Plain Language Guidelines Research Articles

Standard HIPAA Authorization Forms Decreased Response Rates for a Multi-site Pragmatic Trial.

The Health Insurance Portability and Accountability Act (HIPAA) aims to safeguard patient information; however, complex legal language may lead to confusion and mistrust, and hinder enrollment in clinical trials. To evaluate the effect of a standard HIPAA authorization included in mailed survey packets on study enrollment for a multi-site pragmatic trial. This study is nested within an advance care planning pragmatic trial at 50 primary care clinics across three University of California (UC) Health Systems. We included English and Spanish-speaking seriously ill patients. One third of eligible patients received and 2/3 did not receive the HIPAA authorization in their enrollment packet. We compared enrollment rates at 3months and assessed the readability, understandability, and actionability of the standard HIPAA form using the Federal Plain Language Guidelines Checklist for Plain Language, the Automatic Readability Checker consensus calculator (grade 8 is the average reading level for US adults), and the Patient Education Materials Assessment Tool for Printable Materials (PEMAT-P, 0-100%, 70% considered the minimum). Of 4632 eligible patients (mean age 71, 48% women, 11% Spanish-speaking, 40% racial/ethnic minority); 1543 received a mailed enrollment packet with a HIPAA form and 3089 did not. Patients mailed the HIPAA form were less likely to enroll (10.2% vs. 14.8%, p < 0.001). The standard HIPAA form scored at the 12th grade reading level, had a PEMAT-P Understandability score of 42%, had an Actionability score of 40%, and only met 50% of Federal Plain Language Guideline Checklist items. The inclusion of a standard HIPAA authorization in mailed enrollment packets for a large pragmatic trial led to lower rates of study enrollment. This study informs how HIPAA authorization forms should be redesigned to be more accessible to patients to prevent unnecessary barriers to research enrollment.

Exploring Large Language Models to generate Easy to Read content

Ensuring text accessibility and understandability are essential goals, particularly for individuals with cognitive impairments and intellectual disabilities, who encounter problems accessing information across various mediums such as web pages, newspapers, online administrative tasks, or health documents. Initiatives like Easy to Read and Plain Language guidelines aim to simplify complex texts; however, standardizing these guidelines remains challenging and often involves manual processes. This work presents an exploratory investigation into leveraging Artificial Intelligence (AI) and Natural Language Processing (NLP) approaches to simplify Spanish texts into Easy to Read formats, with a focus on utilizing Large Language Models (LLMs) for creating accessible texts, especially in generating Easy to Read content. The study contributes a parallel corpus of Spanish adapted for Easy To Read format, which serves as a valuable resource for training and testing text simplification systems. Additionally, several text simplification experiments using LLMs and the collected corpus are conducted, involving fine-tuning and testing a Llama2 model to generate Easy to Read content. A qualitative evaluation, guided by an expert in text adaptation for Easy to Read content, is carried out to assess the automatically simplified texts. This research contributes to advancing text accessibility for individuals with cognitive impairments, highlighting promising strategies for leveraging LLMs while responsibly managing energy usage.

Simplifying informed consent as a universal precaution

One barrier to participating in clinical research is that patients with low literacy skills (1 in 5 US adults) may struggle to understand the informed consent document (ICD). Writing consents using health literacy and plain language guidelines including simplified syntax and semantics can increase understandability and facilitate inclusivity of research populations with literacy challenges. Our study aim was to evaluate a simplified ICD for understandability while considering factors known to relate to comprehension (reading skills and working memory). We performed an on-line survey of 192 adults ages 18–77 in Georgia. Participants performed significantly better on the simplified ICD test. We built an additional model with all version x measure interactions (i.e., age, sex, race, urbanicity, GMVT, WM). This model did not significantly improve model fit, F < 1.00, suggesting that individual differences did not moderate the effect of simplification. Our findings suggest that using plain language and simplified syntax and semantics in ICD as a universal precaution may reduce cognitive reading burden for adults regardless of differences in reading skill or working memory. Increasing understandability in ICD may help improve targets for clinical trial enrollment.

