Quality Insights: Right? Well, good afternoon, everyone, and welcome to the second of our four part Health Literacy Lunch and learn series for the month of October. Today's topic is focused on developing health literate materials, and how to guide.
Quality Insights: My name is Mitzi Vince and I'm. A communication specialist to your quality on site and your host for today's presentation. We're going to get started in just a few minutes. But first I wanted to go over a couple of housekeeping items
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Quality Insights: And even if you don't need the continuing education credits. We hope that you still complete the evaluation as it helps. Tell us how we did and how we can shape our future programming.
Quality Insights: So to talk a little bit about the continuing education credits to complete the course.
Quality Insights: Each learner will need to watch the sixty minute Webinar, either today's live session or recorded session later on, and complete the evaluation and reflective questions.
Quality Insights: After this course each learner will be able to identify three written communication. Patient barriers describe at least three best practices to create or evaluate written patient education and explain how to check written patient materials for readability levels.
Quality Insights: For today's session there are one point, two, five contact hours that have been approved for nursing quality insights is accredited as a provider of nursing, continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation, one hundred and fifty,
Quality Insights: and, as far as social work goes, the Maryland State Board of Social Work Examiners has approved quality insights renal network, five to extend continuing education credits to participants who meet attendance requirements in the Network five region, and this includes Maryland, Virginia, West Virginia, and Washington, Dc.
Quality Insights: It certifies that this program meets the criteria for one credit hour of category, one continuing education, credit for social workers in the network. Five region
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Quality Insights: social work, continuing education credits for regions outside of the network five area have not been approved.
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Quality Insights: So we have some great information to deliver to you today. So, without further ado. I'd like to introduce our guest Speaker today is misty cabbage
Quality Insights: mit ctl and misty cabbage is an Rn. Project coordinator for quality insights. Her current focus is on clinical education, design, delivery and management. Utilizing Evidence-based educational approaches within innovative training methodologies. One hundred and fifty
Quality Insights: misty has worked for over a decade assisting organizations on improving patient health literacy.
Quality Insights: She authors, or provides oversight for quality, insights, e-learning courses and manages continuing education credits
Quality Insights: so welcome misty and I will Now turn the program over to you.
Misty Kevech: Thank you so much, Mitzi, and welcome everyone. Glad you're joining us today, so let's just dive in because we have a lot of information to go over. Um. So for health literacy there are a variety of literacy type skills uh written numeracy and digital literacy. But today we are going to focus on written letters. Say, Um, we're going to talk about how a patient or um I
Misty Kevech: client. They really need to be able to understand, make decisions, and use the information to be able to be engaged in our society and in healthcare itself. So we, as clinicians and health care providers. We need to do a better job, and that's what we're doing today. What? What are some of the lessons learned? What are some of the best practices.
Misty Kevech: So I did want to start with a couple of facts from a research study that shows about that. Talks about shared decision making and looking at patient education tools.
Misty Kevech: We do know that patients make decisions based upon verbal conversations that they have with their providers, as well as the print printed material that we provide them on. This study shows that the mean readability grade levels were anywhere from eleventh to thirteenth grade
Misty Kevech: that's Upper High School and Freshman Level College um where it's recommended the grade level for Fifth to sixth grade level. Now, some of your patients that's going to be very appropriate. A higher level. But we really need to aim at a lower level, and we can supplement those people that have a higher proficiency of health literacy.
Misty Kevech: The last two bullets on this slide show you how low the reading level is just to get close to Fifth and sixth grade.
Misty Kevech: Now I will start with writing health. Literate patient material is hard,
Misty Kevech: and it takes time. I know I have been on in many organizations. That's like we have this problem. Can you just make us a patient handout that'll take care of the problem. Well, that Isn't going to take care of the problem. It's not just that easy. So you you want to see what you can find that's available, appropriate, and in the most health literate format. Maybe you need to edit it. Maybe you need to use parts of that tool.
Misty Kevech: And hopefully, today you will use that mentality. How can I make something better? How can I make our own documents better? And also, how do I start fresh, and how I can make them good to start with.
Misty Kevech: Now, Don't give up hope about it being hard, I am going to tell you that I have noticed over the last ten years. More and more patient education. Materials are either already at a health literate level, or they just might need just a little bit of tweaking, and and they're pretty good.
Misty Kevech: Okay. So here's a short list of common problems that occur. Um, with written patient handouts.
Misty Kevech: Um, you know too much information paragraphs and multiple pages. I'm. Going to share an example on that. One's forty pages long. Um, it. They're not focused the reading levels high um medical jargons all over the place, and we think that maybe that's common knowledge, but not necessarily.
Misty Kevech: And patients are overwhelmed and lose interest. And I have read some research articles that said Actually, they lose the interest after about two sentences, or in that first paragraph or first few bullets. So we're going to talk about some of this
Misty Kevech: um as we go along, and we're going to look at some documents. I do want you to find your chat towards the bottom. If you hover your mouse around because we're going to jump right in and start using that.
Misty Kevech: So with this quick
Misty Kevech: first glance, what
Misty Kevech: what issues. Do you see with this
Misty Kevech: the two pages of a handout that I put up here for you? I know you're not going to be able to probably read the the words, but just looking at a quick glance, Does this look health? Literate? Um, Now you've got it. Go ahead and start jumping in. It's long. It's wordy. Oh, great Um, no, it's boring There's no color.
