Use Of Plain Language Research Articles

Overcoming Language Barriers in Contracts – A South African Perspective

Language forms the basis of written contracts, but the use of language may also function as a barrier to contracting parties, particularly when the parties are not proficient in the commercial language of choice, such as English in the case of South Africa. The plain language movement and specifically legislative interventions have placed significant pressure on lawmakers to reform the use of traditional legal English, and consequently, traditional drafting styles. However, many contracts continue to exhibit convoluted language, legalese and poor visual appeal, which ultimately functions as a language barrier for many people. This article examines the various language barriers that exist in contracts from a South African perspective. It does so by assessing the barriers that exist under first, the common law (or the so-called default rules), second, the use of standard contracts, and third, the resistance to the use of plain language as well as the limited application of existing plain language legislation in certain types of contractual engagements. The author proposes dismantling the language barriers by adopting both textual and visual communication devices in order to achieve clear and comprehensible language in all types of contracts. Furthermore, it is suggested that such communication devices should not necessarily be limited to consumer contracts that are legislatively required to comply with plain language requirements. It is only by dismantling existing language barriers that social justice within contracts can be achieved in a society with diverse language proficiencies, such as South Africa. Therein, this article offers insights that are relevant not only within the South African context but also for countries that may face similar language barriers characterised by multiple languages and varying language proficiencies within their populations.

Guidance on the Effective Collaboration With Interpreters and Translators in Speech-Language Pathology

Purpose: The purpose of this literature review is to guide speech-language pathologists (SLPs) on how to increase effective collaboration with interpreters and translators in order to enhance communication with clients and significant others from culturally and linguistically diverse backgrounds. Method: A review of definitions of interpretation and translations and practical guidance on certifications and collaborative practices within a health literacy framework approach is described. Strategies to build effective and ethical SLP–interpreter/translator working relationships are reviewed. Results: Findings emphasize the importance of interprofessional collaboration between SLPs and interpreters/translators. When working with professional interpreters/translators, SLPs application of a brief–intervention–debrief framework, use of plain language, and knowledge of local and national training and practice requirements, are identified as mechanisms to enhance effective and ethical collaboration. Conclusion: Effective collaboration with interpretation and translation services should be a key component of clinical practice to ensure that health information is clearly understood by clients and families.

Mastering the art of technical writing in it: Making complex things easy to understand in Atate campus

This research, conducted at the Atate Campus of Nueva Ecija University of Science and Technology, delves into the realm of technical writing within the Information Technology (IT) sector, focusing on the pedagogical strategies that facilitate the comprehension of complex technical topics by IT students. It seeks to uncover the challenges IT students face when engaging with technical documentation and the effective methods to surmount these obstacles. Through a qualitative and quantitative analysis involving a survey distributed to 100 IT students across various academic years, the study identifies significant challenges such as conceptual complexity, jargon prevalence, and the need for audience-tailored documentation. The research highlights best practices like the use of plain language, visuals, real-world examples, and the critical role of user testing in enhancing document clarity and understandability. Furthermore, it examines preferences in writing styles and document structures, offering insights into effective technical communication tailored to diverse audience needs. This study proposes a set of recommendations aimed at improving technical writing curriculum and pedagogy, encouraging future research, and fostering a deeper understanding of technical subjects among IT students through enhanced technical writing skills.

Strategies to develop an LGBTQIA+-inclusive adolescent sexual health program evaluation.

