User Guide | CDC Clear Communication Index, Exercises of Communication

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CDC Clear Communication Index A Tool for Developing and Assessing CDC Public Communication Products User Guide August 2019 CS309804-A Centers for Disease Control and Prevention Office of the Associate Director for Communication CDC Clear Communication Index Contents Clear Communication and Plain Language at CDC ...................................................................... 1 The Index at a Glance ..................................................................................................................... 1 What Makes the Index Different from Other Communication Guidelines and Readability Formulas? .............................................................................................................. 2 How to Use the Index .................................................................................................................... 2 Developing Effective Communication Products (Quick Check) ..................................................... 3 Anatomy of a Material .................................................................................................................... 4 Description and Examples of Index Items ...................................................................................... 5 • Note: Examples taken or adapted from federally sponsored health information sources Appendix A: Developing Effective Communication Products (Annotated Version) ...................... 29 Appendix B: List of Common Public Health Audiences .............................................................. 31 Office of the Associate Director for Communication CDC Clear Communication Index Developing Effective Communication Products (Quick Check) Are You on Track to Know Your Audience? No matter how you use the Index, remember it’s just one step in the process of developing effective communication products. It cannot take the place of formative research or pretesting with your intended audience. See Appendix A for an annotated version of this list and related resources. See Appendix B for examples of common audiences for public health communication materials. 1. Did you identify your intended audience(s)? Always consider the audience and what they need and want. 2. Did you conduct audience research? Get to know your audience—don’t guess or assume. Review existing data or gather new data through formative research. 3. Did you identify your behavioral objective(s) and key messages? What do you want your intended audience to do? Define the behavioral objective(s) of the material based on behavioral and communication theory. 4. Did you determine how your material will be formatted and distributed so that it reaches your audience? Consider how your audience will find, receive and use the material. Choose the best format for your audience and the message (written, visual, audio, video). Identify dissemination channels, such as social media, community organizations, websites, and activities that match the audience. 5. Did you build in time and resources to pretest the material with your intended audience and revise based on feedback? This step can be done multiple times, if needed. Remember, even the most robust communi- cation guidelines cannot substitute for pretesting with your intended audience. 3Office of the Associate Director for Communication CDC Clear Communication Index Anatomy of a Material The following example illustrates how multiple Index items work together to make a material easier to understand and use. Visual supports the text Main message is at the top of the page Uses headings and chunked text Unfamiliar terms are explained 4 Office of the Associate Director for Communication CDC Clear Communication Index Description and Examples of Index Items This section contains descriptions and examples of how to apply each of the 20 items in the Index. Part A: Core Items (applies to all materials) Main Message and Call to Action 1. Does the material contain one main message statement? Make sure the material has one main message statement. The main message statement is the one thing the audience must remember. The statement may be 1–3 short sentences. You can combine the main message statement and the call to action (what you want people to do after receiving and understanding the main message), or they can be separate sentences. Example: • Note: Examples taken or adapted from federally sponsored health information sources 5Office of the Associate Director for Communication CDC Clear Communication Index 4. Does the material contain at least one visual that conveys or supports the main message? Make sure the words and visuals in the material convey the same message and reinforce each other. People expect words and visuals that appear close to each other to be about the same information. When the words and visuals are unrelated, unclear, or contradictory, people can get confused or distracted. Remember, don’t overload visuals with too much information. Government rules about information accessibility on the web mean that all visuals need to have labels and captions. Labels and captions will help audiences easily and quickly get the gist of a visual and reduce chances of misinterpretation. Photographs, graphs, and infographics are visuals. When they are clearly designed and not overloaded with information, they can help people easily and quickly grasp information. Example 1: 8 Office of the Associate Director for Communication CDC Clear Communication Index Example 2: How can older adults prevent falls? • Exercise regularly. Focus on increasing leg strength and improving balance. • Try exercises that get more challenging over time. Tai Chi is a good choice. Benefits of visuals: They • provide an alternative to text to get the main message • break up blocks of words • make materials appear easier to read ✓ Supported by the CDC Style Guide: A visual can convey ideas in a way words cannot. 