Principles of Plain Language

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Principles of Plain Language

• Dr. Annetta L. Cheek, Chair
• Center for Plain Language
• Presented at the University of Maryland
• Horowitz Center for Health Literacy
• 3-10-09

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What is Plain Language?

• Material is in plain language if readers can

• Find what they need

• Understand what they find

• Use it to fulfill their needs

And they should be able to do this the first time
they read or hear it!
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• Think about your audience!

• You must understand your audiences knowledge of
  and familiarity with a topic.

• What is plain language for one audience may not
  be plain language for another audience.

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Why do we recommend plain language?

• There is lots of evidence showing that plain
  language benefits the writer and the reader.
• Readers save time and are more likely to get the
  information or benefit they are seeking.
• Writers save money, because readers make fewer
  mistakes, respond more quickly, ask fewer
  questions, comply more fully with requirements.

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Well look at just a couple examples
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• Veterans Benefits Administration

• One office, in Jackson, MS, decided to rewrite
  one standard benefits letter into plain language.

• Significantly fewer calls from customers.

• More veterans applied for benefits.

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Fewer calls from customers
Old letter Plain Language letter
Calls to each counselor each month 91.4 16
Total calls each year, 10 counselors 10,968 1920
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Another VBA example

• Every several years the Veterans Benefits
  Administration sends a letter to all veterans,
  asking them for an up-to-date beneficiary.

• If a veteran dies and the beneficiary listed in
  his VA file isnt valid, the VA must find a valid
  beneficiary.

• It costs the VA several thousand dollars to do
  the research to find a valid beneficiary.

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Higher response rate, lower costs
Estimated savings 8 mil every mailing cycle
Response rate
Original letter 35
Plain language letter 58
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Federal Communications Commission

• Revised regulations about radio operations on
  pleasure boats to improve their clarity.

• A Washington-based firm studied the ability of
  users to find answers to questions in the old and
  new versions.

• The test groups included both new and
  experienced users.

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Less time for users to solve a problem (in
minutes)
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Overview of Plain Language Techniques
None of the techniques well discuss define plain
language rather, they are ways to achieve plain
language
Together, these techniques help you be clear and
concise.
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Use
Logical organization

• Informative headings

Active voice
Pronouns
Lists and tables
Common words
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Avoid

Abbreviations, jargon, legal terms, Latin
Long sentences
Unnecessary words, redundancy
Information the audience doesnt need
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A general principle Less is more!
Plain language usually but not always helps
you be more concise.
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Organize logically for the reader

• There are several standard ways to organize

Chronological
Most important first
General first, special and exceptions last
If you find material more than once, suspect poor
organization
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Headings
There are three types of headings
Questions Why should we use headings?
Statements Headings help guide readers
Topics - Headings
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The most useful headings

• Are question headings, because people generally
  come to our documents with questions.

• But dont make up the questions use question
  headings only if you know the audiences
  questions.

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Use active voice

• The best sentences are like the ones you first
  learned in school.

• Subject, verb, predicate Who, does what, to
  what or whom.

We charged the incorrect amount.
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Avoid passive voice

• Passive voice is one of the major problems of
  bureaucratic writing.

• Passive voice is harder to understand.

• Passive voice can confuse the audience because
  its not clear who does what.

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What is passive voice?
The actor follows the verb.
Some form of the verb to be is combined with
the past participle of another verb.

• The frog was swallowed by Fred.

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Passive Voice

• Can disguise who does what
• A frog was swallowed.

Active Voice
Makes it clear who does what Fred swallowed a
frog.
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Passive Voice

• Is often longer
• The application must be completed by the
  applicant and received by the grants office by
  June 1st. 17 words

Active Voice
Cuts the number of words We must receive your
completed application by June 1st. 9 words
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Use pronouns to speak to the audience

• Research shows that people relate better to
  information that talks directly to them by using
  pronouns.

• Using general nouns such as beneficiary or
  purchaser requires the audience to translate
  before they can be sure you are talking to them.

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How to use pronouns

• Refer to your organization as we

• Refer to the reader as you in the text and as
  I in questions

• Make sure you define we and you

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Without pronouns

• To establish eligibility for a voucher, an
  applicant must show that the applicant has a low
  income and that the present care of the applicant
  is inadequate. 27 words

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With Pronouns

• To establish your eligibility for a voucher,
  you must show you have a low income and your
  present care is inadequate. 21 words

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Do not use these pronouns!
He/she
His/her
S/he
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Lets use pronouns and active voice

• Applications can be submitted any day of the
  week, including weekends and holidays.
• They will be opened the next business day.
• If your application is acceptable, you will be
  notified, usually within 48 hours.

