Ensuring that written materials are easy to understand and use often starts with plain language best practices and includes field testing to “test” the content, format, and messages with the intended audience. Developers agree that user-centered design and feedback from intended audiences are critically important to developing clear, understandable, and useable information. However, there are often challenges to soliciting meaningful input from the “right” audience members, specifically, those with low literacy or low health literacy.
We know we need to ask people who don’t read well to read our materials and give us feedback. But how do we do that? How do we get people who are reluctant to read to join a group of people who are asked to read materials and discuss with strangers? And how do we engage a focus group member who experiences barriers to participation because of literacy challenges? It can be a hard-sell to get the right people in the room and leave with meaningful feedback, but it is well worth the effort.
The UAMS Center for Health Literacy conducts focus groups with patients with low health literacy. We use plain language best practices to make materials easy and useful for all readers, but we also focus on the needs of those who are likely to struggle the most. The following lessons learned may help overcome known barriers to engaging participants with low literacy or low health literacy in field testing written materials:
- Try recruiting one-on-one with conversations that assure potential participants that they don’t need to read well to participate, that there are no right and wrong answers, and that their opinions are what we value most.
- When possible, allow participants to come to a focus group to watch before they decide to participate, to make sure that they are comfortable.
- Offer reasonable compensation or incentives that have value for participants, and healthy, culturally appropriate food.
- Show participants how to mark-up materials according to difficulty using stoplight coding:
- hard to understand = red light (use red pen),
- easy to understand = green light (use green pen), and
- material that could be better or easier to understand = yellow light (use yellow highlighter).
- Make sure they understand they are not being graded; rather, they are grading the material.
- Limit the volume of material being tested to three or fewer pages per session and keep sessions to no more than one hour.
- Avoid scenarios like “pretend you had a heart attack and you were given this…” which have proven to be challenging for many participants.
- Give concrete instructions in very short chunks, visual examples, and use teach-back to confirm understanding whenever possible.
- Anticipate that some participants will be unable to read and make accommodations for them to participate without having to read the materials.
If you want to learn more, see Dr Hadden’s recently published paper on this topic.
About the author: Kristie Hadden, PhD, is Associate Professor in the Department of Medical Humanities and Bioethics, and Executive Director of the University of Arkansas for Medical Sciences (UAMS) Center for Health Literacy.