9Office of the Associate Director for Communication CDC Clear Communication Index 5. Does the material include one or more calls to action for the primary audience? Tell the primary audience what you want them to do with the information you’ve given them. The action can be a specific behavior, a prompt to get more information, a request to share information with someone else, or a broad call for change. Even when your purpose is to inform an audience, think about why they need this information, and use this insight to create a call to action. Example 1: If you have questions about your relationship, call 1-800-XXX-XXXX. If you are in danger right now, call 911. Find out more about getting help. Example 2: If you plan to go to work after pregnancy, a lactation counselor can help you plan to keep providing breast milk for your baby while you are away. Get more information about: • Pumping and storing your breast milk • Your rights at work Example 3: Science must continue to guide global HIV treatment and prevention efforts. Public health professionals should select HIV treatment and prevention strategies that are evidence based. 10 Office of the Associate Director for Communication CDC Clear Communication Index Example 4: Physical activity can help lower your LDL (“bad”) cholesterol and raise your HDL (“good”) cholesterol. The CDC Style Guide Says… Replace jargon words with their plain language alternatives. For example: Avoid: acquired detrimental following frequently in the event of initial regarding sufficient Use: get harmful after often if first about enough ✓ Supporting Plain Language Guideline: Use short, simple words. (http://www.plainlanguage.gov/howto/guidelines/FederalPLGuidelines/writeShort.cfm) ✓ Supporting Plain Language Guideline: Minimize abbreviations. (http://www.plainlanguage.gov/howto/guidelines/FederalPLGuidelines/writeNoAbbrev.cfm) 13Office of the Associate Director for Communication CDC Clear Communication Index Information Design 8. Does the material use bulleted or numbered lists? Use lists to break up text in the body of the material and make information easier to scan and read. Lists with more than seven items must be broken into sub-lists. Example 1: Before: There are many factors that put you at risk for developing type 2 diabetes. Being overweight or obese is one of the major risk factors. Having a family member, like a parent, brother, or sister with diabetes is also a risk factor. If you are African American, American Indian, Asian American, Pacific Islander, or Hispanic/Latino American you may be at greater risk. After: You may be at risk for type 2 diabetes if you: • Are overweight or obese • Have a parent, brother, or sister with diabetes • Are African American, American Indian, Asian American, Pacific Islander, or Hispanic/Latino American Example 2: Uses bulleted lists ✓ Supporting Plain Language Guideline: Use lists. (http://www.plainlanguage.gov/howto/guidelines/FederalPLGuidelines/writeLists.cfm) 14 Office of the Associate Director for Communication CDC Clear Communication Index 9. Is the material organized in chunks with headings? Break text into chunks to help the audience remember and group similar information. Chunked information also looks less dense and overwhelming to read. A “chunk” is the amount of words or numbers that people can hold in their short-term memory and group with other words or numbers. A chunk should be only one idea that people can connect to other, related ideas. Use headings to organize and label chunks. Headings are sometimes referred to as “advance organizers.” Consider information flow in the material when creating headings and chunks. Headings must accurately reflect the information that follows, or they can distract or confuse the audience. Headings are visually distinct (in font style, size, and with spacing) from the body text of the document. Leave more space above a heading than below. Example 1: Before: Measles is highly contagious, and it easily spreads to unvaccinated people. About 90% of unvaccinated people will get measles if they are exposed to an infected person. Measles spreads through the air when an infected person breathes, coughs, or sneezes. So, you can get measles if you are in the same room or place as an infected person and even after they leave. Measles virus can stay in the air for up to 2 hours. While traveling, you could be exposed to infected people almost anywhere, including airports, airplanes, buses, hotels, restaurants, and stadiums. Infected people can spread measles even if they do not have the measles rash yet. So, you never know when you might be exposed to someone infected with measles virus. After: How contagious is measles? Measles is highly contagious. This means that is spreads easily from person to person. Most people (about 90%) who have not gotten the measles shot will catch measles if they are around an infected person. How does measles spread? Measles spreads through the air when an infected person breathes, coughs, or sneezes. So, you can get measles if you are in the same room or place as an infected person and even after they leave. Measles virus can stay in the air for up to 2 hours. While traveling, you could around infected people almost anywhere, including airports, airplanes, buses, hotels, restaurants, and stadiums. How can I tell if someone has measles? You can’t tell. Infected people can spread measles even if they do not have the measles rash yet. So, you never know when you might be near someone infected with measles virus. 