Clinician-Spoken Plain Language in Health Care Encounters: A Qualitative Analysis to Assess Measurable Elements.

Good communication and use of plain language in health care encounters improve outcomes, including emotional health, symptom resolution, and functional status. Yet there is limited research on how to measure and report spoken plain language, which is the use of familiar, clear language. The authors aimed to describe key, measurable elements of spoken plain language that can be assessed and reported back to clinicians for self-reflection. The authors conducted secondary analysis of transcripts from recorded encounters between breast cancer surgeons and patients with early-stage breast cancer. Two coders used a hybrid qualitative analysis with a framework based on U.S. Federal Plain Language Guidelines. To develop major themes, they examined (1) alignment with the Guidelines and (2) code frequencies within and across transcripts. They also noted minor themes. From 74 transcripts featuring 13 surgeons, the authors identified 2 major themes representing measurable elements of spoken plain language: (1) clinicians had a propensity to use both explained and unexplained medical terms, and (2) clinicians delivered information using either short turns (one unit of someone speaking) with 1 topic or long turns with multiple topics. There were 3 minor themes that were not indicative of whether or not clinicians used spoken plain language. First, clinicians regularly used absolute risk communication techniques. Second, question-asking techniques varied and included open-ended, close-ended, and comprehension checks. Third, some clinicians used imagery to describe complex topics. Clinicians' propensity to use medical terms with and without explanation and parse encounters into shorter or longer turns are measurable elements of spoken plain language. These findings will support further research on the development of a tool that can be used in medical education and other settings. This tool could provide direct and specific feedback to improve the plain language practices of clinicians in training and beyond.

Language planning issues of Hungarian legal language and the clear writing programme as a possible solution

ABSTRACT This paper discusses the ‘fuzziness’ of Hungarian legal language as an issue of language planning addressed in the Hungarian language strategy to be published by the Hungarian Research Centre for Language Planning. First, we give a concise historical overview on the status of Hungarian language in Hungary, only to make it evident how its status had a direct effect on its legal language variant, and how the characteristics of Hungarian legal language are determined by these diachronic changes even today. Second, we cannot ignore the theoretical background of legal language(s), for there are some universal traits that are present regardless of language and as such they are the fundamentals for clear writing incentives. Third, we treat clear writing incentives as language planning programmes aimed at solving issues of legal language or legal language use. These movements receive much criticism (many times rightfully so) because they lack a clear-cut theoretical basis – something we were keen to avoid. Fourth, we introduce the sources of our clear writing practices in a comparative manner, thus comparing our current clear writing programmes to that of the European Union’s Clear Writing and the United States’ Federal Plain Language Guidelines of the Plain Language Action and Information Network (PLAIN). We conclude our paper by outlining further research, monitoring necessities, and opportunities for international cooperation.

EASIER corpus: A lexical simplification resource for people with cognitive impairments.

Thanks to technologies such as the Internet and devices now available to people, we have increasingly greater access to larger quantities of information. However, people with ageing disabilities or intellectual disabilities, non-native speakers, and others have difficulties reading and understanding information. For this reason, it is essential to provide text simplification mechanisms when accessing information. Natural Language Processing methods can be applied to simplify textual content and improve understanding. These methods often use machine learning algorithms and models which require resources, such as corpora, to be trained and tested. This article presents the EASIER corpus, a resource that can be used to build lexical simplification methods to process Spanish domain-independent texts. The EASIER corpus is composed of 260 annotated documents with 8,155 words labelled as complex and 5,130 words with at least one proposed context-aware synonym associated. Expert linguists in easy-to-read and plain language guidelines have annotated the corpus based on their experience adapting texts for people with intellectual disabilities. Sixteen annotation guidelines that discriminate between complex and simple words have been defined to help other groups of experts to generate new annotations. Additionally, an inter-annotator agreement test was performed to validate the corpus, obtaining a Fleiss Kappa coefficient of 0.641. Furthermore, a qualitative evaluation was conducted with 45 users (including people with intellectual disabilities, elderly people, and a control audience). Complex word identification tasks achieved moderate results, but the synonyms proposed to replace complex words achieved almost perfect ratings. This resource has been integrated into the EASIER platform, a tool that helps people with cognitive impairments and intellectual disabilities to read and understand texts more easily.

