Creating Patient Education Resources

Why does Nova Scotia Health create and update patient education pamphlets?

Approximately half of all Canadians experience some challenges understanding the health information and teaching provided to them (Guo, 2012). This is true for many Nova Scotians, especially those whose first language is not English (NS Department of Health, 2010). This can make reading and understanding health materials challenging at the best of times, on top of the added stress of being ill or having an ill family member, loved one, or friend.

To help make sure the information we include in our patient education resources is easy to read and understand, we edit all content for plain language and readability, with the goal of a 6th grade reading level. When our team reviews pamphlet drafts, we remove or explain medical jargon, replacing it with more familiar terms. We do this so readers can better understand their diagnosis, treatment, and instructions given to them by their health care teams (Weiss, 2014).

Further reading:

• Easy ways to build health literacy into your daily routines
• Battling the (mis)infodemic: A look at health literacy in Canada
• Celebrating Health Literacy Month: What is the difference between personal and organizational health literacy?
• When it comes to patient education, are somethings better left unsaid? A look a writing for readability

How can you support patient understanding?

• The SHARE Approach

  • Using this shared decision-making model can increase meaningful dialogue with patients exploring the benefits, harms, and risks of options, and what matters most to them.

• Always Use Teach-back! Learning Module

  • This free online learning module only takes 20 minutes to complete. Learners will be able to identify and use key elements of teach-back and plain language to promote health equity, safety, and quality, and advance organizational health literacy. (Abrams MA, Nielsen GA, Wilson A. Always Use Teach-back! Toolkit. 2024. https://teachbacktraining.org).

• Tips for Talking with Older Patients
  • This resource outlines ways to help you work with older patients to optimize care and improve provider-patient communication. 

Writing in plain language helps readers of all literacy levels by clearly communicating important information as simply and concisely as possible (Osborne, 2018). Some health care providers may be concerned that plain language will offend patients who read well (Osborne, 2018). This has been proven to be a misconception − plain language enables everyone to read and use essential health information (Wizowski, Harper & Hutchings, 2014). Likewise, it has been found that health care providers often overestimate their patient's understanding (Louizou, Panagiotou, Dafli, Smyrnakis & Bamidis, 2024). For this reason, Library Services’ Patient Education Team are guided by international plain language standards (ISO 24495-1, 2023) when developing or revising a patient education resource. 

What does plain language look like?

• Common, familiar words with fewer syllables
• Concise, short sentences or lists
• Focuses on key points
• Complex medical terms, if required to be included, are explained in simpler language

Library Services’ Patient Education Team uses “health care” (two words) instead of “healthcare” (one word) in all patient education pamphlets. 

Why do we use “health care” instead of “healthcare”?

• Plain language experts have confirmed that shorter words with less syllables are easier to read and understand for most readers. When given the option between two short words (“health” and “care”) or a compound word (“healthcare”), “health care” more suitably meets plain language guidelines.
• As outlined in the Canadian Press Style Guide:
  • When used as a noun, “health care” should be used.
  • When used as an adjective “health-care” should be used.

Given that “health care” or “health-care” may appear on the same page within the same patient resource, we have opted to use “health care” consistently regardless of whether it appears as a noun or adjective, for increased readability and understanding. This prevents the word appearing two different ways on the same page without an explanation, which may confuse readers. 

What about readability formulas?

Since readability formulas are based on mathematical equations that rely on sentence length and syllables, they are not recommended to assess the reading grade level of Nova Scotia Health patient education materials. Research has shown that they are not reliable and do not improve reader comprehension. Writing in plain language and organizing information for increased readability is not something that can be calculated; these are learned skills that take practice (Spivak, 2022). Instead of relying on a calculation, content creators are encouraged to follow plain language guidelines and test their materials before use with their target audience. All patient education resources added to the Nova Scotia Health collection are reviewed for plain language by more than one member of the Patient Education Team, to ensure both consistency and reader comprehension. 

Organization of pamphlet content 
All patient education resources should be designed for maximum readability and be presented in a logical format. When reviewing, the Patient Education Team will edit your draft to ensure the following criteria are met:

• Text must have sufficient white space and not be dense. White space between paragraphs of text helps readers absorb information more quickly.
• Use headings, bullets, and spacing to guide the reader and highlight important points.
• The font size of the main text must be no smaller than 14 pt. and the backmatter must be no smaller than 10 pt. Not only does this help readers with low vision, it also helps to make text easier to read for everyone.

Patient education pamphlets that account for varying levels of health literacy support increase people-centred care.

• When patients, families, and support persons understand the information being shared with them, they can make more informed and meaningful decisions about their care and treatment, in collaboration with their healthcare team. This allows for increased shared-decision making and more collaborative care. 

How can you make your patient education pamphlet more people-centred? 

• Accept edits made to lower the reading grade level of the material and create a simpler design that increases readability. 
• Ensure materials are written to include the patient's voice.
• Involve Patient Family Advisors (PFAs) in your working group whenever possible. 

Find patient engagement resources on Nova Scotia Health's Engagement guide.