Adolescent sexual health interventions are increasingly incorporating content that is inclusive of LGBTQIA+ youth (lesbian, gay, bisexual, transgender, queer/questioning, intersex, asexual, and other marginalized sexualities and genders). Evaluations of such programs must also be inclusive to enhance the validity of evaluation results and avoid further marginalization. We present strategies for increasing LGBTQIA+-inclusivity based on our evaluation of SafeSpace, a sexual health curriculum. To design an LGBTQIA+-inclusive program evaluation, we leveraged LGBTQIA+ research staff's insights, pursued a parental consent waiver, developed an inclusive recruitment plan, and crafted demographic and sexual behavior survey measures with input from youth and equity experts. We conducted a pilot study with 42 youth ages 14-17 to assess the feasibility and efficacy of our strategies. We obtained a parental consent waiver and recruited a majority LGBTQIA+ pilot study sample (62%). Using themes from cognitive interviews with youth and experts regarding inclusive framing and use of plain language, we refined demographic measures and expanded sexual behavior measures. Findings suggest that the strategies used to enhance LGBTQIA+-inclusivity in our evaluation of SafeSpace were effective in respectfully and more accurately capturing a fuller range of experiences and identities of LGBTQIA+ and cis-straight youth. The strategies and survey measures developed for this study can be applied to increase LGBTQIA+-inclusivity in other adolescent sexual health program evaluations.

The Making of the International Standard for Writing in Plain Language ISO 24495-1: Its Usefulness, Content, and How It Came into Existence

There is ample evidence across many domains that writing in plain language saves time or money or both for readers and organizations. Communication in plain language is generally more effective and produces better outcomes than traditional writing. In many contexts, readers prefer plain language over traditional writing styles, and use of plain language fosters the building of trust. Finally, the process of translating is usually more efficient for plain language documents. In July 2023, after many years of development, discussion, and alignment, the International Organization for Standardization (ISO) published a standard for plain language. This publication makes an internationally developed and agreed-upon standard available to all people interested in the use of plain language. It is an authoritative source developed by plain language practitioners, linguists, technical writers, designers, and text creators from many different countries. The standard will help all writers (authors) to make their texts (documents, web pages, etc.) most useful for the intended audiences (readers, users). It applies to most written languages and reflects the most recent research on plain language and the experience of plain language experts.

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.

Plain language in web questionnaires: effects on data quality and questionnaire evaluation

ABSTRACT In web surveys, no interviewer is present to clarify question comprehension problems, which can be particularly prevalent among respondents with low literacy skills. Although plain language is used in various contexts to improve text comprehensibility, its use in social science questionnaires has not been investigated to date. Using a between-subjects design, we compared the use of plain language and standard language in a web questionnaire in terms of data quality and respondents’ evaluation of the questionnaire. Plain language did not generally have a positive effect on data quality and questionnaire evaluation. However, in the plain-language condition, we found less item nonresponse and more response differentiation among respondents who spoke a language other than German at home, which suggests that especially respondents who likely have low literacy skills benefit from plain language. Based on our findings, we outline opportunities for future research and give practical recommendations.

Lessons from a plain language analysis: U.S. Clean Air Act Title V public notices as barriers to environmental justice

The Clean Air Act’s Title V program offers opportunities for the public to participate in permit-related decision-making in a handful of ways, but this process rarely leads to substantive changes that prioritize environmental justice (EJ) in overburdened communities. Efforts to increase the use of plain language may be one strategy for improving public participation—as a tool for improving access to the process but also to increase transparency and accountability. We conducted a content review and thematic analysis of Title V public notices across 20 states representing all 10 EPA regions. Our analysis considered the following variables: accessibility and navigability; audience and purpose; overall design and organization; and language and word choice. We also coded for themes related to the actionability of public participation processes and ways documents addressed environmental health and justice. We learned that public notices were often written poorly and, on average, for readers with a college reading level. Little to no attention was given to writing strategies that could improve understanding, such as minimizing jargon, utilizing basic information design principles, and communicating clear processes and timelines. References to specific pollutants were largely lacking, with no acknowledgement of public health and cumulative impacts. With these lessons, we provide specific suggestions to improve public notices. Plain language is needed to bring public participation processes into alignment with increased agency efforts to work in earnest towards EJ. Although political, legal, and organizational barriers may persist, U.S. environmental agencies at all levels must begin working towards becoming environmental health literate organizations.

