May 2020 - Health Literacy Lab

Explaining COVID: Try This…Not This

Posted on May 20, 2020 by Public Linguist

Many thanks again to the participants some from as far away as Carla White and Susan Reid from Health Literacy New Zealand, who participated in my recent Soundbite Series: Covid and Health Literacy

One thing that came out of those exchanges of materials and ideas is that it would be productive to share and discuss some examples of revised messages/materials. Rewrites that are very focused on how to make the text more readable and usable by the general public.

As we discussed in the numeracy seminar, there is much research to show that adults (in the US and elsewhere) struggle with basic calculations and visual representations of numbers. And yet with COVID these precise things are everywhere: rates of spread, rates of death, percentages, and all types of data visualizations – charts, numerical graphs, logarithmic graphs, animated scattergrams, and GIS map.

So how about a literal title for these posts!

INSTEAD OF THIS…TRY THIS

(suggested with all due respect to the folks who worked on the original messages)

Example 1: taken from the comprehensive and constantly updated
NYC “Daily Counts” segment on the NYC COVID-19:DATA https://www1.nyc.gov/site/doh/covid/covid-19-data.page

HINT Dear Reader…focus on the differences in the before and after introductions to the graph.

INSTEAD OF THIS – (original language on the site)

“Daily Counts

This chart shows the number of confirmed cases by diagnosis date, hospitalizations by admission date and deaths by date of death from COVID-19 on a daily basis since February 29. Due to delays in reporting, which can take as long as a week, recent data are incomplete.”

TRY THIS – rewrite

This chart shows you 3 different types of data: 1) Number of cases of COVID by date, 2) Number of hospitalizations by date, and 3) number of deaths every day since February 29. You can use your pointer to move over the dates.

——————–

Why THIS?

Reading and comprehension are improved if you use a good intro – what linguists call a “superordinate pre-statement”. It tells the reader to “get ready to read about x.”
The original intro (pre-statement) is one longer compound sentence and it’s easy for the reader to get confused about what counts are going to be displayed.
numbering ( or creating some type of visual list of content) generally makes the text easier and quicker to read.
And if a reader (me) skips over the intro and goes straight to the graph but gets lost, the rewritten intro is easier to refer back to.

How’m I doing?

Anyone have some other ideas?

Worth a look – how public handles COVID data charts

Posted on May 19, 2020 by Public Linguist

Some nice insights from researchers in London
LSE Covid 19

https://blogs.lse.ac.uk/covid19

https://blogs.lse.ac.uk/covid19/2020/05/19/the-public-doesnt-understand-logarithmic-graphs-often-used-to-portray-covid-19/#comment-51

Simple Should Not Be Stupid: Exhibit #2 The Infographic

Posted on May 15, 2020 by Public Linguist

Continuing on here with the examples of the unintentional ways simplified, “easy to ready” health information doesn’t meet the challenge of educating and preparing the public to better understand and take actions in complex emergencies like COVID19.

EXHIBIT #2

The Infographic

We have grown used to seeing graphically dominant posters, or “infographics” promoting and reminding people of basic hygiene messages: washing hands, staying home when you’re sick, etc. Below are two examples. The first, from H1N1 (2010), the second, COVID 19.

(H1N1 Infographic)

(Covid 19 Infographic)

These posters are excellent at what they set out to do – promote the basic hygiene message. The message represents the hallmark role of public health and messages like this have been used since the early 1900s.

Disseminated widely, they are interpreted easily, quickly and they have a long shelf life. Until Covid you were very likely to still see the “Clean Hands” posters from N1N1 .

The WHY? Of it All

What is often not given as much attention however, including messaging ( and design) is the “why” of each of these directions.

· Why should I throw the tissue away?

· Why shouldn’t I touch my face?

Nearly everyday we hear health experts and local government officials pleading and coaxing people to “practice social distancing”. Keeping our distance is proving to be thorny if not outright contentious. We’ve called on people’s desire to stay safe, protect their loved ones, practice more civic responsibility, and be “in this together.” Libertarian ideologies aside, I think there is still so much more to do to meaningfully teach (and repeat) what we know about transmission, the efficiency of this virus, and the perils of innocuous behaviors – the WHYS of social distancing.

Amidst this tragic pandemic many experts are already reimagining a post-pandemic world. The current approaches to simplifying complexity should be re-examined. Millions who struggle with health and science concepts and information, are left with a diet of “simplified” information and piecing together sound bites from mainstream media, social media and pseudoscience then reinforced by their peers, all picking over the same sub-standard information. A recipe for contributing to health disparities.

Think of David Maccauley’s The Way Things Work. A whole book of infographics!

Page from David Macaulay. The Way Things Work.
Parsippany, NJ :International Playthings, Inc., 2004.

Infographics allow us to combine various elements – text, image, chart, diagrams to present information and explain complex issues in a way that can quickly lead to insight and better understanding.

The “Galileo” of data graphics, Edward Tufte, has written and spoken eloquently and often about the fundamental importance of rendering visual information so that it conveys and teaches “forever tasks”.

