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What’s wrong with this sentence? A low residue diet may be recommended for people who experience repeated episodes of bowel obstruction.

It’s the kind of complex language often used in patient information that people find hard to grasp - and Dr Kelly Lambert, AdvAPD wants it weeded out of nutrition resources.

“A better version of this sentence is: this eating plan is often used after people have a blocked bowel. But health professionals can find it hard to write in plain English because we’re trained to use academic language.

“Many words dietitians use like ‘dietary intake’ or ‘energy’ don’t make sense to most patients,” says Dr Lambert, Senior Lecturer with the University of Wollongong’s School of Medicine. “But if people can’t grasp the information, they can’t follow the advice - or they may search online for simpler information that may not always be accurate.”

Her own 2017 study evaluating the quality and literacy level of online renal diet resources found that while 73 per cent of the information was accurate, it often took a high level of health literacy to understand it. 

“On the other hand, information on YouTube was easy to understand and act on - but only 18 per cent of it was accurate,” adds Dr Lambert whose research is helping Nutrition Education Materials Online (NEMO) improve the readability of patient resources.

It’s not just kidney health either. Australian research has found that both lifestyle advice for weight loss and information on nutrition in pregnancy, for instance, often demand a high level of literacy too.

“Ideally patient information should be pitched at a Year 6 to 8 reading level,” she says.

 The readability of patient resources is a new area of nutrition research - and change is happening. A good example of how to develop readable health information is the system used by the Illawarra Shoalhaven Local Health District in NSW. Its careful process involves:

• Running the text through Hemingway Editor (an editing app that calculates readability and identifies complex words and sentences).
• Checking the edited text with five consumers to get their feedback.
• Revising the text based on the feedback, then having it approved by the Clinical Governance Unit before release.

This same system is now being adopted by some other public health services in NSW.

“Before we hand out nutrition information to patients or recommend online resources, we need to ask ourselves ‘can this resource be understood by most people, regardless of age, background and education?’” Kelly Lambert says.

She has these tips for providing resources for patients.

• Break information into chunks and put the most important information first. Don’t make readers wade through lots of information only to find it’s not relevant to them or they can’t find or understand the most important point.
• Mind your language. Choose simple words: ‘help’ not ‘assist’; ‘need’ not ‘require’; ‘eat’ not ‘consume’. Avoid jargon. Keep sentences short. The Hemingway app will help you spot problem words and phrases.
• Make sure information is easy to act on. Not everyone understands a ‘serve’, and people who don’t cook may not understand cup measurements. Using hand measurements as estimates of portion sizes may be better, e.g. 100g raw meat or poultry = palm of the hand; half a cup cooked porridge = cupped hand.
• Be specific. Advising someone to eat certain foods ‘occasionally’ is meaningless, and advice to ‘reduce salt intake’ is vague. ‘Avoid adding salt to food, eating fewer processed foods - and when you do buy processed foods choose those with 120mg sodium or less per 100g’ is more specific.
• Does the nutrition advice fit the patient’s culture? Many nutrition resources are very Anglo-centric, with foods/ meals that might be typical of Australian diets - but less familiar to someone whose background is Vietnamese, Pacific Islander or Macedonian, for example.
• Design of resources is important. Use plenty of white space and break the text into bullet points. A lot of information can be overwhelming - ideally spread the information across more than one resource and stick to three key points per resource. Resources divided into two columns on the page are a turn off - people will often read the first column and not read the next.

 “Simple information isn’t an insult to readers with higher education or health literacy,” Kelly Lambert adds. “I’ve had doctors with kidney disease as patients and they’ve said they want simple information too. It’s more effective if we write information in a way everyone understands.”

To register for our complimentary presentation by Kelly Lambert on Designing effective printed education materials click here