Clear Communication: An NIH Health Literacy Initiative

Introduction to Plain Language at NIH

Plain language is grammatically correct language that includes complete sentence structure and accurate word usage. Plain language is not unprofessional writing or a method of "dumbing down" or "talking down" to the reader. Writing that is clear and to the point helps improve communication and takes less time to read and understand. Clear writing tells the reader exactly what the reader needs to know without using unnecessary words or expressions. Communicating clearly is its own reward and saves time and money. It also improves reader response to messages. Using plain language avoids creating barriers that set us apart from the people with whom we are communicating.

Part of the NIH mission is to reach all Americans with health information they can use and to communicate in a way that helps people to easily understand research results. The NIH fully supports the Plain Language initiative, which has its origins in a Federal directive that requires agencies to incorporate plain language elements in the development of communications materials for the public. The NIH is committed to the use of plain language in all new documents written for the public, other government entities, and fellow workers.

Celebrating Plain Language at NIH

Health literacy incorporates a range of abilities: reading, comprehending, and analyzing information; decoding instructions, symbols, charts, and diagrams; weighing risks and benefits; and, ultimately, making decisions and taking action. The concept of health literacy also extends to the materials, environments, and challenges specifically associated with disease prevention and health promotion. The NIH Office of Communication and Public Liaison leads an agency-wide “Clear Communication” Initiative. Its aim is to cultivate a growing health literacy movement by increasing information sharing of NIH educational products, research, lessons learned, and research in the area of health literacy. Part of the “Clear Communication” program is the NIH Plain Language Initiative and annual Plain Language Award program, which recognizes excellence in NIH Plain Language communications. NIH employees may nominate any type of NIH communication product—letters, brochures, Web sites, press releases, scientific papers, and reports. NIH also wants to recognize internal documents, such as memos, forms, newsletters, and manuals.

The annual NIH Plain Language Award ceremony honors outstanding NIH communication products including revised websites, fact sheets, multi-media presentations, and other materials, including items designed for Spanish-speaking audiences.

Acting NIH director Dr. Raynard Kington hosted the ninth annual NIH Plain Language Awards ceremony on Tuesday, June 2, 2009 in the Lipsett Amphitheater in Building 10 on the NIH campus. Dr. Kington honored a group of NIH writers and editors who developed communication products that were exceptional for their clarity and focus. The special guest speaker for this event was Jonathan Capehart, Pulitzer Prize-winning editorial writer for The Washington Post.

The NIH Office of Communications and Public Liaison (OCPL) in the Office of the Director is responsible for external and internal communications and also directs the clear communication and plain language initiatives. Archived awards information and a full listing of the 2009 gold, silver, and bronze award winners is available at: http://www.nih.gov/clearcommunication/plarchive/index.htm.

Tips for Using Plain Language:

Certain hallmarks characterize plain language. These include common, everyday words, except for necessary technical terms. Other hallmarks include the use of personal pronouns; the active voice; logical organization; and easy-to-read and understand design features, such as bullets and tables.

1. Engage the reader.

• First, consider who the reader is. Often, there is more than one reader.
• Consider what the reader needs to know. Organize content to answer the reader's questions.
• Write for the appropriate reading level.

2. Write Clearly. Use common, everyday words whenever possible.

• Word Choices:
  • Use common, everyday words
  • Use other personal pronouns such as "you"
  • Use "must" instead of "shall"
  • Avoid using undefined technical terms
  • Use positive rather than negative words
  • Avoid using gender-specific terminology
  • Avoid long strings of nouns

• Verb Forms:
  • Use active voice
  • Use action verbs
  • Use the present tense

• Structure:
  • Use parallel construction
  • Be direct
  • Avoid using unnecessary exceptions

3. Display Material Correctly

Appearance is an important aspect of clear communication. If a document is pleasing to the eye, it will be more likely to attract your reader's attention. Appearance can also be an aid to the reader, improving comprehension and retention. There are four main aspects of appearance:

• Organization. Strong, logical organization includes an introduction followed by short sentences and paragraphs. Organize messages to respond to reader interests and concerns.
• Introduction. In lengthier documents, use an introduction and a table of contents to help the reader understand how a document is organized.
• Short sentences and paragraphs. Sentence length should average 15-20 words. Sentences that are simple, active, affirmative, and declarative hold the reader's interest. Generally, each paragraph should contain only one topic. A series of paragraphs may be used to express complex or highly technical information. The more writing deviates from a clear and to-the-point structure, the harder it will be for the reader to understand what is being conveyed.
• Layout. Layout includes margins, headings, and white space. Provide white space between sections to break up text and to make it easier for readers to understand. Use headings to guide the reader; the question-and-answer format is especially helpful. Try to anticipate the reader's questions and pose them as the reader would. Use adequate margins.
• Tables. Tables make complex information readily understandable. Tables can help the reader see relationships more easily. They may require fewer words than straight text.
• Typography: Typography relates to fronts and typographical elements used for emphasis, such as bullets or italics.

4. Evaluate Your Document

To ensure that you are communicating clearly, evaluate the document or have another person read it and offer suggestions for clarification. Look over the document for:

• Correct spelling, grammar, and punctuation;
• Inclusion of appropriate devices, such as dating, page numbering, and consistency;
• Visual appeal;
• Consistency and effectiveness of layout and typographical devices (avoid overuse); and
• Line breaks that inadvertently separate part of a name or date in a way that reduces clarity.

Where Can I Learn More?

• Plain Language.gov http://www.plainlanguage.gov/
• Proceedings of the Surgeon General's Workshop on Improving Health Literacy, September 7, 2006, National Institutes of Health, Bethesda, MD, http://www.surgeongeneral.gov/topics/healthliteracy/toc.html
• 2003 National Assessment of Adult Literacy, http://nces.ed.gov/naal/
• National Center for Education Statistics (NCES), U.S. Department of Education: http://nces.ed.gov/
• Agency for Healthcare Research and Quality (AHRQ) Summary of Literacy and Health Outcomes: http://www.ahrq.gov/clinic/epcsums/litsum.htm
• The PRISM Toolkit, Group Health Research Institute
  http://www.grouphealthresearch.org/capabilities/readability/readability_home.html

Contact Information

For more information, contact the NIH Plain Language staff at: plainlanguage@od.nih.gov