The challenges of radiotelephony communication and effective training approaches: A study of Korean pilots and air traffic controllers

The utilisation of Aviation English is paramount in ensuring the safety and efficiency of the aviation industry, and it serves as a preventative measure against incidents and accidents related to communication. This study examines the challenges in radiotelephony communication faced by Korean pilots and air traffic controllers, who are English as a second language (L2) speakers. The study aims to identify the causes of communication difficulties and to explore effective English educational materials to mitigate these difficulties. The research employed a questionnaire to gather the perspectives of pilots and controllers, who are experts in the aviation industry, regarding the issues. The results indicate that communication difficulties are caused by a lack of English language proficiency, excessive use of plain language, rapid rate of speech, and accents that deviate from standard English. Moreover, the results suggest that practical training, using materials such as real transmission voice recordings and diverse vocabulary resources, can enhance speaking and listening comprehension skills in non-routine situations. This study provides valuable insights for the development of effective training programs and materials, which could help reduce communication difficulties and improve the safety and efficiency of aviation operations.

Standardy prostego języka i jego wpływ na jakość obsługi klienta KRUS Standards of plain language and its impact on the quality of customer service of the Agricultural Social Insurance Fund (KRUS)

The quality of service in government offices has long been a subject of research and discussion. Public administration units are introducing many changes in their operation to ensure better and faster service delivery. The good image of an office is created primarily by the competence of its employees. It is worth noting that the provision of services by government officials is not an easy task. A very important aspect of working in any office is the communication process. The use of plain language principles facilitates communication between officials and customers. This is the way recommended by experts and advocates of the idea of simplifying public communication. The purpose of this article is to show how the use of plain language in the office affects the quality of customer service. To achieve the assumed objective, a survey among KRUS customers was conducted using a face-to-face survey method. The article introduces the customer in public administration and definitions of terms such as administration, customer, service and quality. The process of communication using plain language principles was also presented. Before the article was written, a review of the available literature on public administration and plain language standards had been conducted. References were made to the works of Marek Bugdol, Tomasz Piekot, the article “Customer at the heart of administration”, and the Integrated Management System of the Agricultural Social Insurance Fund, among others.

Digital encounter decision aids linked to clinical practice guidelines: results from user testing SHARE-IT decision aids in primary care

BackgroundEncounter decision aids (EDAs) are tools that can support shared decision making (SDM), up to the clinical encounter. However, adoption of these tools has been limited, as they are hard to produce, to keep up-to-date, and are not available for many decisions. The MAGIC Evidence Ecosystem Foundation has created a new generation of decision aids that are generically produced along digitally structured guidelines and evidence summaries, in an electronic authoring and publication platform (MAGICapp). We explored general practitioners’ (GPs) and patients' experiences with five selected decision aids linked to BMJ Rapid Recommendations in primary care.MethodsWe applied a qualitative user testing design to evaluate user experiences for both GPs and patients. We translated five EDAs relevant to primary care, and observed the clinical encounters of 11 GPs when they used the EDA with their patients. We conducted a semi-structured interview with each patient after the consultation and a think-aloud interview with each GPs after multiple consultations. We used the Qualitative Analysis Guide (QUAGOL) for data analysis.ResultsDirect observations and user testing analysis of 31 clinical encounters showed an overall positive experience. The EDAs created better involvement in decision making and resulted in meaningful insights for patients and clinicians. The design and its interactive, multilayered structure made the tool enjoyable and well-organized. Difficult terminology, scales and numbers hindered understanding of certain information, which was sometimes perceived as too specialized or even intimidating. GPs thought the EDA was not suitable for every patient. They perceived a learning curve was required and the need for time investment was a concern. The EDAs were considered trustworthy as they were provided by a credible source.ConclusionsThis study showed that EDAs can be useful tools in primary care by supporting actual shared decision making and enhancing patient involvement. The graphical approach and clear representation help patients better understand their options. To overcome barriers such as health literacy and GPs attitudes, effort is still needed to make the EDAs as accessible, intuitive and inclusive as possible through use of plain language, uniform design, rapid access and training.Trial registrationThe study protocol was approved by the The Research Ethics Committee UZ/KU Leuven (Belgium) on 31–10-2019 with reference number MP011977.