Misty Kevech: Small print.
Misty Kevech: Yes, and this is two of ten pages. Um! A great thanks. Um! There's there's not much white space, and we're going to talk about that here in a little bit.
Misty Kevech: Great medical, dense verbiage. Love that kimberly um, and it's just hard to read. It's overwhelming.
Misty Kevech: There's nothing to break it up. And even on just the second page there's not even a picture. Nothing Um! And it's all black and white. It's there's nothing that I did run on this ten page document.
Misty Kevech: Um! I would see what the reading level was, and it was nice great that's actually not horrible for a starting point. But reading level is only one component of when we're looking at health literacy. So, good job, everybody. So where we want to start today is um
Misty Kevech: you're going to receive Uh, Nitzy is going to be sending out hem copy of the handout, slide the slides and two handouts. So you're gonna get this um checklist um as well as another handout. So I am going to ask you, instead of taking notes today. Some of this is so common sense.
Misty Kevech: But also you're gonna get written uh pieces of information that you'll be able to use to help you in your process. I'd rather you think about the process of how you could take a handout. That's not so good, and to make it better at your organization.
Misty Kevech: So I just want you to think through. Put on that your health, Literacy lenses, and let's kind of talk walk through how you could approach this.
Misty Kevech: And Kimberly, i'm gonna come back to your question about software to test the readability level where we getting to that.
Misty Kevech: So you first want to start with. What are the key principles. Um. You want to limit the number of messages that you are put into the document
Misty Kevech: rather than having a document. Say that has types of dialysis, dialysis, catheter care, diet, and other topics, all in one. It may be better to have single focused topics, or maybe two topics that kind of go together.
Misty Kevech: Not that you can't use a workbook or a longer um education sheet. I'm going to show you that on the next slide. Um, but you really need to add it and really reduce down to the key concepts.
Misty Kevech: So you have to think about what's the needs to know? What's the critical information that you need them to be able to walk away with after they read this. Not the nice to know and not the fluff,
Misty Kevech: only the basics. What they absolutely need to be safe.
Misty Kevech: Um. Patients can also follow bullets, short bullets much easier than they can paragraphs of text.
Misty Kevech: And if you're even using bullets. Keep it to like about three to seven bullets only,
Misty Kevech: and you should start asking yourself
Misty Kevech: um questions. Does this hand out Need broke broke into two pieces. Or is it okay? All in one, you know, really think about? You know, perhaps your grandmother an older relative. How would they view looking at this document
Misty Kevech: visually as well as from a literacy standpoint.
Misty Kevech: So here's this another example from a different resource, and I have blurred, or have re taken out the um sources, because everybody has handouts that aren't good. So here's one. This is just the table of contents. It's from a patient for a short great organization.
Misty Kevech: In this there are great positive points for written house literacy, but there are some issues. First place, looking at the table contents. There's tons of topics that are being covered.
Misty Kevech: Like Um, twenty-eight pages worth um. They are relevant for the patient that might be receiving dialysis, but it would be overwhelming, and what we hear from providers. Is that,
Misty Kevech: hey? Curios? They put them into their bag, and that's the last that they're seeing where they take them home and put them in a stack, and they're never seen again.
Misty Kevech: So here's just one of two pages that are talking about lab testing. In fact, there are eleven different lab values that are being discussed.
Misty Kevech: Now this this document could be used, but it's still two pages of just text upon text is a little overwhelming. But how could I use that? If this is a document I want to use?
Misty Kevech: Well, I could hide. I could put a circle around the area that we're going to talk about. I also want to make sure that the lab value I talk about is relevant to this patient. I don't want to talk about high potassium levels if they have other issues I want to focus with where they are,
Misty Kevech: and I could even use a highlighter this way. We'd focus when we talk about it together, and then when they go home they could re You can encourage them to read it again, and we could talk about questions on the next visit. So there there are ways to use longer um brochures. But
Misty Kevech: let's start thinking about um editing out what's not necessary. So we're going to start
Misty Kevech: by. First. You should put your text in a word document, even if it's a Pdf. That you have, Grab the text and drop it into a word you don't care about the graphics or anything else. At this point you let's start. In a word, document,
Misty Kevech: start editing out what's unnecessary. Remember that key. What's absolutely necessary for them to know.
Misty Kevech: Then move the most important message to the very beginning.
Misty Kevech: Keep it short,
Misty Kevech: and you have to be consistent with your work. So if you use the word dialysis in one place,
Misty Kevech: don't use hem a dialysis elsewhere. You want to use the like terms throughout your document, and If you're working on a team to kind of revise your documents or your writing um patient material, then maybe make a list of words that you kind of are using, so that all of your materials are consistent.
Misty Kevech: I next we're gonna keep on editing. So what we want to look for next are those poly syllable words, words that have three or more symbols.
Misty Kevech: And the reason this is important is because this Co. This is tied into many of the readability formulas. Now, readability, you know grade level is a very important component, but there are lots of things that we're going to look at. But now that i'm editing and just getting started.
