Get to know members of your audience (the people who will be reading the material). Ask them for their input and suggestions.

Example

With today's technology it is easy to include your audience in the development of your material. Contact condition-specific organizations. For example:
  • If you are working on material related to muscular dystrophy, contact Parent Project Muscular Dystrophy (PPMD) at www.parentprojectmd.org.
  • If you are working on material related to Fragile X, contact the FRAXA Research Foundation at www.fraxa.org or the National Fragile X Foundation at www.fragilex.org.
  • For other genetic conditions, visit www.geneticalliance.org to see if advocacy organizations for the specific condition exist.
Many organizations have active online support communities or medical advisory councils who are experts in the field. Use the experts, professionals, individuals with the condition, and/or caregivers to ensure your material will meet your audience's needs.

Ask your audience to identify information that would be most useful for them. For example, do they want to know about the natural history of the condition or do they want to know about resources for treatment of the condition?

Example

You've created a pamphlet for Fragile X and your audience is individuals who are new to the diagnosis. They need information in laymen's terms. If you want to define the gene, you need to keep it simple and brief (see *work with your audience to develop the material.)

Before:

FMR1, located at Xq27.3, consists of 17 exons and is approximately 38kb in size 1;2. The mRNA is approximately 4.4kb and contains 1.9kb of coding sequence. Within the 5 untranslated region (UTR) of FMR1 is a polymorphic CGG repeat coincident with a rare fragile site on the X chromosome known as FRAXA. FRAXA was a cytogenetic marker instrumental in the identification of patients and, ultimately, the gene itself.

After:

Fragile X is a family of genetic conditions, which can impact individuals and families in various ways. These genetic conditions are related in that they are all caused by gene changes in the same gene, called the FMR1 gene.

Many terms are archaic and may induce negative images, creating pity, fear, unjustly stereotyping individuals and may be offensive to the audience, whether it be individuals who are caregivers or those who have the diagnosis. Respect the individual and the caregivers. Recognize the person first, then the diagnosis. Don't use labels or archaic terms.

Example

Before:

Fragile X syndrome is the most common cause of mental retardation. This impairment can range from mild to severe retardation.

After:

Fragile X syndrome is the most common cause of inherited mental impairment. This impairment can range from learning disabilities to more severe cognitive or intellectual disabilities.

For example, if your audience is mainly African American, use pictures that show African American individuals. If your audience uses wheelchairs, use pictures that show people in wheelchairs. If you are writing general material that is applicable to a broad audience, include pictures that capture the range of people affected. For example, a brochure discussing cystic fibrosis should include picture of ethnicities other than Northern European because other ethnicities are affected or a pamphlet on Fragile X should include pictures of girls as well as boys.

Use a professional who knows the condition you are writing about (or knows medical terminology) to translate your material. Each language has fine points that would be known to a professional translator but not known to a computer program or to a lay person who speaks the language.

Materials should also be back translated, which means once they are translated from English into another language they should be translated back to English. This provides a way to check the translation, especially when you are not familiar with the language. Translated materials should ideally undergo testing in the target population to assess cultural sensitivity issues.

The average reading level of U.S. adults is 8th-9th grade. One in five adults read at the 5th grade level and below. Research suggests that printed materials for parents should aim for the 6th grade reading level. Materials written for professionals should aim for a reading level at the 12th grade level or lower. ["Adult Literacy in America (NALS)" National Center for Education Statistics, U.S. Dept of Education, Office of Educational Research and Improvement (NCES 1993-275), April 2002.]
  • You can check the reading level of your material using a number of different tools including the Fry, SMOG, or Flesch-Kincaid readability formulas. The FRY and SMOG formulas involve counting words and syllables in a selection of text. The Flesch-Kincaid method also estimates the reading level by counting words and sentences, but is considered less accurate than the FRY and SMOG. Microsoft Word will calculate reading level using the Flesch-Kincaid method.
  • Follow these links for more information about...
    • Fry
    • SMOG (Simplified Measure of Gobbledygook)
    • Flesch-Kincaid and Microsoft Word
Organizing information into a question and answer format makes the information easier to remember. It also helps people find specific information quickly. The best headers are those that express a complete thought or idea. (Doak and Doak, 1996)

Example:

Paragraph Format
Duchenne muscular dystrophy (DMD) is caused by a mutation in a specific gene within the X chromosome that provides instructions for the formation of the dystrophin protein. Females can be carriers but generally do not experience the symptoms of the condition. Duchenne muscular dystrophy occurs in approximately 2 out of 10,000 people and can either be inherited or occur spontaneously. A family history of Duchenne muscular dystrophy is a significant risk factor.

Question-and-Answer Format
How common is Duchenne and Becker Muscular Dystrophy?
Duchenne and Becker Muscular Dystrophies together affect 1 in 3,500 to 5,000 male births. Between 400 and 600 boys in the United States are born with these conditions each year. Females are rarely affected by these forms of muscular dystrophy.

What genes are related to Duchenne and Becker Muscular Dystrophy?
Mutations in the DMD gene cause Duchenne and Becker types of muscular dystrophy. The DMD gene is found on the X chromosome.

Try to limit each piece of material to 3-4 key concepts. Including too much information in written material makes it difficult to understand. People who are unfamiliar with the condition may find it overwhelming to have too much information included in one piece of material. Covering too much information will make your key points difficult to find. Remember that you can create a number of different materials to cover all the important topics.

Example:
  • What is the condition?
    • How common is the condition?
  • What genes are related to the condition?
    • How is the condition inherited?
  • Where can I find more information about:
    • The condition?
    • Treatment?