15Office of the Associate Director for Communication CDC Clear Communication Index State of the Science 11. Does the material explain what authoritative sources, such as subject matter ex- perts and agency spokespersons, know and don’t know about the topic? Acknowledge uncertainty about data, findings, recommendations, guidance and action steps. Public health science continuously evolves, especially in emergency and crisis situations. What we know today may not be complete or fully accurate. And what we know today may not be sufficient to answer all of the public’s questions. Acknowledging uncertainty helps the public understand how the scientific process works and introduces the idea that CDC findings and recommendations may change over time. In other words, by acknowledging uncertainty, we can contribute to the public’s science literacy. Example 1: Post-treatment Lyme disease syndrome We don’t know the exact cause of post-treatment Lyme disease syndrome (PTLDS). Most scientists think the signs and symptoms of PTLDS, like muscle pain and feeling tired, are caused by the damage to the body from the infection. But some medical experts think these signs and symptoms mean the body is still infected. Scientists are still doing research to find out what causes PTLDS. Example 2: CDC is working with public health officials in many states to investigate an outbreak of foodborne illness. The investigation typically takes a few weeks. As soon as a source (the cause of the outbreak) is identified, we will warn the public and conduct food recalls if appropriate. Example 3: Some medicines are known to be harmful to pregnant women. Many medicines have not been tested on pregnant women—so doctors are not sure if they are safe or not. If you are pregnant or planning on getting pregnant: • Write down what medicines you take • Keep track of how much medicine you take • Ask your doctor if it is safe for you to take your medicine during pregnancy 18 Office of the Associate Director for Communication CDC Clear Communication Index Part B: Behavioral Recommendations (may not apply to all materials) 12. Does the material include one or more behavioral recommendations for the primary audience? Tell people upfront what they can do to protect and promote their health. Behavioral recommendations are specific actions people can take to protect their health or the health of others. When you create health or safety messages, focus on behavior rather than medical facts or statistics. Example 1: If you are pregnant, getting a flu shot is the best way to protect yourself from the flu. Here are some other steps you can take to keep yourself and your family healthy this flu season: • Make sure everyone 6 months of age and older gets the flu shot or nasal spray. • Wash your hands often to prevent the spread of germs. If you have been near someone with the flu, talk to your doctor about taking medicine (called antiviral medicine). Antiviral medicine can prevent you from getting sick. Example 2: 4 Steps to Get Ready for a Healthy Pregnancy: 1. Take 400 micrograms (mcg) of folic acid every day for at least 1 month before getting pregnant to help prevent birth defects. 2. Stop smoking and drinking alcohol. 3. If you have a medical condition, be sure it’s under control. Some conditions include asthma, diabetes, oral health, or obesity. Also be sure that your vaccinations are up-to-date. 4. Talk to a health care professional about any over-the-counter and prescription medicines you are taking. These include dietary or herbal supplements. 19Office of the Associate Director for Communication CDC Clear Communication Index 13. Does the material explain why the behavioral recommendation(s) is important to the primary audience? Give the primary audience reasons why they should or shouldn’t do health behaviors and tell them possible consequences of doing or not doing the behaviors. Provide enough information so they can easily and quickly grasp why the behaviors are important. You will help people make informed decisions. Example 1: If you are a woman age 65 or older, schedule a bone density test. A bone density test measures how strong your bones are. The test will tell you if you are at risk for osteoporosis. Osteoporosis is a disease of the bones. It means your bones are weak and more likely to break. There are no signs or symptoms of osteoporosis. You might not know you have the disease until you break a bone. That’s why it’s so important to get a bone density test to measure your bone strength. Example 2: Stand up slowly. Getting up too quickly can cause your blood pressure to drop. That can make you feel wobbly. Example 3: The 2010 Dietary Guidelines for Americans recommend limiting sodium (salt). Eating a lot of salt can raise your blood pressure, and high blood pressure is a major risk factor for heart disease and stroke. Even if you do not have high blood pressure, the lower your blood pressure in general, the lower the risk of heart disease and stroke. 