About Sage Words for Health Literacy

Our approach

We start with our audience.

Our audience is people who, for a variety of reasons have basic, low, or no literacy skills. We work with agencies to know the audience and acknowledge and honor the beliefs, values, and practices of the intended audience.

How do we make written materials useful to this audience?

• We include only two or three main points.

• We use graphics for the purpose of illustrating those points, so that the low literacy client can refer to the information later, and be prompted to remember by the illustrations

• We follow all the main dictates of good health literacy materials: serif fonts, plentiful white space, font that is not too small or too fancy.

• We use plain language.

Useful and Effective Materials

We also have a secondary audience—the health care providers. From their point of view, what makes for good health education materials?

• They include important points that, if remembered, will help the client to understand and take care of his or her health better.

• They contain accurate well-sourced information.

• They are easy to access.

• They are easy to reproduce.

If they are good, low literacy health education materials can be an important part of the clinic system’s approach to improving patients’ knowledge and understanding, and thus their ability to take good care of their health.

About Us

Sage Words seeks to address a need for health education materials with straight forward messages that are easy to understand and relevant to the people reading or hearing them. Within this context, we develop materials for specific audiences that address specific health needs and messages. Audiences may be defined not only by language and race and/or ethnicity, but also by geographical or institutional location, age, or even health provider.

Download Sage Words brochure [pdf]

More About Sage Words Materials

Why no glossy expensive
materials on the SageWords website?

Each element of the resource is intentional and based on either research or experience or both. We follow these health literacy “rules.”

1. We use simple line drawings or cut out photos.

2. We use illustrations in direct relation to text.

3. We use graphics if they help to organize and clarify information.

4. We focus on what the client needs to do.

5. We use only three to five points of information.

1. and 2. When it comes to visuals, low literacy readers have these characteristics among others: their eyes wander about page without finding the central focus; they may skip over principal features and focus on a detail instead. [1]

Thus, simple line drawings, without background, that are not abstract are the best to use for low literacy readers. [1,2,4] (They may even be better than photographs, unless cut-outs are used, removing background detail as in our depression brochure.) And, the more closely the pictures are directly linked to simple words from the text, the more effective. [1,2]

We have worked with a few illustrators now, and choose those that can effectively and accurately convey information graphically. The drawings need to be simple and skillful. They may sometimes need to portray complex actions or to break down instructions into small detail. We do not want them to be unattractive, and especially not cartoon-y and thus condescending: they need to look realistic and familiar to the audience.[2] We have our artists draw from pictures of people who look like the clientele of the agency we are working with, the buildings they live in, the actual clinics they visit. Sometimes stylized pictures look more attractive, but for comprehension, things need to look like the real everyday world of the audience. [2]

3. The use of a different color to distinguish a heading from the text is an example of the third rule. Other uses of color have been shown, in web pages, for example, to “increase intention to purchase” but did not significantly affect retention.[3] Our goal, simply put, is understanding and retention, not persuasion.

4. and 5. It has been in our experience to find any material (including pamphlets from government agencies as well as those from drug companies) that is heavily laden with information, either visual or textual--even when it looks fantastic-- in the closets in clinics or on the floors of waiting rooms.

“The sheer length of print materials sometimes intimidates people with limited literacy skills. They may conclude (on the basis of length alone) that reading the document will be too hard.”[4]

1. Doak, Doak, and Root, Teaching Patients With Low Literacy Skills: Second Edition Lippincott Williams & Wilkins, 1996. Available at: http://www.hsph.harvard.edu/healthliteracy/doak.html

2. Houts PS, Doak CC, Doak LG, Loscalzo MJ. The role of pictures in improving health communication: A review of research on attention, comprehension, recall, and adherence. Patient Education and Counseling 2006; 61 173–190, p 180.

3. Hall RH, Hanna P. The impact of web page text-background colour combinations on readability, retention, aesthetics and behavioural intention. Behaviour and Information Technology, May-June 2004, 23,3, 183-195.

4. Health Literacy Style Manual. Available at: www.coveringkidsandfamilies.org

Our Board

The Sage Words Board of Directors:

Suzanne Hershey, MPA, board president
Owner, Community Sync

Alfonso Carlon, board secretary
Project Director, Center for Health Training

Doug Dempster, PhD
Dean, the College of Fine Arts, University of Texas at Austin

Some of our Collaborators and Subcontractors:

Illustrator Cristina Sitja Rubio www.memoriadistante.net/csrhome.html

Translator Sandra Chada with American International Translators Fschada@aol.com

Translator Consuelo Espejel de Reid translationintospanish@yahoo.com

Thanks also to friend-translators: David Baird, Moisés Morales, Beatriz Reynoso, Roberto Roman, Stephanie Lain

Sage Words Advisory Board

Ronald M. Epstein, MD

Director of Research in Family Medicine, Associate Dean for Educational Evaluation and Research, University of Rochester School of Medicine & Dentistry, Professor of Family Medicine and Psychiatry, Director of the Deans' Teaching Fellows Program

MD, 1984, Harvard Medical School (Medicine) 1980, Columbia University (Pre-Med) BA, 1976, Wesleyan University (Music)

Dr. Epstein’s NIH-, AHRQ- and foundation-funded studies have added to our understanding of the impact of patient-physician relationships and communication on health, the process of care and health care costs. In particular, his research has focused on patient-centered care, patient influence on clinicians’ practice patterns, and clinician mindfulness and self-awareness as applied to stigmatized topics and under-studied populations (e.g. AIDS, somatization, life-limiting illness).

Shari Holland

Shari Holland is the president of Morningside Research and Consulting, Inc., and directs the activities of the firm. Ms. Holland has more than 15 years of experience evaluating public programs and their funding and writing policy documents for elected officials and public audiences.

Ms. Holland has a Master's degree in Public Affairs from the LBJ School of Public Affairs in Austin, Texas, and a Bachelor's degree in Urban Affairs from the American University in Washington, D.C.

Sage History

Sage Words grew out of the experiences of the partners of CHEC (Community Health Education Concepts) who over the years have observed in dozens of health care clinics and provided training to their staffs. With backgrounds in health education and adult education Claire Loe, Carmen Retzlaff and Kath Anderson know that health knowledge acquisition and behavior change do not end with the reading of a brochure or poster, but they have seen how it might start there. Our materials are as much tools for the practitioners who use them as for the clients they serve.

For more about the work of CHEC see www.healthletter.com.