Physicians’ use of plain language during discussions of prostate cancer clinical trials with patients

ObjectiveThis study described physicians’ use of plain language during patient-physician cancer clinical trial discussions. MethodsVideo-recorded clinical interactions and accompanying transcripts were taken from a larger study of communication and clinical trials (PACCT). Interactions (n = 25) were selected if they included invitations to participate in a clinical trial. We used descriptive, qualitative discourse analysis, a method that identifies language patterns at or above the sentence level. We first excerpted discussions of clinical trials, then identified instances of plain language within those discussions. Finally, we inductively coded those instances to describe physicians’ plain language practices. ResultsThe analysis identified four plain language practices. Lexical simplification replaced medical terminology with simpler words. Patient-centered definition named, categorized, and explained complex medical terminology. Metaphor explained medical terminology by comparing it with known concepts. Finally, experience-focused description replaced medical terminology with descriptions of patients’ potential physical experiences. ConclusionThese plain language practices hold promise as part of effective information exchange in discussions of cancer clinical trials. Testing is needed to identify patient preferences and the extent to which these practices address patient health literacy needs. Practice ImplicationsPending further testing, these plain language practices may be integrated into physician clinical trial and other communication training.

El lenguaje claro en la doctrina jurídica: conveniencia de su aplicación en un supuesto de comunicación entre especialistas

The purpose of this article is to defend the point that it is benefitial to use plain language in communications between experts. It is generally alleged that the basis to use plain language in law is the imbalance between the two extremes of the communicative situation—specialists and nonspecialists. Specialists must write thinking of the intended reader of their texts, with the idea that even people without a legal background should be able to understand. While valid in communications between specialists and nonspecialists, this assumption cannot justify the use of plain language in legal scholarship. Legal scholarship is a communicative situation among specialists or between a specialist and a specialist-to-be, i.e., a student. To show this point, five drafting issues are included which are recurrent in legal scholarship, and alternative wordings in plain language are suggested.

Readability and comprehensibility of Malaysian construction contracts

The international construction industry is projected to grow at a compounded annual rate of 4.2% between 2018 and 2023 valued at USD 10.5 trillion. This growth is marred by increasing disputes. In parallel, the use of plain language has been increasing, although construction contracts have been slow to adapt. This affirms the need for this research. It adopted a combined qualitative and quantitative study to establish the potential of adopting the use of plain language in construction contacts. This research investigated readability and comprehensibility of construction contracts by primary users in the rapidly developing construction industry in Malaysia. Four traditionally styled and one plain-language construction contracts were tested using a text-based cognitively inspired readability and complexity tool. Then, 36 primary users of the documents determined the comprehensibility of these contracts through cloze testing. The users’ own evaluation of the contracts was compared against the measured complexity of the contracts. The plain language contract was superior in both text-based and reader-based testing. The combined testing approach provides strong evidence of the potential benefits of adopting plain language to improve both readability and comprehensibility of construction contracts. This could also benefit the industry through potential reduction in disputes.

Commentary: Standard of Care During a Crisis: What Should a Surgeon Know (and Do)?

Commentary: Standard of Care During a Crisis: What Should a Surgeon Know (and Do)?