Trial lay summaries were not fit for purpose

Background and ObjectivesTo establish if trial lay summaries are suitable for lay readers. MethodsA random sample of 60 randomized controlled trial (RCT) reports (15%) from the National Institute for Health and Care Research (NIHR) Journals Library, UK, were selected from 407 available ones. We extracted the lay summary and determined the readability using the previously validated Flesch Reading Ease Score (FRES), Flesch-Kincaid Grade Level (FKGL), Simplified Measure of Gobbledegook (SMOG), Gunning Fog (GF), Coleman-Liau Index (CLI), and Automated Readability Index (ARI) readability scales. This provided us with a reading age. We also assessed the compatibility of the lay summaries with the Plain English UK Guidelines and the National Adult Literacy Agency Guidelines, Ireland. ResultsNo lay summary met the recommended reading age for health care information of 11–12 years. None of them were considered “easy” to read, in fact over 85% were considered “difficult” to read. ConclusionThe lay summary is a key document for disseminating trial results to a broad population who may not necessarily have the medical or technical jargon to read a trial report. Its importance cannot be overstated. Assessing readability in conjunction with plain language guidelines is relatively easy and therefore an immediate change to practice is feasible. However, since specific skills are required to write lay summaries that meet the required standards, it is important that the need for such expertise is recognized and supported by research funders.

What Happens Next? Traumatic Brain Injury in the Community.

Traumatic brain injury (TBI) continues to substantially impact the lives of millions of people around the world annually. Community-based prevention and support of TBI are particularly challenging and underresearched aspects of TBI management. Ongoing cognitive, emotional, and other effects of TBI are not immediately obvious in community settings such as schools, workplaces, sporting clubs, aged care facilities, and support agencies providing homelessness or domestic violence support. This is compounded by a lack of guidance and support materials designed for nonmedical settings. Connectivity Australia, a not-for-profit organization promoting TBI awareness, research, and support, responded to this need by conducting a national survey and series of roundtables to deepen understanding of TBI awareness, challenges, and support needs across the community. The 48 survey respondents and 22 roundtable participants represented Australian departments of health; correctional services; homelessness and housing; Aboriginal and Torres Strait Islander health; community, school, and professional sports; allied healthcare and rehabilitation providers; insurance; and work health and safety. Three key themes were identified: Accessible, nationally consistent plain-language guidelines ; Building research literacy ; and Knowing your role in TBI identification and management . This commentary briefly describes these themes and their implications based on a publicly available full report detailing the study findings ( www.connectivity.org.au/resources-for-researchers/connectivity-research ).

Tools for Overcoming Oppression: Plain Language and Human-Centered Design for Social Justice

<bold xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">Background:</b> Technical and professional communication (TPC) audiences are increasingly international and intercultural. Some of these audiences, such as US asylum applicants, may be vulnerable and suffering trauma following violations of their human rights and dignity. <bold xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">Literature review:</b> TPC has the potential to either intensify the oppression previously experienced by these audiences or empower them to act for their own well-being. Therefore, technical and professional instructors and practitioners have an ethical responsibility to communicate with these audiences through methods that are socially just. <bold xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">Research questions:</b> 1. Are the language and design strategies in the I-589 application and instructions appropriate for their audience from an HCD perspective? 2. If not, how can the documents be revised to correct any failings in the pursuit of social justice? <bold xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">Research methodology:</b> This article uses adapted plain language guidelines combined with human-centered design guiding principles to perform a qualitative document analysis and explore revisions of the application and instructions. <bold xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">Results:</b> Analysis shows that the I-589 documents are not appropriate for their audience and proposes revisions to correct major issues. <bold xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">Conclusions:</b> The findings of this analysis demonstrate a need for continued integration of plain language and human-centered design in practice and pedagogy, research surrounding the ways in which technical and professional communicators should balance the needs of vulnerable audiences with the interests of powerful stakeholders, and meaningful collaboration between them and government institutions.