Misty Kevech: I I find it very valuable to go through and highlight all my three syllable plus words. And then what I do is I start looking at the low hanging fruit which are the easiest words to swap out with something That's not because when we do the readability
Misty Kevech: formulas, what they're doing is looking. How many sentences there are, how many words there are, and these three or more syllables you're not going to get rid of everything. There are words that are very important that you're going to leave um just like the word dialysis or hemodialysis. They're both three syllable. But that is something that you're going to probably be using. But can I get rid of other ones? Can we substitute? And again, I'd add this to this list of
Misty Kevech: tips and tricks when you start another one. These are good substitute words to use. This is the word we've been using. Um, you know. Again, you're not going to eliminate all of them. But see what you can swap out At this point. We haven't even checked the readability yet. But why not get it down to something better than being disappointed when you run the readability, and it's tenth grade, and it seems like it's more pressure on your shoulders.
Misty Kevech: So back to chat. Find your chat. I have some words up here. How about medications throwing some alternatives instead of medications into Chat
Misty Kevech: drugs, hills?
Misty Kevech: Yep. Lots of lots of pills now some time. Meds very good. Um. Sometimes, you know. You may think you know prescriptions
Misty Kevech: is still three syllables. I had a cap my to to make sure. Um. But sometimes you still say, yeah, I got to use that work, but you know many. There are others examples here like if you're going to talk about um best practices
Misty Kevech: our recommendations or recommend it. You could think about best practices, sometimes turning it into two words, Our tab tablets. Yeah, absolutely. So there are. You need to think about words that you can change
Misty Kevech: now. Next, you want to be careful because your words do matter, even though they're not spoken words. You need to make sure that your text shows respect and value. You don't want it to be preachy. You want to also tell them um what they're going to gain from the information on this sheet.
Misty Kevech: So maybe it's just is a sentence at the top that says this handout or this sheet um is about um, lower lowering your salt or lowering your potassium um, just so that the patient can expect what they expect to learn from this sheet.
Misty Kevech: Very simple, simple question or statement. Um, you want to use conversational uh writing. I've seen many patient um materials that are really written more for clinicians. They're, you know, kind of probably copied out of materials that um are in websites that are
Misty Kevech: for clinicians. Make it common language. Use an active voice, use action, words, um, and action works because you want them to do things you want to focus on positive
Misty Kevech: versus negative. Um. So you could use words like, do try to and try to. I won't keep to a minimum. Avoid or don't. Sometimes we do have to use those, but try to stay on the positive, and you know, really active getting that patient to be involved.
Misty Kevech: Um, you want to offer some time examples. Maybe. Um, You know a simple example of exercises that they could. Do you know why they're at the Dialysis Center? Um, just some, you know. Give them an idea, because if you say try to exercise.
Misty Kevech: Um, you know, as often as possible, even when you're a dialysis. I'm just kind of making that up, but they don't even have a clue what they could do so. An an idea will help them start to perhaps do the behavior you're looking for.
Misty Kevech: So you do have to be careful about using abbreviations and acronyms. They're not known by everyone um limit the medical jargon and scientific language. Somebody noted that early at our first document we looked at it had lots of medical stuff in it.
Misty Kevech: Uh we think it's commonplace patients know what all of these terms are. They hear a day in and day out, when they're with us, but that doesn't mean that they understand what it is. You should also curb the use of symbols.
Misty Kevech: Symbols are not universally understood across cultures. So even the little red circle with the line across that crossed it. Doesn't Not everyone knows that means Don't or stop,
Misty Kevech: so also avoid the use of statistics Instead, you should use words like half instead of fifty,
Misty Kevech: and often we see um use of some infographic type, pictures of numbers of bodies. So I have circled. I have the first part with the pictures, and more than one in seven. That's great. They get an idea. But to here this is, says the fifteen, and it goes on. It talks about thirty-seven million people, and I pull this from a Cdc site this week um or last week from um
Misty Kevech: a patient education um toll, and I probably if I was working on this, i'm going to add something into mine. I probably would even get rid of some of that text and not use the percentage, and the million people knowing one in seven is more meaningful for them than it will that there are thirty-seven million people.
Misty Kevech: Okay. So next we're back to editing, we do. You have to do a lot of editing you want to edit without the images or the designs. Just stick with the words, Then you're going to check the readability level. So now we're going to. We're going to move there, and after we do that we're going to edit some more.
Misty Kevech: So let's talk about readability assessments. There are formulas that are based upon reading or grade levels. Most are even us school grades. Um, but they're looking at syllables, length of sentences, and they're all a little bit different.
Misty Kevech: There are a lot of free tools that you can do this with, and we have those in the handouts. Um! There are three that I think are easy to use, that are well, widely used,
Misty Kevech: and the first is actually, they come together. Flush Kincaid grade level and flush. Kincaid reading ease. Um. And the reason I like those, and I use those first now is because they're in word. So if you're using a word document, i'm going to show you how you go about setting it, and how to to use the results that you get,
Misty Kevech: and then the simple measures of Gobble, a group, or the Smog index is the oldest. It's one of the originals back, I think early eighties. Um, and it's the one I stored it with, and I and i'll explain how I use that one occasionally as well.
Misty Kevech: So Let's talk about Flush Kincaid first.
