Monday, 9 September 2013

Research Tuesday: Plain language and clear communication!

I wrote the original blog post below in September 2013. I thought it was fitting to use it during my week of curating the #WeSpeechies handle in Twitter in October 2014.

You may have noticed that I'm quite passionate about the importance of plain language and clear communication (although I'm not always perfect at it myself!). 

During the week starting 5 October I will share:
- my favourite resources
- some of the research I have found
- my favourite examples of language that is very NOT plain
- and much more! 

I'd love to know about:
- your favourite resources 
- any articles you have found on the topic
- and your favourite examples of bamboozling language!

@SP_Harmony (being @WeSpeechies for a week)

9 Sept 2013

I found a fascinating article on the topic of communication competence and Augmentative and Alternative Communication (AAC). I was prepared to blog about this article for this month’s 'Research Tuesday'...

‘Communicative competence’ in the field of augmentative and alternative communication: a review and critique

I've spent a couple of weeks browsing through the article and have finally decided that I need more time with it. The main reason that I need more time is that this article is written in a language that is definitely NOT plain!
For example:
“In critical work, dialectical relationships are acknowledged between the micro-level of the individual and their macro-level social, political and economic contexts.”
I've said it before, and I'll say it again: I find journal articles very difficult to read. Even the plainer ones! That one is not one of the plainer ones.

So this blog post has been diverted to a different cause... Plain Language!

I have found much of my work time diverted to the topic of plain language and accessible information. I presented on this topic at a conference last May. I recently presented a lecture to 2nd year speech pathology students. I'm preparing a workshop for a conference in November. I occasionally tweet about plain language and often scour the internet for everyday examples of unnecessarily complex language.

I've been on the hunt for evidence that writing in plain language is effective and came across this book:

Unfortunately I don't have this in my hot little hands. So the article below will have to do.

Health in the 'hidden population' of people with low literacy. A systematic review of the literature.

Easton P, Entwistle VA, Williams B. Health in the ‘hidden population’ of people with low literacy. A systematic review of the literature. BMC Publ Health. 2010;13:459.

Why I chose this article (apart from what I've already said)...

I haven't come across anything before that discriminates health literacy from functional literacy. I think there's a lot more to this topic than meets the eye and it's something we all need to think more carefully about.

The definitions:

Health literacy is defined as:
“the cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand and use information in ways which promote and maintain good health”
Functional literacy is defined as:
“the ability to read, write and speak in English, and to use mathematics at a level necessary to function at work and in society in general”
The authors state that low levels of either functional or health literacy mean poorer health outcomes such as knowing what medications to take and when. It’s difficult to tell which type of literacy (health or functional) has more impact. It is possible for a person to have good functional literacy but not good health literacy.
So who are the 'hidden population'? People who have well developed oral skills but poor writing and reading skills.
“Several studies have shown that health care staff often do not recognise health literacy difficulties among working age adults who can engage in spoken conversations in the dominant language”

The results:

The authors tell us that many of the studies that met their inclusion criteria did not do a good job distinguishing between functional vs. health literacy. Many of the tests used in the studies were a mixture of the two.

Here's some of the statements they could make though:

  • "There is some evidence... that lower functional or health literacy is associated with poorer health status..."
  • People with lower literacy levels were able to make initial contact with health services, but seem to have poorer patterns of using services and seeking treatments.
  • People with lower literacy levels are more likely to be more distressed about a diagnosis (acknowledging that this is not a health outcome but that it can have an impact on a person and their health)

Complex areas requiring further study:

  • Health risks or conditions as a mediator health literacy and health behaviour.
  • Relationship between literacy and self-management of health problems.
  • Relationship between literacy and health promoting or health risk behaviours.

Clinical bottom line:

People with lower levels of literacy are more likely to have poorer health outcomes. Be aware that there is a 'hidden population' of people who may not reveal their literacy difficulties and it may not be obvious to us in the health care system.
Most of the studies included in the review were US based, so findings may not be generalised to other countries with different health systems.
The authors also refer frequently to the stigma of poor literacy and the barrier this creates. 

What we can do:

We can make our written materials more accessible by applying the principles of plain English!
1. Use an average sentence length of 15-20 words.
2. Use everyday words
3. Use first and second personal pronouns
4. Use active sentences, not passive ones
5. Use verbs and adjectives, not nominalisations (or 'nounisms')

Our audience (clients, patients, families, carers...) is more likely to understand when we write using plain language principles. The more they understand, the more likely they will engage with you and follow your recommendations.

Here's some resources that might be helpful:

Accessible Information Checklist (Ageing, Disability and Home Care, NSW, Australia)
Plain language guidelines (US): Federal plain language guidelines
Plain language thesaurus:
Easy English Guidelines:
My Little Bag of Writing Tricks (Rachel Toor, The Chronicle of Higher Education)


  1. Great! Not writing in plain English is one of my pet peeves. Fancy writing is not better if it doesn't get the message across clearly.

  2. Couldn't agree more Rachel! How many reports, plans and letters do we write that either don't get read or are misunderstood???
    For those who may still be unconvinced, here's some words of wisdom to help convince you... (Beatrix Potters says it quite well I think) :D