-to-read) than “Call for an appointment next month” because the words in the latter are shorter.

Often the “simplified” text looks simpler, but when tested is not more understandable, and often more difficult to understand has been amply demonstrated (Charrow & Charrow, 1979; Davison et al., 1980; Duffy & Kabance, 1982; McNamara, Kintsch, Butler-Songer, & Kintsch, 1996; Kintsch, 1994). And, the Institute of Medicine (IOM) report, “Health Literacy: A Prescription to End Confusion” calls for researchers and practitioners to move beyond reading level to find newer solutions to low health literacy (Nielsen-Bohlman et al., 2004).

At the Lab we call this situation The Simplicity Complex.


Ancker, J. (2004). Developing the informed consent form: A review of the readability literature and an experiment. American Medical Writers Association Journal(19), 97-100.
Charrow, R. P., & Charrow, V. R. (1979). Making legal language understandable: A psycholinguistic study of jury instructions. Columbia Law Review, 79, 1306-1374.
Duffy, T. M., & Kabance, P. (1982). Testing a readable writing approach to text revision. Journal of Educational Psychology, 74, 533-548.
McNamara, D. S., Kintsch, E., Butler-Songer, N., & Kintsch, W. (1996). Are good texts always better? Interactions of text coherence, background knowledge, and levels of understanding in learning from text. Cognition and Instruction, 14, 1-43.
Kintsch, W. (1994). Text comprehension, memory, and learning. American Psychologist , 49, 294-303.
Redish, J. C., & Seizer, J. (1985). The place of readability formulas in technical communication. Technical Communication, 32(4), 46-52.