Misty Kevech: So it is in Microsoft. You're gonna get the slides. I have steps here, but everybody's version of word is different. So you may. This may not exactly work for you, but you'll have the words that you need to look at. Basically We want readability statistics so you can Google it and find out for your version of word where that's at. But this
Misty Kevech: basically under the file, you want to go to an options button looking at proofing and finding that s show, readability, statistics and click. Okay, It's not set as a default, but once you set it, it stays.
Misty Kevech: And then what happens. Remember, we're working. In a word document, we've done a bunch of editing. All you have to do is run your spell. Check that through to deal with your spell check issues, and at the very end you're going to get a report, and it's going to look like this.
Misty Kevech: So at the bottom of that report. It's going to give you um the sentences, but it's going to talk about the reading ease first, and you can see here that the reading is sorry my hefta is almost eighty, and so it's
Misty Kevech: falls right in that. Easy to fairly easy range. That's pretty good, so I might. I've given you the um the scale. But typically I know I want to try to keep mine above seventy. Even eighty is even better. But that's just one component, but this one's not bad,
Misty Kevech: and then you get the reading grade level, which is at the bottom. Now this one is five point four, so it sits right between the fifth and the sixth grade level, which is exactly where I want to be aiming for.
Misty Kevech: You may not come up with this type of a reading level on yours the first time around. I never do. I always have to go back and re edit and re- it and that's okay. But once I finally get it to where I think it's good. I've done everything that I you know, with the text. I think I can
Misty Kevech: um, and if i'm using this tool, especially if i'm using it like on a national basis. I will tend to go ahead and do a smog test on it, too, just to see what it comes out with
Misty Kevech: and with the smog test. All you need to do is copy the text. There's free online tools. You drop your text in, and it will calculate and give you a score, and I can tell you most of the time it's fairly comparable. Um! But I just do that sometimes as a secondary, it's not necessary the flesh concave should be sufficient by itself.
Misty Kevech: So you finally got to the reading level that you were looking for um. You want to. Now think about fonts, paper color, I think about images and design and testing.
Misty Kevech: So let's talk about punctuation,
Misty Kevech: even if you're using bullets which we know are the best way to go is to use that short list of bullets.
Misty Kevech: Um! You still should put a period after it, even though often we do not, uh, but for patients that period, or the exclamation mark That is an indication to them that they that's the end of that one thought, the next line will be a separate thought.
Misty Kevech: So it's important to use periods and appropriate punctuation.
Misty Kevech: You need to use subtitles or headers. Sometimes, if you have a lot of text. We saw that early on the first document, I think, where we did have some subtitles,
Misty Kevech: but there was so much text it didn't really help. But this helps. If you're going to talk about two concepts. Or maybe you're going to talk about some foods.
Misty Kevech: And so, maybe you know, having vegetables or fruits, or you know. So there's somewhere I could say. Oh, I needed to know about what proteins or what meets. I'm allowed to eat, and I would jump there first, perhaps because that's most relevant to my need at the time. So those are very helpful.
Misty Kevech: The other option is to use boxes or sections, and i'm going to show you on the next slide,
Misty Kevech: where they have used like boxes, and how well that works.
Misty Kevech: Um! You need to use dark letters um on light colored paper,
Misty Kevech: so black is really the best color to use. There's been some studies even comparing it to navy blue. I mean there's not much difference when you look at it, but there is through the studies, and for patients to be able to see that Well,
Misty Kevech: um, and it should be on light color paper. White is best,
Misty Kevech: but I know I've created lots of tools, and it's like you know what they're going to get in that bag, or they're going to get into that stack at home, and they're never going to find it.
Misty Kevech: If I put it on a fluorescent pink form. They're going to find it. I'll talk about that pink form, but the problem is, it does decrease the readability for that patient or that person. So you have. Maybe I want to put it on a pale pink, you know, using some pastel colors. Um or i'm using black lettering. Maybe I use a really good image, and we're going to talk about that in a minute. That's
Misty Kevech: colorful. Pick one that I i'm able to print out. That will be more I um visually appealing to that patient and pull their eye towards it.
Misty Kevech: Um! Next is white space, and somebody put that earlier um, and oh, i'm going to come back to Lisa. So if it's just a phrase, it is it okay to put a period? So if it if it if we're not trying to use correct a a hundred percent correct grammar here if it makes
Misty Kevech: sense to put the period to help that patient. In that case I would use it. But sometimes I've had bullets that have only had two or three words, and it doesn't make sense to put a bullet there. You just kind of have to figure out. What
Misty Kevech: does this make sense to put the period or not? Um. And when you're testing, maybe you could ask that question, you know. Was it okay to read this, or would have helped if there was a period after each of these um bullets? Maybe that would, you know it could be a good question to ask. If you're not testing it without a bullet, and if it is, then maybe maybe you will want to do it, or maybe when you write the bullets
Misty Kevech: you write them. Not maybe not in full complete sentences, but maybe not just a a a short phrase. Then. Um, you just kind of have to figure what's going to work best for the patient.