20 Office of the Associate Director for Communication CDC Clear Communication Index 16. Does the material always explain what the numbers mean? Provide reasons why the numbers in the material are important to the main message and the audience’s understanding of the information. As with words, numbers can mean different things to different people. Some numbers may seem significant and worrisome to one group of people and insignificant to another group. Many people –even health professionals—have difficulty interpreting and extracting a meaningful “bottom line” from numbers. To help people make sense of numbers, present them in context. Is the number high or low for this type of health issue or higher or lower than expected? Is the number important for an individual to know about and act on or a number describing a health outcome in a large group of people? CDC often shares “case counts” for many different diseases. This epidemiologic information often shows the place and time for “cases,” meaning a person who got sick from a particular disease or met a particular definition of a disease or condition. There should always be a description of what these numbers mean to individual or population health. • MORE OR LESS: For example, one case of a rare infectious disease might be cause for alarm and immediate public health action while many cases of a common infectious disease may not be alarming. • EXPECTED OR NOT: For example, a disease appears in an unexpected place versus a place where the disease may be common. Sometimes, a disease can occur at a time of the year that is different than what has happened in the past, such as flu season starting early. Avoid using qualitative descriptors, such as high and low or large and small, by themselves. When you use qualitative descriptors, you must also provide the number and explain the meaning. Example 1: The amount of meat recommended as part of a healthy meal is 3 to 4 ounces—it will look about the same size as a deck of cards. Example 2: Radon is a poisonous gas. Testing your home is the only way to know if you have a radon problem. If your home has a radon level of 4 or higher, you will need to make a plan to fix your home. This much radon is unhealthy for you and your family. If radon levels are between 2 and 4, you may want to fix your home. No level of radon is safe. Example 3: About 1 in 8 women in the United States will get breast cancer in her lifetime. That’s a very high number of women. In fact, after skin cancer, breast cancer is the most common type of cancer in women. 23Office of the Associate Director for Communication CDC Clear Communication Index 17. Does the audience have to conduct mathematical calculations? Be sure to do the math rather than expect the audience to calculate. Provide calculations and conversions so that the audience isn’t distracted, confused or intimidated by the numbers and formulas or misinformed by errors in their calculations. Few people are likely to take the time or able to conduct even basic mathematical calculations such as addition and subtraction. Research shows health professionals and trained statisticians can make wrong assumptions and calculation errors, depending on the context and type of calculations involved. Keep the denominators constant. When you use different denominators, people can’t easily compare numbers. Use the same denominator, even for absolute risk (example: 1 out of 3), throughout the material so that audiences don’t have to calculate. Example 1: Calculates BMI Example 2: How much money did you spend on alcohol last year? If you had 3 alcoholic drinks a day and each drink cost $4, then you spent $4,380 last year on alcoholic drinks. What else could you do with $4,380 this year? 24 Office of the Associate Director for Communication CDC Clear Communication Index Part D: Risk (may not apply to all materials) According to the Public Health Foundation’s epidemiology glossary, “risk” is the probability that an event will occur and affect a person within a specific time or age span. However, CDC materials often use “risk” in several different ways. Risk can refer to the • threat or harm to an individual or group of people (example: Drinking contaminated water is a risk to human health.) • outcome of a threat or harm (example: Many people don’t know they are at risk for heart disease even though heart disease is the leading cause of death.) • factors that make threat or harm more likely, that is risk factors (example: Binge drinking is a risk factor for alcohol-related car crashes and unintentional injuries.) • likelihood that a threat or harm will happen (example: Workers who make, use or work near flavoring chemicals have an increased risk of lung disease.) When you write, talk about or show images to convey risk, be sure the meaning of risk you intend is clear from the context and topic of the material. You should not use only qualitative descriptors, such as high and low or large and small, by themselves to describe risk because people may not interpret these words the same way. A large risk to one person may be a small risk to someone else. 25Office of the Associate Director for Communication CDC Clear Communication Index 20. If the material uses numeric probability to describe risk, is the probability also explained with words or a visual? A numeric probability is a statement in numbers about the likelihood of an event, such as heart disease causes 1 in 4 deaths, or a patient has a 5% chance of a side effect from a medication. CDC materials may use numeric probability statements to convey risk from exposures, behaviors or hereditary characteristics. Risk statements that solely rely on numbers may be difficult for audiences to understand. Combine numbers, words and visuals to explain risk statements. People