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Writing in Plain Language - How To

 

CRC staff are happy to help you use plain language guidelines to write, design and/or test your patient education materials. We can tell you what you need to know, when you need to know it.

This page offers optional additional reading and resources.

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  1. Why Plain Language?
  2. Plain Language: What It Is and Is Not
  3. How to Write in Plain Language
  4. Testing
  5. More Information and Training
  6. References

 

1. Why Plain Language?

According to the American Medical Association, several studies indicate that even after adjusting for covariables like education level, socioeconomic level, demographic factors, self-efficacy, and cultural background, literacy is related to health knowledge, health status, and use of health services.

(Report on the Council of Scientific Affairs, Ad Hoc Committee on Health Literacy for the Council on Scientific Affairs, American Medical Association, JAMA, Feb 10, 1999).

  • Plain language is Vital for Those with Low Literacy or Low Health Literacy

    According to the National Adult Literacy Survey (NALS):

    • 66% of U.S. adults age 60 and over have inadequate or marginal literacy skills.
    • 50% of welfare recipients read below fifth grade level.
    • 50% of Hispanic Americans and 40% of African Americans have reading problems.

  • But “You can’t tell by looking.”

    Even health practitioners who have worked with low-literacy patients for years are often surprised at the poor reading skills of some of their most poised and articulate patients.

    • Two-thirds of 58 patients who admitted having reading difficulties had never told their spouse. Nine of them had told no one.
    • Physicians at a women’s health clinic could identify only 20% of their patients who were at the lowest literacy level (<third grade)

  • AND Plain Language is NOT Just for Those With Low Literacy

      • People at all literacy levels prefer written materials that are easy to read, simple and attractive.
      • Plain language enables confident readers to read more quickly and with increased comprehension
      • Readers are more likely to read through the information rather than just skim it.

    In a variety of empirical studies and in the experience of many companies and agencies, plain language has proved to be better than traditional style in many ways.

    • It’s faster to read.
    • Readers are more likely to read plain language documents in the first place. They are less likely to be put off or intimidated.
    • Readers are more likely to comply with plain language documents.
    • Readers strongly prefer plain language to traditional style.
    • Readers understand plain language better than traditional style.
      • In a number of empirical studies, comprehension improved by anywhere from 10-15 % to over 100%.
    • And because readers prefer plain language and understand it better, they’ll make fewer mistakes in dealing with it, have fewer questions and complaints, feel more satisfied, and ultimately save time and money – for themselves and for the writer’s employer.

    More on this topic...

    2. Plain Language: What It Is and Is Not

    Written material is in plain language if your audience can:

    • Find what they need;
    • Understand what they find; and
    • Use what they find to meet their needs.

    -From: http://www.plainlanguage.gov/whatisPL/index.cfm (retrieved 11/12/10).

  • Plain Language is NOT Just "Dumbed Down"

    Some hear the term plain language and think “short words/short sentences”, “dumbed down ideas” or “low reading level.” This description is simply not accurate. In fact, plain language uses evidence-based recommendations about how to structure, write and design information to facilitate reading ease and audience understanding.

    Vibrant plain language is far from plain. It’s lively, engaging, and results in effective communication.

  • Plain Language IS Easy to Read (and more likely to be read)

    The following principles can help writers make materials that are easy to read and understand:

    • Explain purpose and limit content.
    • Involve the reader.
    • Make it easy to read.
    • Make it look easy to read.
    • Select visuals that clarify and motivate.

    More on this topic...(including evidence)

    3. How to Write in Plain Language

    Note:  Learning to write in plain language is a process. There are too many suggestions to absorb and put into practice all at once. So we've broken up the specific rules and tips about content into two sections- "The Basics" and "The Next Level".

     

      Content – The Basics

  • Editing

    • Writing clearly is much harder than it seems. As we mentioned earlier, learning to write in plain language is a process. With practice some or all of the guidelines will become second nature when you write. But even the best writers edit their work. Expect to write several drafts of your document and be prepared to have it criticized and modified. Don’t take it personally.

    Tips:

    • Put your document aside for a day or two before editing. A little time and distance helps you gain perspective.
    • Edit from a reader’s point of view.
    • In a first draft you'll write too much, so in the second cut out half the words.