Misty Kevech: Okay? And next is white space. And somebody mentioned this earlier
Misty Kevech: white space is all the space that's around the text pictures and graphics, et cetera. It's the empty space, and that's a good thing. White space gives a person their eyes a chance to rest, and then they can see
Misty Kevech: and focus in on certain areas on the the tool. So white space is really good to have. Um. I know a lot of times when we've created patient documents. We're cramming it in trying to get it as small as we can to get everything on one page. We don't want two pages,
Misty Kevech: and there's no space left at all that's not good. You either need to to make it to make it a second page. Um! And what you need, you know, you need to see what's really gonna work best
Misty Kevech: next is meaningful pictures and images. So obviously we need to use culturally appropriate. You know your communities. You know your patient populations. Um. Pick out the pictures that mo our most representative, or at least give a um,
Misty Kevech: you know a couple different people within in the
Misty Kevech: image. So a lot of times it could be a different nationality or culture picture, for maybe the clinician that might be talking to the patient or the reverse. So it try to to mix up your cultural pictures, but also it has to be meaningful.
Misty Kevech: So if you're going to add a picture just to make the document pretty, and to stand out that's that they're not going to understand what it's there for.
Misty Kevech: So if this is talking about diets or salt,
Misty Kevech: what you want to do is put a picture, an image that's clear what that is near the text, because that's a queue for a patient that has some reading literacy issues. Oh, there's a salt Shaker. This must be about salt. Then they can work through the words that are on um your handout.
Misty Kevech: But you want to make sure that whatever picture it's really clear that we're going to be talking about that in that section, and and you try to find what's appropriate. You don't have to have a lot of images, but images where it's important.
Misty Kevech: So get back to chat again. Um! Here is a handout, and this time, instead of figuring out what's wrong with this. This is one of page, and I want you to start putting in things that you see here that look good. You might not be able to read all of the text. But
Misty Kevech: tell me what you think looks good on this handout.
Misty Kevech: Large numbers. Great thanks, Beverly.
Misty Kevech: Yes, and numbers and picks for pictures for each tip. Yes, thank you,
Misty Kevech: and the color. There's clear points,
Misty Kevech: and yes, only six tips. Thanks, Cynthia.
Misty Kevech: Numbers numbering things are good. Don't. We all know the top ten, David Letterman types of things over the years. So um! And Kimberly says, Yes, there are six items, so it really helps to be focused. So I think you got like all of the things now. You can see they're not bulleted,
Misty Kevech: but they are short text in boxes. So this is a way to use boxes, even though they don't have an outline around each box that might even make it a little better. But I think it's still separated There's a little bit of space between us. I think that looks good.
Misty Kevech: There are a few multi syllable words in there like catheter infection. Um, dialysis. But those are okay. You're not going to get rid of everything.
Misty Kevech: Um, there's a few um. The reading level is actually at the sixth grade level, because I ran that
Misty Kevech: you've already identified. The pictures are great.
Misty Kevech: The only thing I could suggest is maybe a little more white space might be beneficial. But then, if you're going to do that, you're going to probably have to shrink everything down, and it'll be a little harder to read. Um. This is colored, you know, and we know that black on white is better. But maybe it's okay,
Misty Kevech: and how we would know that is, by testing it, you know. Maybe you would print off two of these,
Misty Kevech: one in black and white, and one in the colored version. Have the patient Look at the colored version. First ask, you know. Write some questions down that you're routinely going to ask the the patients,
Misty Kevech: and, like, you know, Ha! Was this easy to read? Was this interesting? Tell me about what it was about? Um! What could be better with the letters too little, or the letters too little, or where the pictures? Okay. And here you could say, how does the color was the color. Okay, with that. Did that interfere with you being able to see it?
Misty Kevech: Then, after you ask those questions, you could provide them a black and white version, and ask them to look at that and give you some feedback again. Look at consensus. Think about what you know what's going to bet. Be beneficial to your patients.
Misty Kevech: Very good. You guys did great.
Misty Kevech: So now let's talk about fonts. We'll find size. What's recommended is anywhere between twelve and fourteen points.
Misty Kevech: But i'll tell you Personally, I never use anything under thirteen, and I still try not to even use thirteen. I try to do fourteen, and above, and it's hard when you're trying to push a lot of information into um a
Misty Kevech: one page tool. But maybe that's the queue. Maybe i'm trying to push too much stuff in, and maybe it needs to be two pages, or maybe it needs to be two different um
Misty Kevech: patient tools.
Misty Kevech: Um! But so you want to really look at the font size you can, you know, use your headers to be even larger. Um key. Words can be a little bit larger, if need be.
Misty Kevech: Now the fine style, Sarah fonts are what's recommended best, and I gave you some examples of those and what Sara fonts are, as you can see on that s
Misty Kevech: the up at the top where I have the arrow. It's. They call the hands and the feet, so the little like the line at the top and the bottom. It just helps clarify between going from that that not letter to the next letter. Um, and it's supposed to be better. But there are some research studies that are out there that says it really doesn't matter.
Misty Kevech: What I find works best is to find a font that your test patients seem to appreciate better. So here's where I would take a very small
Misty Kevech: on handout, so there's not a lot of words on it. I would do it in a couple of different fonts, and I would pick the one. I think it's gonna, you know. Perhaps I might want to start with the one that might be, I think, is good. Have them Look at that first, and then show them a couple of others.
