Will you listen now? Readability is integral to knowledge translation
The COVID-19 pandemic has been an ordeal for all of us who believe in the importance of evidence-based decision making. Addressing the volume and speed of misinformation is an almost Sisyphean task. By the time we debunk one myth, another myth is taking root. But all day, every day we are evidence warriors. We stand ready to make infographics on why ingesting horse dewormer is a terrible idea, or update our FAQs with the latest evidence so that you reconsider injecting yourself with bleach. We wade into the fray on social media with our myth-busting clips reminding people that if they have scrotal swelling, it's likely not related to the COVID vaccine. And yet it sometimes feels like no one is listening; but, if no one is listening, it’s because they don’t understand what we are saying.
The problem is not with the evidence, but with our delivery of that evidence to end users. Our FAQs, infographics and videos are often complicated and laden with jargon. They are not readable, so they do not connect with those we are trying to reach. Take a minute to ask yourself: how easy it is for a user to understand text?
Worral and colleagues examined the readability of COVID-19 websites in Canada, the United States, the United Kingdom and Ireland. They found that most of the COVID-19 websites had poor readability scores with only 17.2% of websites reviewed meeting the criteria of being universally readable. They further stated that:
This poor readability level affects understanding of the health information; resulting in poor adherence to hygiene measures, social-distancing measures, and further public health recommendations.
Readability is not about having to ‘dumb down’ the evidence. It is about understanding the user you are trying to reach and then sharing the evidence in a way that they can understand and act on that information. Thankfully, there are multiple tools that can be used to support readability so that our knowledge translation efforts can have the intended effect, which is to support the health and well-being of those we serve.
To demonstrate how readability can be applied to knowledge dissemination, we will illustrate how readability tools were used to develop www.realtalkcovid.com. The target audience for www.realtalkcovid.com is the Black and Indo-Caribbean community in Toronto. The City of Toronto analysis of ethno-racial identity and COVID-19 demonstrated that Black and Indo-Caribbean populations were over-represented in case reporting and hospitalisation. As a result, there was a clear need to develop a website where the Black and Indo-Caribbean community could access evidence-based COVID-19 information that could be understood and acted on. When asked what resources were needed to increase vaccine confidence and uptake, 73.2% of Black respondents said that they needed ‘culturally-responsive and relevant information for the community’.
The purpose of www.realtalkcovid.com is to provide evidence-based information so that members of the Black and Indo-Caribbean community can make the best decisions for themselves and their families.
Credit: https://nikkitaldar.myportfolio.com/covid-19-awareness-website
Readability was one of the most important considerations when developing www.realtalkcovid.com. Some of the readability tools we used were:
- Flesch-Kincaid reading grade level: (0.39 average no. of words per sentence) + (11.8 average no. of syllables per word) -15.59
- The Gunning Fog reading grade level: 0.4 (average no. of words per sentence = no. of words with three or more syllables x [100/no. of words])
- Simple Measure of Gobbledygook (SMOG) reading grade level: (3 + √ [no. of words with three or more syllables]) x (30/no. of sentences)
(Wang L, Miller M, Schmitt M, Wen F; 2013)
As an example, consider the following vaccine efficacy statements: one is from the Centers for Disease Control (CDC) website, and the other is from www.realtalkcovid.com.
CDC: ‘COVID-19 vaccines also help keep you from getting seriously ill even if you do get COVID-19. Getting vaccinated yourself may also protect people around you, particularly people at increased risk for severe illness from COVID-19.’
www.realtalkcovid.com: ‘We highly recommend getting vaccinated. It will help protect you and your family. It’s not perfect. And yes you can get COVID even if you are vaccinated. But your chances of dying are way lower.’
Both statements want to convey the same message to the public; however, the statement from the CDC website requires a reading grade level of 10 or above, depending on the chosen readability tool. In contrast, the similar statement from www.realtalkcovid.com scores a 7.4 or lower. It is generally accepted that written materials should be designed within the 4th to 6th grade range (Patient Safety Network, 2019).
If no one is listening, it’s because the problem lies with us. The most important lesson we learnt was that accuracy without readability will not be effective in reaching our target audience. In our zeal to help people by sharing evidence, we forget to deliver it in a way that is understandable. The good news is that we can be part of the solution. Before you click the ‘post’ button, ask, ‘Have I made it easy for you to understand what I say?’ ‘Will you listen now?’
References
- Barwon Health. Health literacy guide; 2019.
- City of Toronto. COVID 19: Ethno-racial identity and income; 2021.
- Patient Safety Network. Health literacy; 2019.
- The Black Scientists’ Taskforce on Vaccine Equity. Toronto's Black community townhalls unpacked; 2021.
- United States Government. Write for your audience. Plain language; n.d.
- Wang L, Miller M, Schmitt M, Wen F. Assessing readability formula differences with written health information materials: application, results, and recommendations. Res Social Adm Pharm. 2013;9:503-16.
- Worrall AP, Connolly MJ, O’Neill A, O’Doherty M, Thornton KP, McNally C, et al. Readability of online COVID-19 health information: a comparison between four English speaking countries. BMC Public Health, 2020;20(1635).
Authors
Amanda Ottley¹
Courtney Stone²
Bridget Weber²
Marlyn Henry²
Tamaraleah Jackson²
Karla Baronia²
Michael Ondieki¹
1 Nelion Strategy Inc, Scarborough, ON, Canada
2 Arizona State University, Phoenix, AZ, USA
Acknowledgements
The grassroots group Save Toronto Carnival (STC) worked collaboratively with Nikki Talder, Jennifer Arsenault and Kristyn Klamut to design the site. This project was led by Amanda Ottley of Nelion Strategy and Elise Roopchan of STC. The site was funded under the City of Toronto Vaccine Engagement Team grant for the South Scarborough Cluster led by Scarborough Centre for Healthy Communities.
Disclaimer
The views expressed in this World EBHC Day Blog, as well as any errors or omissions, are the sole responsibility of the author and do not represent the views of the World EBHC Day Steering Committee, Official Partners or Sponsors; nor does it imply endorsement by the aforementioned parties.