    Also see the editing checklists in the “More Information and Training” section at the end of this document.

  • Use Simple, Everyday Words

    Use simple, familiar words instead of unfamiliar words.

    Write as if someone is asking you what you mean. If you are writing for a diverse audience, sometimes you must be an interpreter as well as a writer.

    Here are a few examples of simple words and phrases you might substitute:

    Instead Of: Use:
    accomplish do
    ascertain find out
    disseminate send out, distribute
    endeavor try
    expedite hasten, speed up
    facilitate make easier, help
    formulate work out, devise, form
    in lieu of instead of
    locality place
    optimum best, greatest, most
    strategize plan
    utilize use

     

  • Cut out unnecessary words

    Instead of:

    Use:

    in order to

    to

    with regard to

    about

    in the event that

    if

    until such time

    until

    during such time

    while

    in view of the fact

    because

    subsequent to

    after

    it would appear that

    apparently

     

  • Avoid or explain technical words

    Whenever possible, avoid words that your readers do not know. If you must use a technical term define it - either by giving a definition or an example.

  • Keep it Short

    Readers can only take in so much new information at one time. Some recommend that sentences should average 15 words in length and that no sentence should be longer than 25 words. This rule is not hard and fast, however. Readers can understand longer sentences if they are well constructed and use familiar terms. A variety of sentence lengths make your writing more interesting.

  • Emphasize the Positive

    Positive sentences are inviting and encourage people to read on. Negative sentences can seem bossy or hostile. They can cause your readers to mistrust your words and often discourage people from reading on.

    Instead of:
     If you fail to pass the examination, you will not qualify for admission.

    Use:
     You must pass the examination to qualify for admission.

    However, negative phrasing is appropriate for emphasizing dangers, legal pitfalls, or other warnings. You can also use negative phrasing to allay fears or dispel myths.

  • Write in active voice

    Voice is the form a verb takes to indicate whether its subject acts or is acted upon. When the subject of a verb does something (acts), the verb is in the active voice. When the subject of a verb receives the action (is acted upon), the verb is in the passive voice.

    Active voice: Conor hit the ball.

    Passive voice: The ball was hit by Conor.

    Because the active voice emphasizes the doer of an action, it is usually briefer, clearer, and more emphatic than the passive voice.

    More on Active vs. Passive Voice

  • Use personal pronouns

    Pronouns help readers relate better to documents. When you address the reader as “you”, he or she feels directly addressed and is more likely to understand what his or her responsibility is. When your writing reflects this, it is more economical and has a greater impact on the reader.

  • Keep it simple

    Sometimes you need to use a paragraph instead of just a few sentences to make your message clear. The clearest isn't always the shortest.

    Instead of:
    Plateauing or career blockage refers to structural barriers to career advancement arising due to a combination of age imbalances and a static or contracting workforce.

    Use:
    "Plateauing" or "career blockage" refers to the lack of opportunities for public servants to be promoted to the executive level. This problem arises because there is a large number of public servants who have many years to work before they retire and because the size of the public service is being reduced. For these reasons there are fewer openings available at higher levels.

  • Make it easy to scan

    • Use descriptive headers.

      • You increase readability by using headers that specifically describe the sections of your documents. Your reader absorbs information more quickly and easily, and understands its relationship to other information, if you use headers. The headers can then become a table of contents that communicates information more effectively to the reader.

      Use clear and consistent style for headings and subheadings.

    • Break up dense copy.

      If dense copy fills a page, you increase the chances that your reader will become discouraged. Give your reader a visual and mental break by using shorter paragraphs and headers.

      Use vertical lists (bullets). Vertical lists highlight a series of items in a visually clear way. Use vertical lists to help your reader focus on important material.

    • Leave lots of white space.

    Content: The Next Level

    Once you're familiar with the basic content suggestions, try adding these to your plain language repetoire.

    • Don't change verbs into nouns

      Nouns created from verbs are hard for the reader to understand and give the sentence an impersonal tone. When you write a noun that is derived from a verb, see if you can turn it back into a verb.

      Instead of:
      The requirement of the department is that employees work seven and one-half hours a day.

      Use:
      The Department requires employees to work seven and one-half hours a day.

      Instead of:
      You will work on the establishment of goals for the hiring, training and promotion of designated group employees.