Misty Kevech: But i'm going to tell you Most patients are not even going to notice the difference there, if you ask them, but it's worth testing it and seeing. But whenever you find the font that works for you the best you think is the best. Then stick with it. So when you're editing or revising some of your other handouts, change them to that to that all your new kind of use that as a consistent format.
Misty Kevech: So um you do. You can use bold to emphasize keywords or phrases
Misty Kevech: you don't want to use bold all over the place, because then that loses the emphasis. Um! But you do want to avoid using italics and underlying because it smushes letters together, and it's just harder to read same way that all all caps do.
Misty Kevech: Okay. Now, here's page two. This is a Cdc Um. Dialysis um handout that we saw the first page, and you would only give the page that's appropriate to the patient. In this case you might have a patient that has cisco's or graphs. Um! So here, see, I can tell you I checked it's cap a calibrate, which is not seraphon, but it's actually not too bad. I know it's harder to see um that on your screen. Perhaps
Misty Kevech: I did check the font size. It's thirteen um now it It was a Pdf.
Misty Kevech: So I thought. I share a tip now for me to figure out what the P. What they find size was is, I had to do two ways. I could copy the text and drop it into a word document, and usually that carries over, so I can see what my font is. But if you have a adobe
Misty Kevech: more than just a reader version. You can usually do um. Go under the tools, and you can do edit text, and then you can see. Put your cursor, and you can see what the text size is. So I did check, and it's thirteen, which is acceptable. Um! But again it's on the smaller end.
Misty Kevech: And the other thing I noticed here is the um
Misty Kevech: the ex uh the information that's in each. Oh, sorry I somehow I must have missed
Misty Kevech: there. Sorry that's what I was.
Misty Kevech: This was thirteen. Sorry I got a mistake click here, but at the bottom it's their uh logo, and I could not check to see what it is, and really that didn't really matter what their logo is. That's not important that they can read. But I know the text at the top was thirteen.
Misty Kevech: So then I looked at this, and I thought, Okay, So what else could be used to improve the fonts? What are your ideas? Go ahead and drop this in the chat. What could we do to improve the font Saw finds in general
Misty Kevech: bold, great,
Misty Kevech: short text for each tip. Great,
Misty Kevech: and those are actually my only suggestions I came up with.
Misty Kevech: I thought the same thing, too. I thought you could go through and bold a couple of these points, and um, even if it's just like wash, your hands would be fine to bold. Um, very good.
Misty Kevech: So next you want to go back. You've already tested this. You want to um.
You want to look at
Misty Kevech: you that testing. And so we talked about that in asking your patients um, and it's you want to create a safe environment for that, So tell them this is a new tool or a tool that we revised, and we want to see. We're testing this with some past. In fact, I won't even use the word testing. We're asking some patients to look at this to tell us what are some of the problems with it. What could we do to make it better? Because patients like you?
Misty Kevech: We'll be getting this tool, and we want to make sure we're clear and can get the right information to them. So you want to create a safe environment that it's not about that patient that you're asking to to read it that we want to make sure they understood it. We want to do this for everyone. People like you, and that way they're going to be more willing to give you feedback um, and and once you get them started they'll give you all kinds of feedback, and you know that,
Misty Kevech: and then you'll continue to add it
Misty Kevech: next. The next step is, Do I need it? Translate this?
Misty Kevech: So i'm going to tell you a story about a meeting I had Monday or Tuesday this week.
Misty Kevech: Um, So what we were talking about an e-learning um activity that we're going to be doing, and I and we talked about handouts, and there's going to be some patient handouts. No details. But, I ask, are you going to need translations? And the one a person from quoting insights set, and I'm going to use this phrase a lot. So if you're on the call, I I've found great value in this,
Misty Kevech: and she said, Oh, I would never use um. Give a patient tool out if there wasn't a translation available, and in her case Spanish is what she needed. Because you know it. Why, why would I not find value if I don't have both? I can't offer
Misty Kevech: both to one patient and not the other that needs the Spanish, and I thought that was such an equitable answer that she provided. But so to get started, though with translations that is going to be hard now. Um,
Misty Kevech: i'm going to tell you. You have to think about. You know. We talked about the pictures that's one piece, but you want to think about how you your translator, who you're going to use um, and also prioritizing the work that you're going to do. So Let's talk about prioritizing first.
Misty Kevech: What I would do is think about um
Misty Kevech: the most use dot handout that you have that you give out this to everybody. It's really important. That's the one I would start with. You would also want to think Which which languages do I need to have it in um. You know what who do we have now? What you have now. Two years from now may be very different. We live in a very diverse world today, so you might need to add Chinese. You might need to add um. You know other languages as you go along.
Misty Kevech: But I would start with the most important, or what's your high priority if you're trying to reduce um catheter infections right now with your dialysis, catheters,
Misty Kevech: and that is a high priority. You're working on a quality improvement plan. I might want to look at those tools that we have now. Get them in better um health literacy level, and get those translated so that at least they're available in an alternative language if need it. And the other thing is, look at Um,
Misty Kevech: Okay. We just wrote a new tool. We're gonna get ready to roll it out. Well, if you're getting ready to roll it out, why not get that in the process and get that translated now, too? Because you're gonna have a whole list, but prioritize can't get them all done. Nor do you need to do everything. Pick what you have to start with,
Misty Kevech: what matters most to to your patients.