“…I’ve been ever since preoccupied with how the fundamental tasks of thinking can be replicated in our designs of information, so that our architectures support learning about causality – that’s a forever cognitive task – support, that our architectures support making comparisons, which is a fundamental forever task. Our displays help us assess the credibility of a display, and how do they know that? That’s a forever task.”

So it’s true we are calling for the public to act responsibly and intelligently for their own safety and the safety of all of us. Can simple information really do that heavy lifting? I’m not seeing it.

The goal should be to adopt better communication methods from the excellent theory and practice from reading research, cognition and information processing, information design, usability and, intramedia effects. At the very least we cannot expect people to adopt and stick with hard to do things like staying home indefinitely, social distancing and wearing masks if they’re not somewhat in on the discussion with all of us together.

Covid: simple should not be stupid – Exhibit #1

Posted on May 10, 2020 by Public Linguist

Since the early 90s, in response to large scale national studies revealing the low health literacy of at least half of the population, public health experts have promoted a “prescription to end confusion”. Simple, “easy-to-read” “plain language” to yield improved health literacy, and thus improved health behaviors and better health outcomes.

For just as many decades (?! ) my professional work has involved reviewing lots of health information to determine readability and usability. Looking at these simplified texts I have seen a growing pattern of

deleting out most of the connections that make sentences easier to read;
deleting out basic science concepts and information.

Much of this overly simplified information has little ability to prepare or educate the public to better understand and take actions in the face of complex health and especially a complex emergency like COVID19.

Common Problem #1 With Simplified Writing

One of the most common problems with much “simplified” health messages is the misconception that readers are best helped by short, disconnected sentences that read like the telephone book.

Here’s what I mean.

4 steps are common in “simplifying” :

· use simple vocabulary
simple sentences
use one line per sentence
use a readability formula to check the reading level.

These sentences may be “simple” on the surface but the text – the group of sentences is not very comprehensible. The staccato of these five disconnected statements would strike any fluent reader as odd and unsatisfying. This type of writing runs counter to accepted reading and information processing theory and practice.

In this short text (cluster of sentences) there is just not enough information, stepping stones, to make good inferences. It’s like giving someone a puzzle and saying “Here you go. You figure it out.” Yet its format is ubiquitous, especially among those writing for low literacy and low health literacy audiences.

Reading involves making meaning across sentences and paragraphs. A well-written group of sentences helps the reader make those connections and make meaning. At minimum these five sentences could be reimagined as:

Vaccines protect us from many kinds of illnesses like measles, polio and the flu. But right now there is no vaccine for the virus called Coronavirus. (And) we can’t use antibiotics to fight Coronavirus because antibiotics do not kill viruses. Antibiotics kill bacteria. So doctors are working to develop (make) a vaccine but this could take a year or more.

As many in public health are re-imagining what a post-pandemic world will look like I believe that un-interrogated simplification of health messaging is an undertow we should be very wary of. We should promote better ways to clarify and communicate health information and advance public health and science literacy at the same time.

SHOW ME THE SCIENCE!!!:public understanding of Covid

Posted on May 8, 2020 by Public Linguist

In one of the many information-filled updates given by the White House Task Force on Covid Dr. Deborah Birx was discussing the importance of antibody testing and she said:

The antibody piece is critical, as you described, because at this time, we can’t – if we have – let’s say asymptomatic status is inversely – symptomatic status is inversely related to age, and so the younger you are, the more likely you are to be asymptomatic: We have to know that because we have to know how many people have actually become infected.

Got it!

We need to do antibody testing, not only test people who are symptomatic, because some populations, like younger people, may have been exposed to the virus. Younger people often had the virus but didn’t but didn’t have symptoms. This would make them dangerous transmitters and that would really make it hard for us to contain the virus. (my “translation”)

I almost picked this topic and this remark at random. Most of what she and Dr. Anthony Fauci have spoken about over these weeks has required the lay person to listen carefully and translate.

Now, just think of some of the terms that have become part of your daily listening environment, if not your daily small talk over the last 3 months:

novel virus
emerging infectious disease
chain of transmission
modeling
rate of infection
flattening the curve
social distancing
high throughput vaccine development
antibody testing immunity passports

Each word, not just a vocabulary word – but coded language signifying (pointing to) an important and complex science, health or behavioral concept.

Now just think about this fact.

Over 40 years of large-scale study data tells us that less than 1/3 of the US population is science literate. Ask adults in the US if antibiotics kill viruses or bacteria and about half will respond incorrectly. As for naming the steps in the scientific method, half are in the dark. And probe the purpose of a control group in a new drug’s development and you’re likely to get blank stares from half the population. Less than 25% understand what it means to study something using the scientific method. (Science & Engineering Indicators 2018)

What people attend to and the effects of any message on a person’s attitudes and behaviors is a thorny business – it involves a multitude of complex and interacting mediators – knowledge, cognition, culture, intramedia effects, etc. But at the very least we cannot expect people to adopt and stick with hard to do things like staying home indefinitely, social distancing and wearing masks if they’re not somewhat in on the discussion– in on the “why” of all this.

Just not going to happen.

The millions who are not very science savvy, for whom basic health concepts are shaky, need :

1. Better messages that go beyond basic hygiene and explain the “why” of things.