From Angela Williams, Editor, Palio

A mere 12% of Americans have proficient health literacy skills, according to the 2003 National Health Assessment of Adult Literacy. Fifty-three percent ranked as having an intermediate health literacy level, and a whopping 35%, or 77 million American adults, were attributed with a basic to below-basic health literacy level. This latter percentage, according to assessment findings, had difficulty with what were deemed common health tasks — following directions on a prescription drug label or adhering to a childhood immunization schedule using a standard chart.

These stats don’t bode well for patient comprehension — or patient health. Especially since health educational materials, such as drug operating instructions, patient brochures, and Web sites, are often written to a tenth-grade reading level (when its low-literate readers may only be able to understand language at a fourth or fifth). Ideally, tools used to boost comprehension for those with low literacy should be used in all patient-directed materials intended for that audience. If they’re not, those materials may not be as (low-literate) reader-friendly as they need to be.

Next time you’re developing patient-directed communications for an audience including low-literate members, consider these 7 best practices for tailoring your message.

1. Use the right fonts — and font size. Stick to plain sans serif fonts and vary sizes for emphasis and hierarchy. All type should be at least 12-point font, and leading should be at least 2 points greater than the corresponding font size to enhance readability.
2. Shoot for fourth or lower. Whatever your barometer for reading level, be it Flesch-Kincaid, SMOG, or some other readability formula, make sure copy checks in at a fourth-grade level or lower.
3. Organize content in a clear, straightforward manner. Structure main points in a logical manner, and make sure supporting points relate clearly. Break up dense amounts of copy using numbered or bulleted lists or simple charts. Call attention to main points with color or bolding.
4. Keep it simple. Delete unnecessary words, and minimize use of polysyllabic words, which can sabotage reading level very quickly. Aim for short sentences and simple constructions.
5. Say what you mean. Pay attention to your word choice, and draw on common terminology. Language should be literal, not figurative, as should graphics. Pictures and diagrams set beside text can improve comprehension for a low-literacy reader.
6. Don’t be afraid of a little repetition. Often, we try to vary language to avoid redundancy, but for a low-literate audience, repetition is key. Opt to use the same word rather than synonyms to avoid confusion and reinforce key ideas or terms.
7. Conclude with a call to action. Low-literate readers can be overwhelmed by a lot of content all at once. A simple, closing directive helps them focus on the main takeaway.

Just as you would reasonably create English and Spanish versions of products for English- and Spanish-speaking audiences, consider versioning patient materials geared towards commercial and low-literate audiences, too. Doing so may not only expand your reach to a broader range of patients, but also improve comprehension of disease state, increase appropriate utilization, and foster better disease management in one of your most needy demographics.

Palio is a full-spectrum global pharmaceutical and consumer advertising, marketing, and communications agency that excels in brand creation and specializes in brand strategy, product launches, global marketing, and digital and integrated media.

From Allen Mercier, Senior Editor, Palio

My high school typing class is never far from my thoughts. It all began in that concrete room of hum and thrum. No, the power of the written word wasn’t on my mind. What I return to daily is far simpler. However, those simpler times now complicate my life. I see the fallout in e-mails, Word docs, InDesign files, and PDFs. Double spaces may be invisible, but I see them everywhere.

Our typing teachers taught us to insert two spaces at the end of a sentence. It’s not our fault, right? We were young and impressionable. I’ve heard the excuses ad nauseam (pharma folks will recognize this common side effect). Double spaces were perfectly acceptable in the days of the IBM Selectric, but we now live in the digital age; the rules have changed. The Chicago Manual of Style states, “A single character space, not two spaces, should be left after periods at the ends of sentences (both in manuscript and in final, published form) and after colons.”

I know what you’re thinking: Rules were meant to be broken. To that I respond with a quote from an article written by a typographic pro, Ilene Strizver: “Forget about tolerating differences of opinion: typographically speaking, typing two spaces before the start of a new sentence is absolutely, unequivocally wrong.” So please do me a favor and stop spacing out.

From Mike Radigan, Senior Editor, Palio

Ever heard of the “fat-finger theory”? As someone who used to work in the financial services industry, I’m embarrassed to admit that I hadn’t. Well, actually, let me clarify: I knew this concept existed, I just didn’t realize it had a name. And a strange one at that.

The fat-finger theory is the moniker given to the idea of how something as innocuous as a careless digit can be responsible for casting a massive economic ripple effect in global financial markets. Basically, it has to do with typos. Yes, you read that correctly. No, it’s not a typo.

In an article published on CNN.com earlier this month, Bob Greene, a contributor and best-selling author, explains how a potentially devastating typographical error can wreak frightening and very real havoc in our world economy, and how a simple, ill-executed keystroke could be responsible for a monetary meltdown. Basically, he calls attention to the fact that typos hold the power to be so damaging and yet are so often overlooked or ignored in today’s lightning-fast wired society…until they cost us all piles and piles of money.

According to Greene, earlier this month when our fragile financial system was threatened once again and the Dow dropped nearly a thousand points in 15 minutes, Wall Streeters (amongst others) began desperately searching for answers. What had happened? How could stocks and other investments plunge so quickly out of left field? Apparently, nothing of this magnitude had ever happened so unexplainably.

That’s when the fat-finger theory reared its ugly nail bed. Financial industry insiders speculated that plummeting market values were due to a “simple” mistake. In this case, suspicion fell on an anonymous stock trader racing through one of many daily transactions. In his haste to keep up with the pace of the markets and the demands of brokers and clients, this phantom trader’s careless, “fat” finger had mistakenly keyed a “b” instead of an “m,” selling billions of shares of stock in the process instead of the intended millions.

As it turns out, by the time Bob Greene’s article hit the Web, no single cause of this swift financial hit had been identified, but it was looking increasingly unlikely that a typographical error was to blame. Greene’s response to this? “Drat.”

Mr. Greene sees the lack of evidence validating the fat-finger explanation as sad. He writes, “If a typo had been shown to have [the kind of muscle to bring down a financial system], maybe the societal trend to regard typos as no big deal might have been reversed. In our computer-screen age, typos – and their cousins, misspellings and grammatical errors – have been given a reprieve.”

Greene makes an excellent point – a point I certainly agree with. The ultra-fast pace of the digital age has forced many of us to place a premium on the speed of producing the written word at the expense of accuracy. When errors accumulate, credibility is lost and online reputations suffer. Web sites, e-mails, IMs, and text messages are now dominant mediums of communication – that is undeniable. But in our rush to communicate as much and as rapidly as possible, we’re not always making sure to put our best foot forward. After all, presentation is everything.