Misty Kevech: And then the next thing you need to look at is who's translating it? I hear this a lot. Oh, we have somebody that's bilingual. They do that, and that's great, especially if they're a clinician. But I will caution you if it's just somebody that can that speaks the language and can write the language.
Misty Kevech: Medical terminology does not go across very easily. You do need to have a medical transcription. Um, a certified organization, do it. Or if you're using perhaps a nurse. Maybe that will work. I still would check it. But um!
Misty Kevech: But you need, if you need to find a certified medical Trans Translation Company Um, since it's tips that we've done over the last probably nine years I got. We started translating a lot of materials,
Misty Kevech: and what I did is looked around um for some companies that were certified medically, and looked at their sites, read about them, and we narrowed it down to two organizations, and what I did is, I sent one tool in English um a common tool that we used to both companies the same tool.
Misty Kevech: I had them translate it back, and we paid for those, and then we did a comparison, word by word, you know, to make sure, you know, punctuation marked by punctuation mark. We found a few differences. And then we looked up those words because we didn't speak the language, and
Misty Kevech: we we realized, you know there were. That's a little different. So we picked an organization. Then, after we started getting translations from them off, probably for the next, you know, maybe twenty five versions of things that we got
Misty Kevech: what we would do if we would copy it. The text in Spanish we use. We did Vietnamese, and we did a bunch of other languages, too, and we would drop it into an online translation like Google Translate or Bing has one. There's lots of them out there. We would drop it in and have it translate from like
Misty Kevech: Chinese to English, and we know what our English version is. And then we compared that, and we look to see where there are differences where there's subtle differences. Was it okay? Until we felt confident with this company that you know we we felt we don't have to test everything. We just randomly test it after that point.
Misty Kevech: But then, after a while, you might need to update your um handout. You know guidelines change all the time, so what we would do is we would use those online tools not to translate the whole whole page. But we would go, and I would
Misty Kevech: type up the new new ones, and then I would put it into uh Google, translate it to Spanish. I would grab it, put it into the document. I also would do a second and go out to like Bing and do another English to Spanish. Yeah, it's the same. Okay, Then what I do is I go to my document in Spanish. I take more at least a sentence or two more than what i'm get. Ha! What i'm fixing, so it's in contact, and then I drop it back into an online tool
Misty Kevech: and do Spanish to English to make sure it translates back um. We're very cautious when we do that, because we're not. You know we don't speak the language, or if we have a colleague that does, or even I've used colleagues husband, and that I I would say, Okay, could he read this Spanish we made. Here's the change we made. Asked him to translate that for us. Just date this this one line, and then I could say, Yeah, I feel very confident we were okay, not to go through a translation.
Misty Kevech: So it is important.
Misty Kevech: Um.
Misty Kevech: But those are things that you can do now with search for health literature. There are good things out there. Use the Cdc. You know your National Kidney Foundation American kidney Fund. Um. Obviously even quality insights, You know we use evidence-based resources, even if you're going to use the material of something that
Misty Kevech: one of these organizations has that tweak it and make it better. At least you're getting, you know, up to date information, and I think in your the last session in this series. Um you will have here from uh a speaker that's going to talk about resources, and where to find things, so that'll be great.
Misty Kevech: Now we're getting. I want to make sure we have time for uh questions. So I want to show you this is a two page document.
Misty Kevech: Kind of looks pretty good.
Misty Kevech: I ran the readability. I know it's busy, and we're going to come back to that. I did run the readability, and it came out to sixth grade reading level. Okay, that's good, and the flush can at the flesh, reading ease with sixty-eight point four not the best but that's close to seventy. Maybe I could live with that. But what other
Misty Kevech: quick issues do you see? Go ahead and to chat? I'm going to change this over to one page just so you can see better.
Misty Kevech: Print is very, very small. How about How about Font? T is ten
Misty Kevech: very good. There's italics great
Misty Kevech: wordy. Yes, too much overwhelming, and it's two pages, Um, you know, to think about giving this to a patient. It's great information,
Misty Kevech: but it is um like the color changes in boxes made it easier to read. Very good.
Misty Kevech: Um needs to be bit yeah bigger. And the other things I saw here, too, is um the good thing.
Misty Kevech: Well, the background I concerned me a little bit, because it was marvelous and gray, you know. Would White be better, you know. Maybe not. Maybe it wouldn't matter. I I don't know. I've never really worked with a marbley background. Um! Good use of positive action. Verbs were there
Misty Kevech: under healthy tips. They do use some avoids, but there were not that many of them
Misty Kevech: um the label, the nutrition label. It's great, but it and that's a good way to teach numeracy literacy skills, and to assess them. But the labels too small. Um! And so it it could maybe be on the back of a handout, with maybe some practice questions that they could look up to see what the potassium level is in a product off of a label.
Misty Kevech: Um, So that's kind of what what you um What you need to do is you need to be in quiz of? You need to say, Hmm. Look from that with a health literacy lens.
Misty Kevech: So to summarize a couple of key points. Remember, reading levels alone are not just what to aim for, but you do need a good readability level, but you have to look at that whole picture,
Misty Kevech: remember less is best. Limit your messages
Misty Kevech: lead with the most important message.