Enhancing patient and public contribution in health outcome selection during clinical guideline development: an ethnographic study

BackgroundPatient and public involvement (PPI) is a cornerstone in enhancing healthcare research and delivery, including clinical guideline development. Health outcomes concern changes in the health status of an individual or population that are attributable to an intervention. Discussion of relevant health outcomes impacts the resulting clinical guidelines for practice. This study explores how the input of PPI contributors at the National Institute of Health and Care Excellence (NICE) is integrated into guideline development, particularly in relation to health outcome selection.MethodsThe study used an ethnographic methodological approach. Data comprised: observations of committee meetings, scoping workshops and training sessions, and in-depth interviews with PPI contributors, health professionals and chairs from clinical guideline development committees. Data were analysed thematically.ResultsPPI contributors’ input in the guideline development process was often of limited scope, particularly in selecting health outcomes. Key constraints on their input included: the technical content and language of guidelines, assumed differences in the health-related priorities between PPI contributors and health professionals, and the linear timeline of the guideline development process. However, PPI contributors can influence clinical guideline development including the selection of relevant health outcomes. This was achieved through several factors and highlights the important role of the committee chair, the importance of training and support for all committee members, the use of plain language and the opportunity for all committee members to engage.ConclusionsLay member input during the outcome selection phase of clinical guideline development is achievable, but there are challenges to overcome. Study findings identify ways that future guideline developers can support meaningful lay involvement in guideline development and health outcome selection.

A Curriculum, Instruction, and Assessment (CIA) Framework for Health Literacy Education (HLE) in Medical and Health Professions Schools

There is increasing need to implement Health Literacy Education (HLE) as essential curriculum content in medical and health professions schools, supported by skill-based instructional strategies and authentic assessments. This paper reviews two decades of historical progress in health literacy and advances a new conceptual model to organize Curriculum, Instruction, and Assessment (CIA) themes for Health Literacy Education (HLE). Three themes are integrated into the Health Literacy Education (HLE) curriculum: 1) interprofessional communication in HLE, 2) cultural and linguistic competencies in HLE, and 3) a language typology that informs HLE. Two pedagogical themes are integrated into HLE instruction: 1) skill-based instructional strategies to improve oral communication (n = 7), and skill-based instructional strategies to improve written communication (n = 3). Skill-based instructional strategies to improve oral communication of medical and health professions students includes use of plain language, use of Teach Back or Show Me, encourage patients to ask questions, use medical interpreters and translators, be an active listener, respond with empathy when breaking bad news to patients, and use Chunks and Checks method. Skill-based instructional strategies to improve written communication of medical and health professions students includes write in plain language, evaluate written materials, and use pictures or visual aids to aid patient understanding. Two themes are integrated into HLE assessments: 1) formative assessment, and 2) summative assessment. The paper promotes the Curriculum, Instruction, and Assessment Framework for Health Literacy Education (CIA-HLE) for use by faculty in medical and health professions schools to ensure their students are well prepared to use oral and written communication with their patients as guided by selected research studies and initiatives. To further advance interprofessional collaboration and dialogue across the medical and health professions, a language typology and a knowledge typology are provided as building blocks to health literacy education.

Development of communication tool for resident- and family-led care discussions in long-term care through patient and family engagement.

BackgroundEffective communication between residents (older adults), families, and the healthcare team supports person‐centred care. However, communication breakdowns can occur that can impact care and outcomes. The aim of this paper is to describe a feedback approach to developing a communication tool for residents and families to guide information sharing during care discussions with the healthcare team in long‐term care.MethodsDevelopment of the communication tool included consultation with key stakeholders for their feedback and input. Following initial development of the tool template by our research team, we invited feedback from our study collaborators. Next, individual interviews and a focus group were conducted with family members, followed by individual interviews with selected residents from two long‐term care homes in Ontario, Canada. Participants were asked to provide input and feedback on the tool's content and usability and to share ideas for improving the tool. Content analysis was used to analyse the interview data.ResultsFeedback from residents and family included suggestions to enhance the tool's content and use of plain language, and suggestions for potential application of the tool.ConclusionFeedback highlighted the value of engaging residents and family members in the development of a communication tool. The communication tool offers a structured format to support participation of residents and families in information sharing for care discussions with the healthcare team.