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• You can submit your application any day.
• We will open them the next business day.
• If we accept your application, we will notify
  you, usually within 48 hours.

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Using lists and tables

• Lists can be a very powerful way to convey
  information.

• Make sure that all the items in a list are
  constructed in a parallel way each item should
  start with the same part of speech.

• Try not to mix and and or in one list, it
  can be confusing.

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Heres a CMS example

• Medicaid Apply if you are aged (65 years old or
  older), blind, or disabled and have low income
  and few resources. Apply if you are terminally
  ill and want to receive hospice services. Apply
  if you are aged, blind, or disabled live in a
  nursing home and have low income and limited
  resources. Apply if you are aged, blind, or
  disabled and need nursing home care, but can stay
  at home with special community care services.
  Apply if you are eligible for Medicare and have
  low income and limited resources.

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And in list form

• You may apply for Medicaid if you are
• Terminally ill and want hospice services
• Eligible for Medicare and have low income and
  limited resources or
• 65 years old or older, blind, or disabled and
  have low income and few resources and
• You live in a nursing home or
• You need nursing home care but can stay at home
  with special community care services.

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And one more

• During this same period, prescriptions for HRT
  declined rapidly, following highly-publicized
  reports from the Womens Health Initiative (WHI)
  study that showed an increased risk of breast
  cancer, heart disease, stroke, blood clots, and
  urinary incontinence among postmenopausal women
  who were using hormone replacement therapy that
  included both estrogen and progestin. (50 words
  in one sentence)

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And as a list

• During this time, prescriptions for HRT declined
  rapidly. The Womens Health Initiative (WHI)
  publicized studies showing increased health risks
  among postmenopausal women who were using both
  estrogen and progestin . Risks included
• breast cancer
• heart disease
• stroke
• blood clots
• urinary incontinence (41 words in 3 sentences)

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Use common words

• Avoid uncommon words, bureaucratic words,
  foreign words, and jargon.

• Even highly educated people read faster and
  with better comprehension if you stick with
  common words.

• Big words do not make you look smarter!

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Common words

• Tell

• Instruct

Receive, Obtain
Get
Parameter
Limit
Assistance
Help
Regarding
About
Retain
Keep
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Avoid abbreviations jargon legal terms Latinisms
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Abbreviations

• Readers complain more about abbreviations and
  acronyms than about any other feature of
  bureaucratic writing.

• Using abbreviations turns your material into a
  research project for readers.

• If your abbreviation has another, more common
  meaning, your audience will forget your special
  meaning and remember the more common one.

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How can you fix abbreviations?

• Dont use more than two, and at most three,
  abbreviations in each written document.

• Instead, use nicknames such as unit instead
  of WPU for Witness protection unit, or case
  review instead of PQCR for Peer Quality Case
  Review.

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Jargon
Bureaucratic writing is often full of jargon
metabolic demands
circulation system
hypertension
expiry date
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Bureaucratic and legalistic words

• Herein
• Hereafter
• Hereby
• Pursuant to
• In accordance with
• Shall (use must instead)

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Latin terms

• i.e. and e.g. are major problems.

• Many people do not know what these mean.

• Many who do know the meanings dont remember
  which is which.

• Other Latin terms to avoid via per

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Keep sentences short

• In most material, sentences should average 20
  words or fewer, with no sentence longer than 40
  words.

On the web, limit the average to 15 words, with
no sentence longer than 30 words.
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Consider this sentence

• If this continues, over time some recurring
  infections may have to be treated with different
  and stronger antibiotics and the very real
  possibility that eventually no antibiotic will be
  effective in killing the bacteria. (34 words in 1
  sentence)

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All you need is this

• If this continues, some recurring infections may
  have to be treated with stronger antibiotics.
  Eventually some infections may resist all
  antibiotics. (21 words in 2 sentences)

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But this is even better for a general audience
Eventually, we will have to use even stronger
antibiotics to kill some infections. Some may
resist all antibiotics. (18 words in 2 sentences)
.
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One more example

• The National Cancer Institute's Cooperative
  Planning Grant for Cancer Disparities (CDRP)
  Research Partnership Program issued by the
  Radiation Research Program is an effort to
  strengthen the national cancer program by
  developing models to reduce significant negative
  consequences of cancer disparities seen in
  certain U.S. populations. (45 words)

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Do you need more than this?