Each of these topics could make up a separate unit of information. Think about the right level of detail to include for your audience. You might look at well-established support groups (e.g., www.parentprojectmd.org) to get an idea for ways to separate the information.

In general, short words tend to be more common and are better to use (doctor vs. physician). There are some common words that are hard to understand because they are vague or have multiple meanings. For example, the phrase "test results in the normal range" does not describe what is 'normal', and 'range' has a number of different meanings, depending on the reader's personal experience. Be as specific as possible and test the materials with the end users to make sure they understand the information by creating a survey or talking with a group of them.Avoid terms that parents may find offensive, such as mentally retarded. Use current terms such as intellectual disability.

Helpful Hints:
  • Use the Google "define:" function to find alternative words and synonyms. Go to www.google.com, type define: your word (replace "your word" with whatever word you are looking up). For example, define: subcutaneous gives under the skin and beneath the skin as alternatives.
Example:
Medical Term Common Word(s)
cardiovascular heart and blood vessels
Categories groups
Cautiously with care
Chronic does not end or constant
Cognitive learning or thinking
The active voice shows the subject of the sentence performing the action. The active voice is more clear and engaging for the reader. The passive voice is signaled by the verb 'to be'.

Example:

Passive Voice Active Voice
Treatment must be done every day. You must do treatment every day.
Your lungs will be tested by a doctor. A doctor will test your lungs.
Short sentences are easier to understand than long sentences. "Short" means 15 words or fewer. Sometimes longer sentences sound better and, in that case, it is better to use more words. Try to take out extra words and use specific language. Each paragraph should discuss only one topic and have a clear opening sentence.

Example:

BEFORE: The Dietary Guidelines for Americans recommend a half hour or more of moderate physical activity on most days, preferably every day. The activity can include brisk walking, calisthenics, home care, gardening, moderate sports exercise, and dancing.

AFTER: Do at least 30 minutes of exercise, such as brisk walking, most days of the week.

Concrete examples are easier to understand than abstract ones. Including examples can also help to form a mental image of the concept and make it easier to remember.

Example:

Abstract
Alzheimer's has its share of safety hazards and everyday activities can be dangerous and difficult.

Concrete
When a person has Alzheimer's, everyday activities such as driving a car, chopping vegetables, getting the right water temperature, or turning a stove on or off can be dangerous.

  • Start with a clear title. Be sure to include the purpose of the material.
  • Organize ideas in the order that the audience will use them. The organization may be different for different audiences. For example, 1) description of the condition, 2) diagnosis of the condition, 3) treatment of the condition, and 4) inheritance and recurrence risk.
  • Use major headings to "chunk" text. The headings should express a complete idea, rather than just a word or two, to tell the reader the type of information that will follow. Leave more space above headings than below them to make a stronger connection to the text.
  • Place the most important information at the beginning and end of the document.

Sentence format
Many readers frequently move back and forth between text and pictures. Having pictures can help readers better understand the words, clarifies the words' meaning, enables them to construct or elaborate a model of the situation, and aids in building a mental model of the unfamiliar.

  • Use graphics to help communicate your messages, not for decoration.
  • Choose the best type of graphic for your materials: photographs (real life events, emotions), line drawings (procedures, sensitive issues), or cartoons (set casual tone or convey humor). Each can be useful for different purposes.
  • Make graphics culturally relevant and sensitive.
  • Make graphics easy for your readers to follow and understand by including captions and emphasizing key information.
  • When illustrating internal body parts or small objects, use realistic images and place them in context.
  • Avoid poor quality graphics.
[Adapted from "Scientific and Technical Information: Simply Put" produced by CDC & ATSDR, 2nd edition, 1999]

Example:

BEFORE
This is a multipurpose passenger vehicle that will handle and maneuver differently from an ordinary passenger car, in driving conditions that may occur on streets and highways and off road. As with other vehicles of this type, if you make sharp turns or abrupt maneuvers, the vehicle may roll over or may go out of control and crash. You should read driving guidelines and instructions in the Owner's manual, and WEAR YOUR SEATBELT AT ALL TIMES.

AFTER


  • Use white space, bullets, and headings to organize your material and keep it from being over crowded.
  • Limit the amount of text on each page.
  • Leave white space around the margins of the page and between columns.
  • Use a font size of at least 12 point. Headings should be larger than the size of the rest of the text.
  • Do not use fancy lettering.
  • Do not use all capital letters.
  • Use bold or underlining to emphasize text. Limit the use of italics because they are harder to read.
Headings and bullets divide up text and give "sign posts" to help the reader know where they are in the document.

Example:

No Headings
Duchenne muscular dystrophy (DMD) is caused by a mutation in a specific gene within the X chromosome that provides instructions for the formation of the dystrophin protein. Females can be carriers but generally do not experience the symptoms of the condition. Duchenne muscular dystrophy occurs in approximately 2 out of 10,000 people and can either be inherited or occur spontaneously. A family history of Duchenne muscular dystrophy is a significant risk factor.

With Headings
How common is Duchenne and Becker Muscular Dystrophy?
  • Duchenne and Becker Muscular Dystrophies together affect 1 in 3,500 to 5,000 male births.
  • Between 400 and 600 boys in the United States are born with these conditions each year.
  • Females are rarely affected by these forms of muscular dystrophy.
What genes are related to Duchenne and Becker Muscular Dystrophy?
Mutations in the DMD gene cause the Duchenne and Becker types of muscular dystrophy. This gene is found on the X chromosome.