Designing plain‑language patient materials is more than swapping a few words for simpler ones; it is a systematic approach that blends clear writing, thoughtful layout, and rigorous testing to ensure that every patient—regardless of education level or background—can grasp the information they need to make informed health decisions. When done correctly, plain‑language resources reduce confusion, improve adherence to treatment plans, and enhance the overall patient experience.
Understanding Plain Language and Its Importance
Plain language is a set of communication principles that prioritize the reader’s comprehension above all else. In the healthcare setting, the stakes are high: misunderstandings can lead to medication errors, missed appointments, or unnecessary hospital readmissions. By presenting information in a straightforward, concise, and organized manner, clinicians and health systems empower patients to become active participants in their own care.
Key benefits include:
- Reduced cognitive load – Simple sentences and familiar words require less mental effort to decode.
- Improved recall – Information presented in a logical flow is easier to remember.
- Higher satisfaction – Patients feel respected when providers speak in a language they can understand.
- Better health outcomes – Clear instructions translate into higher adherence rates and fewer adverse events.
Core Principles of Plain Language Design
- Know Your Audience
Identify the typical health literacy level of the patient population you serve. While you should not assume a single literacy level, having a baseline helps shape word choice, sentence length, and the amount of detail provided.
- Use Active Voice
Active constructions (“Take your medication with food”) are more direct and easier to follow than passive ones (“Medication should be taken with food”).
- Prioritize the Main Message
Lead with the most critical information. If a patient reads only the first two sentences, they should still understand the essential point.
- Keep Sentences Short
Aim for 15–20 words per sentence. Shorter sentences reduce the chance of embedded clauses that can confuse readers.
- Choose Common Words
Replace medical jargon (“myocardial infarction”) with everyday equivalents (“heart attack”). When technical terms are unavoidable, define them in plain language the first time they appear.
- Be Specific
Vague instructions (“Take the medication as needed”) should be replaced with concrete guidance (“Take one tablet every 8 hours, even if you feel fine”).
- Use Numerals for Numbers
Numerals are processed faster than words. Write “2 weeks” instead of “two weeks,” but spell out numbers one through nine when they appear at the beginning of a sentence.
- Organize Information Logically
Group related concepts together, use headings and subheadings, and follow a predictable order (e.g., what, why, how, when, and what to watch for).
Assessing Readability: Tools and Metrics
Before finalizing any material, evaluate its readability using established formulas:
| Tool | Formula | Typical Grade Level Interpretation |
|---|---|---|
| Flesch‑Kincaid Grade Level | 0.39 × (average sentence length) + 11.8 × (average syllables per word) – 15.59 | Target ≤ 8th grade for most patient materials |
| SMOG (Simple Measure of Gobbledygook) | 1.0430 × √(number of polysyllabic words × (30/number of sentences)) + 3.1291 | Often yields a slightly higher grade; aim for ≤ 8 |
| Gunning Fog Index | 0.4 × [(average sentence length) + 100 × (polysyllabic words/total words)] | Target ≤ 8 |
| Flesch Reading Ease | 206.835 – 1.015 × (average sentence length) – 84.6 × (average syllables per word) | Scores 70–80 are considered “fairly easy” |
These tools are available as free online calculators or built into word‑processing software. Remember that readability formulas assess surface features (sentence length, word length) but do not capture conceptual difficulty, cultural relevance, or layout considerations. Use them as a first filter, then move to user testing.
Step‑by‑Step Process for Creating Plain Language Materials
- Define the Objective
Clarify the specific behavior or knowledge you want the patient to gain (e.g., “Patient will know how to self‑inject insulin”).
- Gather Content
Assemble the clinical information from subject‑matter experts. Keep the source material as concise as possible.
- Draft in Plain Language
- Write a first draft using the core principles above.
- Limit each paragraph to a single idea.
- Use bullet points for step‑by‑step instructions.
- Apply Readability Checks
Run the draft through at least two readability tools. Revise any sentences that push the grade level above the target.
- Design Layout
- Use a clean, sans‑serif font (e.g., Arial, Calibri) at 12‑pt size or larger.
- Provide ample white space; avoid dense blocks of text.
- Use left‑aligned text; centered text can be harder to scan.
- Add Supporting Elements *(without creating a separate visual‑aid article)*
- Simple icons (e.g., a pill bottle for medication) can reinforce meaning.
- Highlight key actions with bold or colored text, but limit to one or two colors to avoid visual clutter.
- Conduct Patient Review
Recruit a small group of patients who reflect the target audience. Ask them to read the material aloud and explain it back in their own words. Note any points of confusion.
- Iterate
Incorporate feedback, re‑run readability checks, and repeat the patient review until the material meets both comprehension and readability goals.
- Finalize and Distribute
Produce both printed and electronic versions, ensuring that the final format matches the environment where it will be used (e.g., clinic waiting room handout vs. discharge email).
