Covid: simple should not be stupid - Exhibit #1

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.