Making information accessible and easy to understand
Information can only change motivation and behaviour if people can access it and
understand it. Thus providing accurate information in the right place for the target
audience is crucial if information is to affect action. Information providers need to
know where and when the target audience will seek information before designing an
information campaign. Will the target audience seek information on the web or just
before they take their medication or, for example, when they are about to use a sunbed?
Preliminary research with the target audience can answer such questions and so help
guide effective information provision.
Once the most appropriate context for information presentation is established,
information providers must ensure that what they say is easily understood. For exam -
ple, if patient information leaflets provided with medications are written in tiny writing
and include technical terms patients do not understand then they are not likely to
enhance adherence. Ease of comprehension is partly determined by what the recipient
already knows. If you want to give someone good directions (e.g. in a city) you ideally
want to be aware of what landmarks they already know. Yet evidence suggests that
health professionals often overestimate patients’ knowledge and, therefore, their ability
to understand health-related information. For example, Boyle (1970) found that only
20 per cent and 42 per cent of patients, respectively, were able to accurately identify
the position of the stomach and heart. Similarly, Hadlow and Pitts (1991) found that
while the vast majority of doctors were able to select correct clinical definitions of
conditions such as stroke, eating disorder and depression, only 18 per cent, 30 per cent
and 32 per cent of patients were able to do so, respectively. Thus prior explanation
of medical and unfamiliar terms is required if they are to be used in information
designed for the general population.
Text can also be more or less difficult to read depending on how it is written and
the words that are used. The level of reading difficulty can be assessed using a variety
of measures. For example, the Flesch Reading Ease measure (FRE) (Flesch, 1948)
assesses the average number of syllables in words used and the average sentence length.
A score between zero and 100 is generated with higher scores denoting easier texts
(e.g. scores of 65 and above are acceptable for literate adults). Media professionals
regularly edit text to achieve good readability. For example, the most popular
newspaper in the UK is said to have a reading age of 9! Considerable additional effort
is required to ensure that health information is readable by the vast majority of the
population. For example, in a survey of more than 1,000 leaflets provided by palliative
care units in the UK and Ireland, Payne et al. (2000) found that 47 per cent were
printed in less than font 12. Two-thirds had poor readability scores as assessed by the
FRE, which implied that they would only be understood by 40 per cent of the UK
population.
Providing wanted information
Health professionals tend to underestimate patients’ desire for information. Even when
they are facing bad news and potential terminal diagnoses, evidence indicates that
patients want to know as much as possible (e.g. Jenkins, Fallowfield and Saul, 2001)
- but what do they want to know? Coulter, Entwistle and Gilbert (1999) reviewed
166 MOTIVATION AND BEHAVIOUR