Double Dutch Finally Fixed? A Large-Scale Investigation into the Readability of Mandatory Financial Product Information

With the introduction of short-form disclosure documents, financial regulation in the EU emphasizes the use of plain language to facilitate comprehensibility. We evaluate whether these documents and the accompanying plain language guidelines improve the readability of mandatory product information addressed to mutual fund investors. Applying advanced text mining algorithms, we benchmark the readability of product information by means of objective and readily replicable methods. While mutual fund information on average does not come in plain language, we find that readability improved significantly following the introduction of Key Investor Information Documents (KIIDs). Improvements are driven by simpler syntax and writing style. By contrast, the authors find that the use of jargon remains pervasive and report noncompliance with mandatory design requirements. We discuss our results and propose potential disclosure improvements.

Plain language practices of professional writers in Quebec

This article investigates the plain language practices of professional writers in Quebec, using a survey. We contacted 55 professional writers and asked them to complete an online survey about how they apply plain language in their work, and the type of writing assistance they would find useful. We also asked 40 of those writers to carry out a simplification task to see what kind of simplifications they were actually making.&#x0D; If the feelings about the reality of the writers’ work is in line with the literature, opinions on plain language guidelines are not. Most writers in our survey find them useful and precise enough, and this contrasts with reported criticisms of such guides. In the simplification task, we noticed that writers focus on the overall understanding of the text, and not only on some linguistic characteristics (as shown in plain language guidelines). The more experienced the writer, the more changes they will make to visual/structural aspects or relational efficiency. Putting the focus on the reader’s needs is their main concern.

Towards Equitable Communication of Kinesiology: A Critical Interpretive Synthesis of Readability Research

ABSTRACT Thirty-nine years ago, Bain and Poindexter (1981) implored higher educators of kinesiology to develop curricula that prepare students to use what they learn in practical ways. Lay resource material, however, often fails to meet metrics for adequate-to-optimal readability, regardless of who produces them. Research suggests that many people trained in kinesiology are not trained to communicate its content to lay adult audiences. Thus, the purpose of this study was to advance knowledge about this academic-practice-divide in kinesiology concerning plain language communication. Methodology for a critical interpretive synthesis was used to qualitatively synthesize readability research in kinesiology. Twenty-four peer-reviewed research articles met the study inclusion criteria, all published between 1992 and 2020 (M = 2010.1, SD = 8.8). There were 1550 materials studied across the articles. It was typical for these materials to run counter to plain language guidelines (i.e., low readability in one-or-more critical areas). Most materials were unsuitable for adults with basic health literacy or less – about half of the U.S. adult population. Following their presentation of results, the article authors often suggested one of six ways for improving lay material readability. Two major themes emerged from the qualitative synthesis of the articles: (a) how article authors discussed readability issues and what they proposed to be done to fix them, and (b) critiques of the research articles included in this study. The findings of this literature review shine light on the need to use readability research in kinesiology in programs that train people in an area of the discipline.

Helping the helpers: Evaluating the impact of a controlled language checker on the intralingual and interlingual translation tasks involving volunteer health professionals

ABSTRACTCochrane is a non-profit organization which mainly relies on volunteer health professionals for the production, simplification, evaluation, and multilingual dissemination of high-quality health content. The approach that Cochrane volunteers adopt for the simplification (or intralingual translation) of English health content is non-automated and involves the manual checking and implementation of plain language guidelines. This study investigated whether and to what extent the introduction of a controlled language (CL) checker – which would make the simplification approach semi-automated – increased authors’ satisfaction and machine translation (MT) quality. Twelve Cochrane authors completed a standardized questionnaire and answered follow-up questions on their level of satisfaction and preferences. Forty-one Cochrane evaluators assessed the quality of the Spanish MT outputs of simplified texts. Authors showed a preference for the introduction of a CL checker. Differences in MT quality scores were slight.