better understand probabilities when they are presented with words and visuals that match and reinforce the meaning of the numbers than when numbers are presented alone. Generally, people more easily understand • natural frequency expressions (1 in 4) than percentages (25%). • absolute risk (6% chance of a disease) than relative risk (50% less chance of a disease) or number needed to treat (number of people who need a preventive treatment to prevent one case of a disease). For more definitions and explanations of risk terms, see the Public Health Foundation’s Glossary of Epidemiology Terms on the CDC web site. Example 1: Foodborne illness, sometimes called food poisoning, is common. Each year, about 1 in 6 Americans (or 48 million people) gets sick. Example 2: Supported by the CDC Style Guide: Visuals are often the most effective way to display large sets of numbers or data. 28 Office of the Associate Director for Communication CDC Clear Communication Index Appendix A: Developing Effective Communication Products (Annotated Version) Are You on Track to Know Your Audience? No matter how you use the Index, remember that it’s just one step in the process of developing effective communication products. It cannot take the place of formative research or pretesting with your intended audience. To ensure that your communication effort is a success, consider the audience, message, and channel. 1. Did you identify your intended audience(s)? Always consider the audience and what they need or want. Explore these resources to help you define the audience for a communication product. • CDCynergy: 3.3 Finalize Intended Audiences (http://www.orau.gov/cdcynergy/web/BA/Content/phase3/phase3mainframeset.htm) • Pink Book—Making Health Communication Programs Work (http://www.cancer.gov/cancertopics/cancerlibrary/pinkbook/page5#3) • Health Literacy Online: Learn about Your Users and Their Goals (http://www.health.gov/healthliteracyonline/usersgoals.htm#basics) 2. Did you conduct audience research? Get to know your audience—don’t guess or assume. Review existing data or gather new data through formative research. During this phase, explore your intended audience’s knowledge and attitudes about the health topic. Start with the following tools from CDC’s Gateway to Health Communication and Social Marketing Practice. • Audience Insights (http://www.cdc.gov/healthcommunication/Audience/index.html) • Research and Evaluation Tools (including HINTS and Census data) (http://www.cdc.gov/healthcommunication/Research/index.html) • Market Research Databases The OADC Strategic and Proactive Communication Branch provides access to market research databases. Contact the branch or submit a request through Create-it for access to the databases. Explore these resources for more information on formative research methods. • CDCynergy: 3.6 Undertake Formative Research (http://www.orau.gov/cdcynergy/web/BA/Content/phase3/phase3mainframeset.htm) • Pink Book—Making Health Communication Programs Work: Communication Research Methods (http://www.cancer.gov/cancertopics/cancerlibrary/pinkbook/page9) 29Office of the Associate Director for Communication CDC Clear Communication Index 3. Did you identify your behavioral objective(s) and key messages? What do you want your intended audience to do? Define the behavioral objective(s) of the material based on behavioral and communication theory (see CDCynergy: 3.5 Examine and Decide on Communication-Relevant Theories and Models http://www.orau.gov/cdcynergy/web/BA/Content/phase3/phase3mainframeset.htm). • Address barriers and motivators to change • Determine the key information the reader needs to achieve the behavioral objective(s) 4. Did you determine how your material will be formatted and distributed so that it reaches your audience? If the audience isn’t exposed to the material or isn’t familiar with or doesn’t use the format you’ve chosen, then you’ve missed the mark. Choose the best format for your audience and the message (written, visual, audio, video). If the material will be available online, follow usability guidelines. Identify dissemination channels, such as social media, community organizations, websites, and activities that match the audience. 5. Did you build in time and resources to pretest the material with your intended audience and revise based on feedback? This step can be done multiple times, if needed. Remember, even the most robust communication guidelines cannot substitute for pretesting with your intended audience. Decide how many people you need to pretest the materials with. Depending on the audience and material, you may be able to test with less than 9 individuals, which does not require Office of Management and Budget (OMB) approval. If you need to pretest with 10 or more individuals, the OADC Strategic and Proactive Communication Branch has a generic clearance, the Health Message Testing System. You can also apply for a “fast-track” clearance if you are testing customer satisfaction. If you plan on doing many rounds of pretesting and other formative research, you may want to apply for your own OMB clearance. Contact your CIO’s clearance officer for more information on fast-track and other OMB clearance options. Explore these resources. • Pink Book—Making Health Communication Programs Work: Steps in Developing and Pretesting Messages and Materials (http://www.cancer.gov/cancertopics/cancerlibrary/pinkbook/page6#3) • Health Literacy Online: Iterative Design and Testing Methods (http://www.health.gov/healthliteracyonline/intro.htm) 30 Office of the Associate Director for Communication