Health Literacy Lessons From COVID-19

Healthwise Communications Team

At a time when the public needs access to reliable and comprehensible health information more than ever, the U.S. Centers for Disease Control (CDC), the White House, and other government sites have created record amounts of content for consumers. Unfortunately, much of it is written in a way that helps just a small percentage of Americans, leaving many people at a disadvantage.


Many Government Websites Are Too Complex for Readers

In April, Dartmouth College researchers evaluated 137 federal and state web pages with COVID-19 education intended for a general audience.1 Their goal was to find out whether the content met guidelines set in place by the CDC, the American Medical Association, and the National Institutes of Health, all of which recommend that medical content for the public be written at an eighth-grade reading level or lower.

The Dartmouth team found that, on average, government sources of COVID-19 information were written at just above an 11th-grade reading level, making the material too complex for many readers.

Three factors came up repeatedly, each of them making the content harder to read than it needed to be:

  • Sentences that were too long
  • Words with too many syllables
  • Difficult/unfamiliar terminology

In some cases, the CDC itself even failed to meet its own recommendations.

Difficulty relating medical concepts is nothing new in healthcare.2 That’s because the writing is often by doctors, scientists, and statisticians who already know the terminology forward and backward—they’re college-educated specialists who have been immersed in the medical world for years. To them, changing a five-syllable word to a three-syllable word feels like all the simplification that’s needed. Some even chafe at the idea of “dumbing down” the writing.

But for the average person who doesn’t work in the healthcare field, that three-syllable word might be utterly baffling.

Of particular concern in the Dartmouth study was the discovery that 9 of the 10 states with the highest illiteracy rates had websites written above a 10th-grade level. The communities who struggle the most with written content are being given the most complex information, making it virtually impossible for them to get the answers they need during the pandemic.


The Importance of Health Information Readability Guidelines

The U.S. Plain Writing Act of 2010, which applies to anything published by the government, recommends that “federal agencies use clear government communication that the public can understand and use.”3 The guidelines are intended to help people accomplish three goals:

  • Find what they need
  • Comprehend what they read
  • Do what they need to do the first time they read it

When long sentences, big words, and unfamiliar terminology are used, it becomes much harder for people to process what they read (or watch on a video or television). This is a huge part of why many people end up following medical advice they find on social media—it’s been written in plain language they can understand. Encouraged by this, many people then trust that source because it speaks to them at their level. Unfortunately, many of these sources are inaccurate, biased, or even dangerous.

"Information about COVID-19 can be complex, contradictory, and sometimes false,” says Joseph Dexter, the senior author of the Dartmouth study. “It is important that members of the public be able to use public health recommendations from trustworthy sources and not have to turn to less reliable outlets."

In 2003, the National Assessment of Adult Literacy evaluated the health literacy of over 19,000 people over the age of 16.4

  • Only 12% of adults had proficient health literacy.
  • People over the age of 65 had lower health literacy than younger adults.
  • Higher education levels correlated with higher degrees of health literacy.

Think about that. Only about 1 out of every 10 people can easily comprehend health information. It’s no wonder that simply throwing complicated medical guidelines out on the web hasn’t stopped the current epidemic in its tracks.


Changing the Face of Health Content

In the face of COVID-19, placing pressure on federal and state entities to revise the way they present health information is more important now than at any time in our history. Change at that level won’t happen overnight, though—government entities have never been known for moving quickly. In the meantime, hospital systems and health plans should evaluate the sources they use, with an eye to plain language and inclusivity.

All medical advice should be accurate and communicated in way that everyone can easily comprehend. This goal is absolutely achievable if government entities and healthcare organizations take health literacy into account when creating content.

Everyone deserves access to medical help they trust and understand. Let’s work together to make sure no one is left behind as we move forward and transform the way we talk about health.