• The Cooperative Planning Grant for Cancer
  Disparities (CDRP) Research Partnership
  strengthens the national cancer program by
  developing models to reduce negative consequences
  of cancer disparities. (25 words)

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Omit excess words

• Generally, less is more.
• Challenge every word you write. Do you really
  need it?
• Bureaucratic writing contains many unnecessary
  words.
• Eliminating excess words is a skill youll work
  on your entire writing career.

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A couple examples

• The Office of Cancer Survivorship was established
  in 1996 by the National Cancer Institute in
  recognition of the large number of individuals
  now surviving cancer for long periods of time.

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The National Cancer Institute created the Office
of Cancer Survivorship to recognize many
individuals now survive cancer for long periods.
Or even better
The Office of Cancer Survivorship recognizes the
many individuals now survive cancer for long
periods.
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Another example

• We are faced with the challenge of making sure
  that all divisions of the organization were
  aligned with the strategic direction and goals of
  the new structure.
• We need all divisions to accept the new goals and
  structure.

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And one last example

• Prevalence can also be expressed as a percentage
  and it can also be calculated for a specific
  amount of time prior to January 1, 2004 such as
  diagnosed within 5 years of January 1, 2004. (35
  words)

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• Prevalence can also be expressed as a percentage
  and calculated for a specific period before
  January 1, 2004, such as diagnosed within 5
  years of January 1, 2004. (28 words)

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Dont tell the audience what they dont need to
know

• Dietary supplements are not over-the-counter
  medicines. This can be very confusing. The part
  of the Food and Drug Administration that controls
  dietary supplements is the same part that
  controls foods sold in the United States.

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News flash!

• Readers dont care that the part of the Food and
  Drug Administration that controls dietary
  supplements is the same part that controls foods
  sold in the United States.

In general, they dont care what federal agency
is doing something. They dont care when an
organization was created. They dont care what
law a program is based on. They dont care what
the official name of the program is.
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Heres a question sent to FEMA

• I just found out that the products I have been
  using to clean my home are toxic! Have I damaged
  my health by using these products?

Do you think this is what the person needed as a
response?
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• Answer First of all, what is meant by toxicity?
  Somewhere on the order of 70,000 different
  chemicals have been identified as toxic. A
  chemical produces a toxic effect at
  concentrations that alter the normal state of the
  organism. For many chemicals, there is a dose at
  which there are no toxic effects, there is a dose
  at which the effects are reversible, and there is
  a dose at which the effects may have permanent
  consequences. An example of some toxic chemicals
  that many of us are exposed to regularly are
  caffeine, tobacco, and alcohol. At doses normally
  consumed by the average person, the "high" effect
  felt by the individual response can be quite
  different. One person may be able to drink 5 cups
  of coffee with out visible effects, while another
  person might get the shakes after 2 cups of
  coffee. This is an example of how the dose and
  response varies from one person to the next. At
  some point, each of these chemicals can have a
  much more serious effect on the individual. At
  extremely high doses . . .

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The Ministry of Health has developed Version 16
of the New Zealand Influenza Pandemic Action Plan
(NZIPAP), which is the result of 18 months of
intensive work around pandemic planning by the
Ministry of Health, district health boards and
central government agencies. The NZIPAP
recognises that Maori, Pacific peoples, and
people from lower socioeconomic groups, who have
poorer health outcomes than the rest of the New
Zealand population, may be similarly
disadvantaged in the event of a pandemic.
Therefore, work is currently underway to ensure
that the specific needs of ethnically diverse
Pacific communities are recognised and addressed,
in the event of a pandemic. This work is being
led by a multidisciplinary Pacific expert group,
including primary care and public health
clinicians, academics and community
representatives. (126 words)
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• The Ministry of Health has developed a plan to
  respond to an outbreak of pandemic flu. This plan
  recognizes that the segments of New Zealands
  population, such as the Maori and Pacific
  peoples, that currently have poorer health may be
  especially at risk in a pandemic. The plan will
  ensure that if a pandemic does occur, we can take
  care of the health needs of these peoples. (67
  words)

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Summary

• Plain language
• focuses on the reader, not the writer.
• saves the writer time and money because readers
  call or write back less often with questions.
• gives better customer service.
• gets better results.

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Questions?
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Resources
www.plainlanguage.gov www.centerforplainlanguage.o
rg www.health.gov/communicaton/literacy/
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How to reach us
Dr. Annetta Cheek acheek_at_patriot.net Joanne
Locke joannelocke_at_gmail.com