Clear communication
for better health
Guidance for applying the ISO Plain Language
Standard to health Information

Authors:
Stacy Robison and Cinzia Theobald

Table of contents
Introduction

01

What makes health communication
unique?

02

What is plain language?

03

Plain language and health literacy

04

How to use plain language in healthcommunications

05

Glossary10

Introduction
Effective health communication plays a vital role in promoting
public health, empowering individuals to make informed
decisions, and improving health outcomes.
However, the complexity of medical and scientific information createsbarriers to understanding for your audience, leading to confusion,
misinterpretation, and limited engagement with essential health messages.
Adopting a plain language approach is crucial to bridge this gap and ensure
clear and accessible communication.
This resource serves as a guide to help improve your health communicationmaterial. It offers valuable insights into the importance of writing in plain
language and exploring the nuances of health communication. Writers
working in a variety of professional settings and sectors, from community
organizations to government agencies, will find it helpful.
By highlighting the significance of plain language in health communicationand the benefits it brings to both individuals and public health initiatives, thisresource aims to inspire you to embrace this approach in your writing. Itprovides practical advice and strategies for incorporating plain language
principles into the creation of your health communication materials,
empowering you to effectively engage and educate your priority audiences.
This resource supports the ISO plain language standard ISO 24495 -Plain
Language — Part 1: Governing principles and guidelines, an invaluable
standard for writers seeking to achieve excellence in written communication.
It builds on the ISO standard by providing specific guidelines for creatingclear, concise, and user-friendly content, ensuring consistent quality andaccessibility across various health communication materials. We strongly
advise using this resource together with the ISO Plain Language Standard for
a comprehensive approach to your health communication.

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What makes health communication
unique?
We all need clear health information to take care of ourhealth, understand health risks, and keep our families safe.
Health communication is unique for several reasons:1

It often includes unfamiliar medical – and in the case ofinformed consent, legal – terminology and concepts.

2

It may require readers to interpret statistics or evaluate
risks and benefits that affect their health and safety. In
fact, much of health communication relates tocommunicating risk:
Personal risk (such as improving nutrition to prevent
diabetes)Community risk (such as preparing for a hurricane)
Global risk (such as responding to the recent COVID-19
pandemic)

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It is often deeply personal, and the context in which people
seek health information is significant; readers may be
experiencing stress, fear, confusion, pain, or illness.

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It has vast implications for health and wellbeing. For
example, calculating the correct dose of medicine,following directions after surgery, or checking a nutrition
label to make sure a food is safe for someone with anallergy.
It is frequently communicated in times of great uncertainty
or crisis.
As such, there are unique considerations to communicating
health information in plain language.
2What is plain language?
Plain language is communication that puts your readers first. It considers:
what they want and need to know;

their level of interest, expertise and literacy skills;

the context in which they will use the document

Plain language ensures your readers can find what they need, understandwhat they find, and use it to make informed decisions or take action. Thus,
plain language focuses on how successfully your readers can use yourdocument rather than on mechanical measures such as readability formulas.
ISO 24495 -Plain Language — Part 1: Governing principles and guidelines laysout a process to help writers to develop documents that communicate
effectively with their intended readers. The International Plain Language
Federation (IPLF) defines plain language as:“A communication is in plain language if its wording, structure, anddesign are so clear that the intended readers can easily: find what
they need, understand what they find, and use that information.” iThere are four main principles of plain language based upon this definition:
Principle 1:

Principle 2:

Principle 3:

Principle 4:

Readers getwhat they need(relevant)Readers caneasily find what
they need(findable)

Readers caneasily understandwhat they find(understandable)Readers caneasily use theinformation(usable)

This resource provides you with some guidance on how to align your healthdocuments with the provisions of ISO 24495 -Plain Language — Part 1:
Governing principles and guidelines.
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Plain language and health literacy

