Patient Empowerment: Gnitacinummoc with Stneitap Using Plain Egaugnal (Part II)

1. Patient Empowerment: Gnitacinummoc with Stneitap Using Plain Egaugnal(Part II) Jennifer St. Clair Russell, MSEd, CHES Director, Public & Professional Education American Kidney Fund

2. Purpose of Session The goal of this webinar is to increase participants’ ability to develop patient materials using plain language principles.

3. Objectives By the end of this session, you will be able to: • Define health literacy and plain language; • List three questions to ask when writing plain language materials or to identify plain language materials; and • List at least three “rules” to follow when writing plain language materials.

4. Health Literacy

5. What is Health Literacy? The degree to which individuals can obtain, process, and understand the basic health information and services they need to make appropriate health decisions.(Institute of Medicine 2004)

6. Impact on Health Those with limited health literacy skills: • More likely to be hospitalized • More likely to use emergency services • Report poorer overall health • Less likely to be screened • More likely to be diagnosed at a later stage • Less likely to control chronic conditions • Diabetes • Hypertension • Chronic Kidney Disease

7. Plain Language

8. What is Plain Language? • Presenting information so it makes sense to most people. • Using straightforward, concrete, familiar words. • Matches the needs of the reader with your needs as a writer—effective and efficient communication.

9. Plain Language is Not… • “Talking down” • “Dumbing down” • “Baby talk” • Patronizing • Simplistic

10. Medical Professional: Materials more likely to be read Increased understanding of content Instructions more likely to be followed Fewer questions Quicker responses to patient questions Increased patient satisfaction Increased adherence → better outcomes Patient: Needed information more understandable and user-friendly More likely to follow the instructions they were given More positive views of the facility Better overall experience Better overall outcomes What Are the Benefits?

11. Audience-Centered Communication Plain language begins with the needs of the audience: • What you communicate is determined by your purpose for communicating. • How you communicate should be determined by your audience’s reasons for listening and their comprehension skills.

12. Plain Language Basics Written Communication

13. Identify your audience To help you do this, try answering the following questions: • Who are my readers? • Why am I writing this document? • How will my readers use this information?

14. Words

15. Before Frequency of blood sugar testing will be determined by a physician. The patient must provide his or her mailing address and insurance information. After Your doctor will tell you how often to check your blood sugar. You must provide your address and insurance card. Use Pronouns

16. Before Dialysis center patient infection prevention procedures development. Draft patient protection regulations. After Setting up procedures to prevent infection among dialysis center patients. Draft of rules to protect the rights and health of patients. Avoid Noun Strings

17. Before BP CAPD HbA1c SOB After Blood pressure Peritoneal dialysis Average blood sugar Shortness of breath Use Acronyms Carefully

18. Before The bill was paid for by the insurance company. Insurance information must be provided prior to an appointment. After The insurance company paid the bill. You must give us your insurance card before your visit. Use Active Voice

19. Before These sections describe types of information that would satisfy the application requirements of Paragraph 12 as it would apply to Medicare. After These sections tell you what things are needed for Paragraph 12 of Medicare. Use the Simplest Verb Tense

20. Avoid Hidden Verbs Before • If you cannot make the payment of the $20 copayment fee, you must make arrangements with our office before you arrive for your appointment. After • If you can’t pay the $20 copay, you must let us know before your visit.

21. Use “Must” to Communicate Requirements Before Section 1 Program Enrollment • Any individual who wishes to enroll in the program shall complete an application. • The individual shall be notified by mail in all cases where enrollment is denied, and shall be given 30 days within which to appeal such decision.

22. Use “Must” to Communicate Requirements After Section 1 How can I join the program? • You must complete a form to join. • Our group will contact you by mail if your form is not accepted. You must file an appeal within 30 days.