Use of Plain-Language Guidelines to Promote Health Literacy

Research problem: Studies by the American Institute of Medicine and the European Health Literacy Survey describe considerable levels of either inadequate or problematic health literacy. This health literacy problem is intensified when frontline healthcare practitioners must rely on printed education materials to compensate for the lack of time to instruct patients about their health management. Applying plain-language guidelines to health promotion materials may increase their effectiveness, particularly for patients with low health literacy. Research questions: 1. In what ways have plain-language guidelines been applied in health information materials for patients with varying degrees of health literacy, according to recent studies? 2. Have studies found that materials that apply plain-language guidelines are effective in health information promotion? Methodology: This article presents the findings from an integrative literature review of research into the use of plain language to promote health literacy. The systematic review identified scholarly, evidence-based studies that included reference to the use of plain-language guidelines. This article describes the detailed selection process and characterizes the corpus of articles along four dimensions: objectives, methodology, plain-language guidelines used, and findings. Results and conclusions: The review identified 13 articles that explored the use of plain-language guidelines in health literacy promotion. Analysis of these articles demonstrates that plain-language guidelines could play a strategic role in educating patients. Use of plain language could help healthcare practitioners to communicate critical and sometimes very complex health information effectively.

The Social Justice Impact of Plain Language: A Critical Approach to Plain-Language Analysis

Introduction: This study investigates how plain language, examined from a social justice perspective, is implemented in mortgage documents and what the implications are for African-American homebuyers. About the case: We argue that plain language has the potential to engage issues of human dignity and human rights because language accessibility in documents plays a large role in how citizens engage in civic and social activities. In regard to the home ownership process, in which African-American homebuyers are more likely to experience discrimination, we need a study of the implementation of plain language in documents that might contribute to communication breakdowns between the banking industry and this historically marginalized group. Situating the case: We examine plain language from a social-justice stance by turning a more critical eye toward how and why plain-language guidelines are implemented. Methods/approach: Our study focused on the initial disclosure statements for adjustable-rate mortgages. We paired critical discourse analysis with the Securities and Exchange Commission's Plain English Handbook guidelines for disclosure statements to analyze three disclosure statements. Results/discussion: We found that, generally speaking, each of the three disclosure statements effectively adhered to plain-language recommendations. However, the idea that plain language increases accessibility, reader comprehension, and usability is complicated, and the accessibility and usability of each document varied. Conclusions: We advocate for a human-centered approach that explores ways that plain-language guidelines can be applied along with a critical focus on amplifying agency and reducing inequity.

Unpacking the Right to Plain and Understandable Language in the Consumer Protection Act 68 of 2008

The Consumer Protection Act 68 of 2008 came into effect on 1 April 2011. The purpose of this Act is, among other things, to promote fairness, openness and respectable business practice between the suppliers of goods or services and the consumers of such good and services. In consumer protection legislation fairness is usually approached from two directions, namely substantive and procedural fairness. Measures aimed at procedural fairness address conduct during the bargaining process and generally aim at ensuring transparency. Transparency in relation to the terms of a contract relates to whether the terms of the contract terms accessible, in clear language, well-structured, and cross-referenced, with prominence being given to terms that are detrimental to the consumer or because they grant important rights. One measure in the Act aimed at addressing procedural fairness is the right to plain and understandable language. The consumer’s right to being given information in plain and understandable language, as it is expressed in section 22, is embedded under the umbrella right of information and disclosure in the Act. Section 22 requires that notices, documents or visual representations that are required in terms of the Act or other law are to be provided in plain and understandable language as well as in the prescribed form, where such a prescription exists. In the analysis of the concept “plain and understandable language” the following aspects are considered in this article: the development of plain language measures in Australia and the United Kingdom; the structure and purpose of section 22; the documents that must be in plain language; the definition of plain language; the use of official languages in consumer contracts; and plain language guidelines (based on the law of the states of Pennsylvania and Connecticut in the United States of America).&#x0D;

Preventing and controlling human noroviruses in South Carolina long-term care facilities: An analysis of institutional policies and procedures