Communicating in plain language makes it easier for people to access,understand, and use health information and services to make informed
health decisions (also known as “health literacy” ii ).
It encompasses an individual’s ability to navigate healthcare settings,
understand medical terminology, interpret health-related instructions,critically evaluate health information, and actively engage in healthcare
decision-making processes.
When writing health documents, you have a responsibility to address healthliteracy by presenting clear, accurate, appropriate, and accessible healthinformation. iii
Using plain language health communication is an important strategic step toimprove health literacy and health outcomes for your patients or clients.
Other potential benefits include:
social benefits such as empowering people to address economic andenvironmental determinants of healthenabling people to play an active role in improving their own healthmobilizing people to engage in community action for health and push
governments to meet their responsibilities in addressing health andhealth equity.
This resource is designed to support you to improve the quality ofcommunications you provide to all by providing guidance to:
1. enhance health literacy through the effective application of plain
language principles.
2. consistently make health information, including public health and safety
information, easy to understand and use and to meet the needs of theintended audience.
It is important for all information to be understandable, accessible, andrelevant. Health information must also be actionable, timely, and credible. iv

4How to use plain language in healthcommunications
We recommend that you consider the following guidelines when creating
health-related plain language communications.
Note: This guidance applies to printed and digital information that isprimarily in the form of text or text accompanied by simple graphics. It is notintended to apply to verbal communication between patients or clients andtheir providers in a clinical setting.

consider psychographic factors like motivation,intent, and perceived susceptibility. For
example, if sharing information about a healththreat, consider whether your readers perceive
they are at risk and then frame the informationaccordingly;

Identify yourreaders

identify relevant socio-demographic
characteristics of your readers to help inform
health information design and dissemination;
consider social/cultural factors and complexityof identity as it relates to health – includingintersectionality (the complex, cumulative way
in which social categorizations like race, class,and gender combine, overlap, or intersect
especially in the experiences of historicallymarginalized individuals or groups 1 );tailor as much as possible and include culturally
relevant and familiar examples or terms; if
tailoring is not possible, try not to exclude
people in imagery and terminology.

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Identify yourreaders’ purpose

empathize with your readers. Expressing
empathy in health communication has beenshown to build trust, which makes it more
likely that your readers will listen to andfollow a recommended course of action; 1
address personal impact. You can increase
the sense of relevance to health issues byreferring to the personal experiences of yourreaders or explaining how the issues canaffect their family or community (orconstituents).

consider whether your readers are likely to beexperiencing pain, stress, confusion, or fear.
Each of these can affect working memory andcomprehension. If this is the case, limit theamount of information and repeat key
messages;

Identify thecontext

consider whether your readers have previous
experience with the health threat or similar
health risks or topics that can be referenced
to make information more relevant;identify what your readers may behearing/reading about the health issue fromother sources that may affect theirunderstanding of information and guidance.
Address misinformation directly and provide
alternative correct information;
give your readers the information they needwhen they need it to make appropriate healthdecisions. During an emergency, this means
providing frequent and reliable updates.
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Select thedocument typeconsider all channels that are available andtheir capacities to reach priority audiences(for example, mass media, community-based
authors, social media, or interpersonalcommunication) and choose the mostappropriate ones;make information available online, but also
consider the digital literacy skills of theintended reader.

avoid paternalism (acts of authority by thehealth care professional in directing care,
instructions, or information to patients or laypeople); 1

Select content
your readers
needbe explicit about the behavior or action you
want your readers to take to protect
themselves and others;build awareness of existing or emerging healththreats or benefits, support understanding of
the risk, promote knowledge of solutions, andinstil confidence to act;
be transparent about how you analyze data
and make recommendations or policies;
clarify what is known and not known andsteps for how remaining questions will beanswered;
let your readers know where they can go for
more information or support.