23. Before You cannot come in now. Do not enter this area. I would not recommend that treatment. After You can’t come in now. Don’t enter this area. I wouldn’t recommend that treatment. Use Contractions

24. Instead of Accomplish Ascertain Disseminate Endeavor Expedite Formulate Utilize Use Do Find out Send out; Give out Try Speed up; Faster; Quick Work out; Form Use Use Simple Words

25. Before Convalescence Prognosis Modalities of therapy Asymptomatic Immunosuppressive drug After Get better; Heal; Recover Chances of getting better Treatment No symptoms Anti-rejection drug Avoid Jargon

26. Avoid or Explain Technical Words Before Test results confirm End Stage Renal Disease. Renal replacement therapy must begin immediately. After Your test results show that your kidneys are no longer working. The kidneys clean waste from your blood. Since your kidneys are no longer working, your blood must be cleaned another way soon. One way your blood can be cleaned is by having hemodialysis. Hemodialysis is a process where your blood is cleaned by a machine.

27. Sentences

28. Use Short Sentences Before • The surgeon decided to operate immediately when the patient arrived in critical condition with severe brain damage. After • The patient arrived in critical condition with severe brain damage. The surgeon decided to operate immediately.

29. Before The leg injury is disabling, therefore, the payee is entitled to benefits. An error was made in calculating your refund. After We found that you have a disabling leg injury so you will get benefits. We are sorry. We made a mistake when we calculated your refund. Use the Right Tone

30. Place Words Carefully Before • You are only required to provide the following… • If you are determined to have a disability, we will only pay you for the following… After • You are required to provide only the following… • If we find that you have a disability, we will pay you only for the following…

31. Instead of Absolutely necessary Joined together Enclosed you will find Very unique Surrounding circumstances Use Necessary Joined Enclosed Unique Circumstances Cut Out Unnecessary Words

32. Use “If-Then” Tables Before • Do not take more than 6 doses in any 24-hour period. Administer dosage, based on weight, every 4 hours. If weight is not known, use child’s age to determine dose. • Children under 2 years of age should not use this product. • 2 years of age to under 6 years of age or weight between 24 – 47 pounds, check with a doctor before using. • 6 years of age to under 12 years of age or weight between 48 – 95 pounds, take 1 teaspoon. • Over the age of 12 or that weigh 96 pounds or more take 2 teaspoons.

33. Use “If-Then” Tables After

34. Before No fewer than… Has not yet attained May not … until Is not … unless After At least… Is under May only … when Is … only if Avoid Double Negatives

35. Paragraphs

36. Write Clearly - Paragraphs • Include one issue per paragraph • Put a summary sentence at the beginning of each paragraph • Write short paragraphs • Include only one issue in each paragraph

37. Write, Review, Edit and Re-write

38. Your turn… All plans must cover certain medications, like anti- depressants or immunosuppressants. Standard plans do not cover everything, including over-the-counter drugs, vitamins (except Vitamin D), cold medicine and a few other medications. A plan’s formulary will include what is covered. Generics may be less expensive, but may not be an option for some patients. Patients should discuss their medications with their physician to determine if a generic may be substituted for a name-brand drug prior to purchasing it.

39. Sample Answer: All plans must cover some drugs. These include depression and organ transplant drugs. Standard plans don’t cover all drugs, like over-the-counter drugs, cold medicine and a few other drugs. Vitamin D is covered by standard plans, but other vitamins aren’t. Each plan will list what drugs are covered. Generics, or non-name brand drugs may be cheaper. Check with your doctor before you buy a generic.

40. Plain Language Checklist NIH developed a checklist to help writers write in plain language: • Audience • Organization • Words • Sentences • Paragraphs • Design

41. And now, a word about… Design

42. Questions?

43. Resources • National Assessment of Adult Literacy http://nces.ed.gov/naal • American Medical Associationwww.ama-assn.org/ama/pub/category/8115.html • American College of Physicians Foundation www.acpfoundation.org/hl/hlresources.htm • Government Plain Language Web site www.plainlanguage.gov • Online Readability Calculatorwww.editcentral.com