Long-term care (LTC) facilities are the number one setting for human norovirus (HuNoV) outbreaks in the United States (60%). We aimed to determine alignment of policies and procedures in LTC facilities in South Carolina with Centers for Disease Control and Prevention (CDC) recommendations and to determine readability based on Federal Plain Language Guidelines and Microsoft Word readability statistics. Most facilities (n = 21) had procedures for hand hygiene, but recommendations for handwashing events and duration varied greatly. Less than half (n = 11) had separate procedures devoted to HuNoV outbreak control. Fifteen required disinfection of bodily fluids. Seven had procedures for exclusion of sick staff during an outbreak. Both hand hygiene and bodily fluid cleanup procedures had low mean scores for readability. Mean Flesch Reading Ease and Flesch-Kincaid Grade Level for both procedures were in the range of difficult to understand. Most LTC policies and procedures were not consistent with CDC recommendations for HuNoV. Moreover, readability of all procedures is needed so LTC workers can easily understand and implement prevention and control procedures.

From the Editor in Chief

O N E of the least-noted pieces of legislation from the last Congress was the Plain Writing Act of 2010 (Public Law 111-274). The law resulted in a document, Federal Plain Language Guidelines (Plain Language Action and Information Network, 2011), that makes for interesting (dare I say provocative?) reading for those involved in academic writing and those considering submitting manuscripts to The Elementary School Journal. Although this law was intended to apply only to communications and reports from the federal government, it has serious implications for our field that go well beyond the language used in public documents and the lengthy technical reports that accompany major federal evaluations. I believe these guidelines could help many more professionals in the field understand what researchers have accomplished. Rather than address all the points made by the authors of the Guidelines, I will highlight a few and supplement them with material from a recent New York Times blog that included tips for writers (Hale, 2012). Though the federal documents and Constance Hale’s New York Times blog are written in radically different styles, they share a common purpose—the pursuit of clarity. Both aspire to guide authors in how to communicate the often-complex material we address in clear and comprehensible language. In other words, how can we write so that readers do not have to read and reread the same paragraph several times to comprehend the material? How can we write in a way that lets readers understand the purpose of the article and remember the salient findings? Obviously, writing skills develop over time and require a good deal more than adherence to a small set of writing tips and guidelines. Nonetheless, these guidelines can help. In this piece, I will describe a few. Others can be found in the sources. The emphasis will be on those that matter the most to me or that I have found the most helpful. 1. Excess verbiage: Hale notes, “Writing style begins with clarity: Find the right words, and decide what to leave out” (2012). Focus heavily on removal of excess verbiage; from the Guidelines: “Unnecessary words waste your audience’s time. . . . great . . . content is like a conversation. Omit information that

Plain Language in Environmental Policy Documents: An Assessment of Reader Comprehension and Perceptions

Several government agencies are seeking quality improvement in environmental policy documents by asking for the implementation of Plain Language (PL) guidelines. Our mixed-methods research examines whether the application of certain PL guidelines affects the comprehension and perceptions of readers of environmental policy documents. Results show that the presence of pronouns affects inferential comprehension of environmental impact statement summaries (EIS summaries), but that the effect varies with the reader's education level. Further, headings in question phrasing affect a reader's perception of familiarity and reliability of EIS summaries. A reader's perceptions of EIS summaries and attitudes toward the organizations creating the documents are also affected by overall design features. PL guidelines on the use of pronouns and question headings are not fully supported by our research and need further validation with regard to comprehension. This article ends with a call for further research.

Writing As A Survival Skill: How Neuroscience Can Improve Writing In Organizations

This article looks at the apparent paradox between the demand for strong writing skills and the lack of colleges of business that require their MBA students to complete writing courses. In the past, most approaches to teaching writing proved inadequate in producing graduates with the ability to write clearly, effectively, and efficiently. This article examines the implications of neurocognitive research on the reading process for the teaching of writing and ends with a set of 16 guidelines for teaching MBA students how to write well - principles that reach far beyond those specified in the SEC’s plain language guidelines.