Adopting Consensus Terms for Testing in Precision Medicine.

PURPOSEDespite the well-understood benefits of biomarker and genetic testing in precision medicine, uptake remains low, particularly for patients with low socioeconomic status and minority ethnic backgrounds. Patients report having limited familiarity with testing terminology and may not be able to accurately explain testing's role in treatment decisions. Patient confusion and lack of understanding is exacerbated by a multiplicity of overlapping terms used in communicating about testing. A LUNGevity Foundation–led working group composed of five professional societies, 23 patient advocacy groups, and 19 industry members assessed and recommended specific terms for communicating with patients on testing for tumor characteristics and germline mutations.METHODSMembers completed a precision oncology testing framework analysis (biomarkers, germline variants, testing modalities, biospecimen, and commonly used testing terms) for nine solid tumors and blood cancers. The evaluation was segmented into terms that distinguish between somatic and germline testing. Additional data were captured in a comprehensive survey (1,650 respondents) led by FORCE (Facing Our Risk of Cancer Empowered) on patient preferences on germline testing terms.RESULTSThirty-three terms were noted in patient education related to biomarker, genetic, and genomic testing. Biomarker testing was selected as the preferred term for testing for somatic (acquired) alterations and other biomarkers. Genetic testing for an inherited mutation and genetic testing for inherited cancer risk were selected as the preferred terms for testing for germline variants.CONCLUSIONDemocratizing comprehension about precision oncology testing through intentional use of plain language and common umbrella terminology by oncology health care providers and others in the oncology ecosystem may help improve understanding and communication, and facilitate shared decision making about the role of appropriate testing in treatment decisions and other aspects of oncology care.

Assessing Teach-Back Utilization in a Downtown Medical Center.

Background:The St. Vincent Charity Medical Center's Patient and Family Education Policy directs staff to provide patients with easy-to-understand written and verbal communication. This includes using plain language and Teach-Back. Teach-Back—or asking patients to explain in their own words what they have learned—is a best practice that health care professionals use to ensure patient understanding. The effective use of plain language is key to using Teach-Back successfully. From random audits, we could assess whether staff were documenting their use of Teach-Back. We had not, however, ascertained whether that documentation was a true account of the use of Teach-Back.Brief description of activity:We created a three-part project to (1) assess staff knowledge and use of Teach-Back, (2) assess and address barriers to use of Teach-Back, and 3) assess patients' recall of their providers using Teach-Back.Implementation:Internal medicine resident physicians (hereafter termed “residents”) and nurses completed an anonymous, online survey regarding their experience with Teach-Back. After vetting, these responses were integrated into mandatory provider training. Focusing on health literacy and Teach-Back, the training addressed barriers, reinforced positive experiences, and tailored practice encounters to patients. We then randomly surveyed inpatients to assess their recall of their providers using Teach-Back.Results:The majority (96.3%) of providers indicated that Teach-Back should be used frequently. Only 79.9%, however, reported using Teach-Back. Providers regarded Teach-Back as important and rated their confidence level as high. Providers also reported barriers to Teach-Back. Of the 135 patients surveyed, 46% recalled their providers using this method.Lessons learned:We note a gap between providers' self-reported use of Teach-Back and patients' recall of their providers using it. Providers may be overstating their utilization rate. The survey, further, assessed patients at random points in their hospital stays, to include those who had not yet received Teach-Back education. These factors could contribute to the observed discrepancy. Most notably, results confirmed our position that regular provider training helps address barriers and misconceptions about Teach-Back. [HLRP: Health Literacy Research and Practice. 2021;5(3):e226–e232.]Plain Language Summary:Our Health Literacy Institute was created in 2007 after receiving a grant to institutionalize health literacy across the continuum of patient care. Health literacy refers to a person's ability to obtain, understand, and process basic information, which empowers them to make appropriate health decisions.