Misty Kevech: Edit: edit, Edit:
Misty Kevech: No check your readability Lot of lab level after you have added it,
Misty Kevech: know that fonts matter,
Misty Kevech: test it with actual patience and translate it if it's needed. I mean, those are common sense things to do. It is a process. Don't get frustrated. Um be encouraged because what the changes you're making are going to impact your patients lives.
Misty Kevech: There are some resources. You will get the handouts, and I know Miti even through them into chat earlier. Um! These are some of the references that I used, and this is the evaluation um we do for you to get the certificate that has the continuing add credits.
Misty Kevech: Um. Or if you just need a certificate either way, we want to hear from you, for with the evaluation there's A. Qr. Code. If you want to use your phone, i'll leave this slide up for a minute for you to grab the Qr code. There is a link um
Misty Kevech: as well, and I don't know Mitzi. Do you have the link that you might even be able to drop into chat. I forgot to ask you um if you had that available, I assure you i'll go ahead and put that in chat right now. You are great. Um!
Misty Kevech: And you know you you will get some more um flyers and information coming out. But this will be available in recording as well. I hope we're gonna take some Q. A. And hope um that this has been helpful.
Quality Insights: Okay, Um, everyone. I just now posted the link to the evaluation in the chat. Well, but I did.
Quality Insights: Um.
I will get that.
Quality Insights: In the meantime, if you have any questions that you would like to ask um, please go ahead and enter those into the chat or the Q. A. Box. At this time.
Misty Kevech: The only questions I remember seeing earlier was about readability, and we covered that. And I think,
Misty Kevech: and a lot of this is common sense. Or
Misty Kevech: if you are around, I used to use stories all the time about my dad from a health literacy standpoint, because you just go to a couple of physician appointments with him. Um, you you! You start to look at everything with that. Look,
Misty Kevech: you know what they give him. You know what
Misty Kevech: what they want him to read.
Okay, great,
Misty Kevech: you know. And and I started off in the presentation with
Misty Kevech: It's hard, you know. Um, but it's a challenge, but it's a good challenge. Um, but I am. I will tell you over the last several weeks. As I prepped um I had slide. I want it bad slides. I want it, or bad resources to use for slides.
Misty Kevech: I had trouble because I was trying to stay focused with kidney and dialysis. I had trouble finding horrible examples to show you. So things are better over the last ten years. Things are much better. Can they get even better? One hundred? Um. Yep.
Okay.
Misty Kevech: And I will tell you. Another thing is, is, try not to do it alone if you can. If you can do two people or three people. If you have a lot of things that you're going to try to to
Misty Kevech: work on, Maybe you start as a team and do one together, and then like, come up with this common words, those common uh
Misty Kevech: three syllable words that you want to make a two syllable. Make a little reference chart for yourself, and then you could work on each of them and then proof each other. You'll get a lot more work done. It does help. Um. We always have other people look at our own work to see if we could reduce it, and somebody else's eyes is going to see something different than you do.
Quality Insights: Well, Misty, i'm not seeing any other questions right now, but I will give everyone a couple more minutes to enter those in. In the meantime I just wanted to. Um again. Remind everyone, if you can please, complete that evaluation at the end uh the link is in the chat,
Quality Insights: and also slides and related materials are going to be available on the Health Equity page of your network's website after today's session.
Quality Insights: If you enjoyed today's presentation, we have additional opportunities to learn more about this subject. You can enroll in our e-learning course called advancing health literacy for the kidney disease community. It's available on our a disco learning platform, and I will, I I believe Andrea put that in the chat earlier, but i'll go ahead and enter that in as well.
Quality Insights: So you have that available. If you're interested in checking that out,
Quality Insights: and also Don't forget to register for next week's session uh which is going to be taking place on Wednesday, October the nineteenth. At noon. We're going to be talking about applying learning style needs to improve the delivery of health, education and engagement,
Quality Insights: and i'm gonna try and put the link for registration for that in the chat as well. For some reason I'm having trouble pasting. And Nope, there we go
Quality Insights: that work this time. So there's the link to register for next Week's session,
Quality Insights: and I don't see any other questions at this point. So, um, Misty and Andre, i'll turn things over to you if you have any closing remarks.
Andrea Moore: Thank you. Uh, Misty, I see you're responding to the question. That was, okay today. Yeah, great Um. So yeah, if you do not um want our need, the Ces, you do not have to complete the evaluation, but we certainly encourage it and appreciate it. The more feedback that we get from you all the better that we can tailor these sorts of Webinars Um, just really based on your needs and in your liking. Um, missy, I want to echo. Was someone else shared in the chat? Someone
Andrea Moore: that this has been the best Webinar that they have attended on the topic of health literacy. Super super helpful. We really really thank you for your presentation. It was engaging. Um, I learned a lot. I don't know that I ever really paid a ton of attention to the syllables, maybe because we have to say things like dialysis and catheter, and it's hard to get around those. But um really appreciate it, and i'm going to use that tip moving forward. So Um, Thank you again, and thank you
Andrea Moore: and you all for attending, and we hope that you will join us for the final two of our four-part health literary. Let's help Literacy month, luncheon learns. So thank you.
Quality Insights: Great thanks so much, everyone, and enjoy the rest of your day.
Quality Insights: Thank you.