7Information
designmake sure the words and images convey thesame message and reinforce each other;ensure images are culturally relevant andinclusive;
make sure images are accessible to people
with disabilities (for example, by including
captions and alt text for screen readers);
use images that show positive, healthpromoting actions. 1

Choose familiarwords

be careful with abbreviations (for example,mixing up tsp and Tbs could be harmful).
Introduce abbreviations if your readers needto learn them or if they are already very
familiar;
use familiar frames of reference andexamples;
limit use of numbers. If using numbers, usewhole numbers. If using numbers for risk,
explain what the numbers mean and put incontext. Don’t make readers conduct
mathematical calculations. 1

Writeclear sentences

provide context first, then describe thebehavior. For example, write “If you haveshortness of breath or pain in your chest, tell
your doctor” rather than “Tell your doctor if
you have shortness of breath or pain in yourchest.”8

Considerincluding images
and multimedia

place anatomical images in context of thebody;use images that help to convey the message
rather than tokenistic icons;
ensure imagery is inclusive.

Project a tone that
respects yourreaders’ needs andsituation

Community test
your documents

Review and evaluate
your documents

avoid alarmist language, particularly in a
public health crisis;
respect personal autonomy. Provide
information so that your readers can makethe best decision for themselves and theirloved ones.

have processes in place to community test
documents with readers representative of theintended audience.

regularly review and evaluate relevant
documents;
when choosing evaluation metrics for healthinformation, include constructs such as
behavioral intent, self-efficacy, perceived risk,
and source credibility.
9Glossary

For the purposes of this resource, the following terms and definitions apply.
Crisis communication
Refers to the strategic process of communicating information and managing
public perception during times of emergency, crisis, or significant disruption.
With regard to health, this includes a wide range of events such as publichealth emergencies, disease outbreaks, and natural disasters. Effective crisis
communication needs to provide clear, concise and consistent messaging toaddress public concerns, promote safety, and provide guidance to thepublic.
Digital literacy
The ability to use digital technologies and navigate the digital world
effectively. In a health context this relates to the ability to effectively find,understand, and use health related information from digital sources. It
includes having the knowledge and skills necessary to navigate healthrelated websites, apps, and online resources to make informed decisions
about one’s own health and wellbeing.
Health communication
Health communication consists of interpersonal or mass communication
activities focused on improving the health of individuals and populations. It
involves translating complex medical and scientific information into
accessible language and formats that are easily understood by diverse
audiences including patients, caregivers, healthcare professionals, policy
makers and the general public.
Intersectionality
Intersectionality acknowledges that individuals are not defined by a single
aspect of their identity, such as gender, race, religion, or age. Considerationmust be given to a combination of multiple social dimensions and thecomplex interactions between them to better understand and address socialinequalities.

10Paternalism
Paternalism in a health context is where health professionals or healthauthorities make decisions or take actions on behalf of patients or the
public with the intention of protecting their wellbeing. This limits theautonomy of the individual and assumes that healthcare providers andauthorities know what is best for the patient or the public without seeking
their input or considering their preferences.
Risk communication
Risk communication is the process of conveying information to individuals,
or communities about potential risks or hazards. Typically, the goal of risk
communication is to enhance understanding of risks to enable informed
decision-making and promote actions to mitigate or manage the risk.
Tailoring
Refers to the process of creating individualized communications, andtypically starts with a theory-driven assessment of characteristics that areunique to an individual and are related to the outcome of interest. In
contrast to generic forms of health communication (e.g., health brochures
or information websites), tailored communications provide individuals withinformation that is relevant for them and that fits with their particularsituation. As a result, this information is more likely to be considered as
personally relevant and, consequently, to be read. v[i] PLAIN International What is plain language? - Plain Language Association International (PLAIN)(plainlanguagenetwork.org)[ii] CDC https://www.cdc.gov/healthliteracy/learn/index.html[iii] WHO https://www.who.int/teams/health-promotion/enhanced-wellbeing/ninth-global-conference/healthliteracy[iv] World Health Author Principles for Effective Communications
https://www.who.int/about/communications/principles[v] Bol N, Smit ES, Lustria MLA. Tailored health communication: Opportunities and challenges in the digital era.
Digit Health. 2020 Sep 23;6:2055207620958913. doi: 10.1177/2055207620958913. PMID: 33029355; PMCID:PMC7520919.

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