      Use:
      You will establish goals for hiring, training and promoting employees from designated groups.

    • Avoid double negatives

    If your readers have to stop and remember that a double negative makes a positive you are making them work too hard.

    Instead of:

    Use:

    He was not absent.

    He was present.

    The procedure will not be ineffective.

    The procedure will be effective.

  • Avoid unnecessary preambles

    Unnecessary preambles can weaken or hide the point they introduce.

    Some unnecessary preambles:

    • It is important to add that...
    • It may be recalled that...
    • In this regard it is of significance that...
    • It is interesting to note that...

  • Avoid unnecessary qualifiers or redundancies

    They add no additional meaning to a sentence. Here are some examples:

    • Their claim was totally unrealistic
    • We are completely convinced
    • It is definitely worth experiencing
    • Work in partnership with
    • Additional requirements needed to provide a level of safety
    • Maintain successful bilateral agreements
    • The new incoming freshman.

  • Be careful with modifiers

    Place adjectives, adverbs and adverbial phrases next to the word they are modifying to avoid confusion.

    Misplaced adjectives are incorrectly separated from the nouns they modify and almost always distort the intended meaning.

    Instead of:
    She ate a cold bowl of cereal this morning (suggests the bowl is cold)

    Use:
    She ate a bowl of cold cereal this morning (the cereal is cold, not the bowl)

    If improperly placed, adverbs such as only, even, both, merely, just, also, mainly, in particular, almost and at least can cause confusion.

    Instead of:
    I only contributed $10 to the fund for orphans. (I was the only one who contributed?)

    Use:
    I contributed only $10 to the fund for orphans. (I contributed only $10)  

    Instead of:
    We ate the lunch that we had brought slowly. (We brought it slowly?)

    Use:
    We slowly at the lunch that we had brought. (We ate slowly)

    Phrases too can be misplaced:

    Instead of:
    The three bankers talked quietly in the corner smoking pipes. (Is the corner smoking?)

    Use:
    The three bankers smoking pipes talked quietly in the corner. (The bankers are smoking.)

    -Examples in this section are from: http://www.towson.edu/ows/moduledangling.htm, where you can also find more details and examples.

  • Problem Words- commonly misused word pairs

    See http://www.plainlanguage.gov/howto/quickreference/dash/dashproblem.cfm

  • Use parallel construction

    Whenever a paragraph includes a series of similar items, make sure that all the items are in the same form. Describe each item using similarly constructed phrases. For example, use the same tense for all verbs that describe listed items.

    Instead of:

    Going on vacation?

    inform a neighbor of your departure...
    your neighbor should pick up your newspapers...
    small valuables should be stored...
    use clock timers that activate lights...
    before leaving, ensure all entries are secured...

    Use:

    Going on vacation?

    inform a neighbor of your departure
    have your neighbor pick up newspapers
    store small valuables
    use clock timers that activate lights
    secure all entries before leaving

  • Use point form and lists appropriately

    You can make parallel points clear and easy to remember by using a vertical list. Each item in the list is preceded by a bullet or a number. Bullets or numbers draw the reader’s attention and separate the items better than dashes.

    Here are some guidelines for vertical lists:

    • The items in the list must form a logical group.
    • Each item should contain only one idea.
    • Each item should work separately with the lead-in to form a complete sentence.
    • Put anything common to all items in the lead-in.
    • Keep bulleted lists no longer than 5 to 7 items. Break-up longer lists under separate headers.
    • Use numbers instead of bullets only when you are describing step-by-step procedures.
    Design

    The way you present information on the page is just as important as the words and sentences you use to present that information. A well written document can be hard to read if it is poorly laid out. How your document looks can make the difference between your message being understood or lost.

  • Type style and size

        • Choose a solid, plain typeface which is easy to read.
        • Don't combine more than two to three different typefaces on the same page because it will give a busy, confusing appearance.
        • Twelve point is a good size for most writing. Ten point is the minimum size to use. Consider that some people may prefer a larger type size.
        • Use boldface type or larger print size to cue the reader to important text.
        • Avoid ALL CAPS and reverse type (e.g., white on black) as cueing methods. They may make the copy harder to read. Sources vary on recommendations about italics and underlining. We suggest you not use them.