Choosing the Right Words: Vocabulary and Syntax
- Avoid Acronyms and Abbreviations unless they are universally recognized (e.g., “BP” for blood pressure). If you must use them, spell them out on first mention: “blood pressure (BP).”
- Replace “Medical” Terms
| Jargon | Plain Language |
|---|---|
| Hypertension | High blood pressure |
| Dysphagia | Trouble swallowing |
| Edema | Swelling |
| Analgesic | Pain medicine |
- Use Concrete Verbs
- “Press the button” instead of “activate the device.”
- “Sit up straight” instead of “maintain proper posture.”
- Limit Negatives
- “Take the medication with food” is clearer than “Do not take the medication on an empty stomach.”
Effective Structure and Organization
- Header – State the purpose in a single line (e.g., “How to Take Your Blood‑Thinning Medication”).
- Why It Matters – One short paragraph explaining the health benefit or risk.
- What to Do – Step‑by‑step instructions, each beginning with an action verb.
- When to Do It – Timing details (e.g., “Take every morning after breakfast”).
- What to Watch For – Simple list of side effects or warning signs.
- Contact Information – Phone number or portal link for questions.
Consistent structure across all patient handouts creates a mental model that patients can rely on, reducing the effort needed to locate critical information.
Design Elements that Support Comprehension
- Typography: Use a single, legible font family. Bold only headings and key actions; avoid all‑caps text, which can be perceived as shouting and is harder to read.
- Spacing: Insert a blank line between paragraphs and a larger space before each new heading. Use 1.5‑line spacing for body text.
- Margins: Keep margins at least 1 inch on all sides to prevent text from feeling cramped.
- Color Contrast: Ensure a contrast ratio of at least 4.5:1 between text and background (WCAG AA standard). Black text on white or off‑white background is safest.
- Icons and Simple Graphics: A small pill icon next to medication instructions or a clock symbol next to timing cues can reinforce meaning without requiring extensive visual‑aid design.
Testing and Refining Materials with Patients
Cognitive Interviewing is a proven method for uncovering hidden comprehension barriers:
- Think‑Aloud Protocol – Ask patients to read the material while verbalizing their thoughts.
- Probing Questions – After each section, ask “What does this mean to you?” or “What would you do next?”
- Error Identification – Note any misinterpretations and trace them back to specific wording or layout choices.
Collect both qualitative feedback (e.g., “I’m not sure what ‘dose’ means”) and quantitative data (e.g., “90% of participants correctly identified the dosing schedule”). Use this information to prioritize revisions.
Integrating Plain Language into Clinical Practice
- Standard Operating Procedure (SOP): Embed plain‑language creation steps into the SOP for patient discharge or education material development.
- Staff Training: Conduct brief workshops for nurses, pharmacists, and front‑desk staff on the basics of plain language. Even a 30‑minute session can dramatically improve the quality of ad‑hoc explanations.
- Template Library: Maintain a repository of pre‑approved plain‑language templates (e.g., medication handouts, follow‑up instructions) that clinicians can customize quickly.
- Quality Assurance: Assign a “plain‑language champion”—often a health educator or quality improvement specialist—to review new materials before they go live.
Common Pitfalls and How to Avoid Them
| Pitfall | Why It Happens | Remedy |
|---|---|---|
| Over‑simplifying to the point of omitting essential details | Desire to keep text short | Use a “must‑know” checklist to ensure critical information stays. |
| Assuming all patients have the same literacy level | One‑size‑fits‑all mindset | Create tiered versions: a brief “quick‑read” plus an optional expanded FAQ. |
| Relying solely on readability formulas | Formulas ignore context and cultural relevance | Pair formulas with patient testing. |
| Using too many fonts or colors | Attempt to make material “engaging” | Stick to one font family and a maximum of two colors (one for headings, one for body). |
| Adding dense tables or charts without explanation | Belief that data speaks for itself | Provide a short narrative that interprets each table or chart. |
Resources and Tools for Ongoing Development
- Plain Language.gov – Federal guidelines and checklists for plain‑language writing.
- CDC Clear Communication Index – A scoring system that evaluates the clarity of health communication materials.
- Readability‑Calc.com – Free online readability calculator supporting multiple formulas.
- Microsoft Word Readability Statistics – Built‑in tool that provides Flesch‑Kincaid scores after a spell‑check.
- Health Literacy Toolkits – Many professional societies (e.g., American Medical Association) offer downloadable plain‑language templates.
Conclusion: Sustaining Plain Language Excellence
Designing plain‑language patient materials is an ongoing commitment rather than a one‑off task. By embedding clear‑writing principles, systematic readability checks, patient‑centered testing, and consistent design standards into everyday workflows, health organizations can ensure that every piece of information—whether a medication handout, a discharge summary, or a preventive‑care flyer—speaks directly to patients in a language they can understand and act upon. The result is not only a smoother patient experience but also a measurable step toward safer, more effective care.