  • Serif or sans serif font?

    Serif fonts are characterized by short lines extending from the upper and lower ends of the letters. Sans serif fonts do not have these lines. A serif typeface makes text easier to read because it leads your eye from letter to letter. Some examples of serif fonts are:

    • Book Antiqua
    • Garamond
    • Palatino Linotype
    • Times New Roman

    A sans serif typeface is good for titles because it draws your eye down into the body of the text. Some examples of sans serif fonts:

    • Arial
    • Tahoma
    • Verdana

  • Justify the left margin only

    Justifying means making the margins flush. Justifying the right hand margin decreases readability because it causes the eye to stop at irregular spacing between words. Use a justified left margin and an unjustified, or ragged, right margin as this document does.

  • Leave white space

    White space makes a page more inviting, makes it look easier to read, and helps readers keep their place. If material looks hard to read, poor readers are not likely even to try. Good readers are also put off by dense text or jam-packed pages.

    • Keep paragraphs no more than four or five sentences.
    • Leave space between paragraphs.
    • Divide your documents into sections of related information.
    • Be generous with margin space.

  • Use graphics/illustrations when appropriate

    • Why use visuals/illustrations?
      • Simplify concepts
      • Cut down on required reading
      • Pictures are easier to remember than text
      • Better for visual learners
      • Emphasize key points
      • Emotional and cultural appeal

    • How to Use them

      The best visuals:

      • Support the text
      • Are placed close to the related text (with captions)
      • Are realistic
      • Are culturally appropriate
      • Are literal and not abstract. 
      • Have action captions. Captions clarify the point of a visual. Because our eyes are drawn first to visuals, the accompanying captions may be some of the most important text on a page. 
      • Show the right/correct thing to do or way to do it. If it’s absolutely necessary to show the wrong way, use a big X through the illustration. Many do not understand the symbol of a circle with a line through it.

      Be wary of using charts to explain information. People with poor math skills can find charts hard to understand.

    4. Testing

    Testing your document may seem like it will take too much time and effort. But you should carefully consider it, particularly if the document will be widely circulated. It may end up saving you from answering lots of questions, thereby saving you time in the long-run. Only your readers can tell you if your writing is useful, relevant and readable.

  • Audience Testing

    It is important to get feedback from people who are likely to use your document. We often write documents which are more suitable for ourselves than for our readers.

    The testing process will tell you:

    • if your audience wants to read your work,
    • if they can read it, and
    • if they can make use of it.

    If your draft does not pass the test, the results will give you valuable information on how to revise your work for your audience.

  • Protocol Testing

    Protocol Testing involves a one-on-one interview with a reader. It will tell you what a reader thinks a document means. It is valuable in determining if the reader is interpreting your message the way you intended.

    Ask the reader to read to a specific cue (usually a dot identifying a stopping point). Each time the reader reaches a cue, ask for an explanation of what that section means. At the end of the document, ask additional questions, such as.

    • What would you do if you got this document.
    • Do you think the writer was trying to help you.
    • Do you think your friends would understand this document?

    This last question is important because sometimes people are more comfortable telling you what they think others might find confusing, rather than admitting that they don’t understand something themselves.

  • Readability Testing

    Most guidelines suggest writing at no higher than a 6th grade reading level. Readability in terms of U.S. school grade levels can be determined by formula. Formulas, for the most part, are applicable to running text but not to lists, charts, and tables. The majority of formulas establish readability based on two factors:

    • The number of hard words in a sample. The more hard words— that is, the more syllables in the sample—the higher the readability level.
    • The average length of sentences. The longer the sentences— the more words in the average sentence—the higher the readability level. 
  • The manual Fry formula

    The Fry is commonly recommended. Pfizer, for example, uses it because it:

    • Is easy to use and takes only about 15 to 20 minutes to obtain results
    • Uses reasonably small sample sizes (100 words), so it is suitable for both short and long documents
    • Reveals which types of words and sentences are difficult
    • Is well recognized within the reading community
    • Is not copyrighted

    Instructions for using the Fry readability test are available at http://www.pfizerhealthliteracy.com/pdf/PfizerPrinciples.pdf. See chapter 5.

    CRC staff can test your document for you.

    5. More Information & Training

    6. References

    This document is adapted from:

    Additional References: