Article from the Boston Globe’s On Call Magazine, November/December 2002

By Helen Osborne, M.Ed., OTR/L
President of Health Literacy Consulting

Selecting brochures that older adults can use and learn from takes more than simply verifying the content is accurate. Health professionals need to consider the diverse abilities and challenges faced by their intended readers.

Carolyn Bottum, MPH, understands the difficulty of choosing informational materials that match the reader’s needs. As an elder healthcare consultant, she has spent a lot of time focusing on what kinds of materials are best for older adults. She says that when you choose brochures patients can’t read or relate to, you send a message you don’t intend. Patients get the idea that either they or the information is not important. Either way, the brochure will not do what it was intended to do.

To help you choose materials that will benefit the older adults you work with, Bottum offers these guidelines for you to consider.

Organization and Content

Readers shouldn’t have to search for information they need. Look for brochures that focus on essential, not extraneous, information. For example, an easy-to-read diabetes brochure will include basic information about the disease and its treatment. It will not go into detail about pathophysiology. The brochure should highlight skills and behaviors and have bulleted lists of actions readers need to take. Information should be presented in a logical order, using headers to clearly identify key points.

Learning Challenges

As people age, some are prone to health problems that affect their ability to read, process, or remember information. They may also have lifelong literacy or language limitations. To compensate for these challenges, select brochures that are simply written and designed in ways that make them easy to understand. Here are some specific language and design elements to consider:

• Word choice and sentence structure. Booklets should be written in plain language, using mostly one- and two-syllable words that readers are familiar with. Sentences should have only one idea and average no more than 15 words. Paragraphs, too, should be short, with only  three or  four sentences in each.
• Print size and color. Many older adults have difficulty seeing. Look for materials written in large print — 14-point type or bigger. At a minimum, it should be in 12-point type. There should be a “high contrast” between the color of the lettering and the color of background. Most often, black text on plain white or light-colored paper works best. As a rule, avoid materials that are overly stylized or designed to be “cutting edge.” Bottum reviewed a particularly hard-to-read document that had fancy green type on an ornate purple background. Needless to say, she did not choose it for older adults.
• Visual elements. Don’t rely just on text to convey the message. Look for brochures with visual elements that help people understand the most important information. One good device to look for is pictographs – simple line drawings that convey ideas or actions. Look also for drawings or photographs of people readers can relate to. This should be someone about the same age as the readers. It can also be a picture of a public figure that readers know and respect, such as an actor or some local figure like a police officer, firefighter, doctor, or mail carrier.

Motivation

The term “older adult” refers to people with diverse needs and goals. Some older adults, for example, are motivated by the idea of living longer. Many others, however, are more interested in preserving their independence. To appeal to readers, a brochure about fitness for homebound “older-older” adults may be more successful if it links exercise with walking to the grocery store rather than living another 15 years.

Familiarity With the Ideas

People who immigrated to this country, even 20 or 30 years ago, may be unfamiliar with traditional American concepts and slogans. Bottum recalls working on a public health campaign to encourage seniors to get flu shots. In this campaign she used the phase “Flu Shots Are Better Than Chicken Soup.” To her surprise, many seniors from Southeast Asia and Europe were not familiar with chicken soup as a home remedy and, therefore, did not understand the implied message. The lesson learned, says Bottum, is to test materials with intended readers and make sure they understand and can relate to the concepts used to present the information, as well as  the information itself.

Comfort Level

Words and pictures can sometimes make people feel uncomfortable or embarrassed. Bottum has noticed, for example, that seniors are more likely to take home a booklet entitled “Is Someone Hurting You?” than one labeled “Elder Abuse.” Consider, as well, whether readers are likely to be embarrassed by any of the drawings or illustrations. Bottum talks about an effective prostate cancer brochure that included an anatomical illustration. To be discreet, she says, a well-placed detail of the prostate covered the man’s groin area in a larger, full-figure illustration.

Lifestyle

Consider the readers’ lifestyle as well as their physical, cognitive, and emotional needs. If possible, select materials that present information in the context of people’s everyday experiences. One brochure that does this well, says Bottum, is a nutrition brochure for those who have had heart attacks. Since many of the intended readers, especially men, live alone and eat out rather than cook for themselves, this brochure included numerous “heart healthy” menu selections from local restaurants.

Interactive Features

Many brochures have interactive features such as medication log sheets readers can use to keep track of the drugs they are taking. The simpler these features are the better, says Bottum. A medication log sheet, for example, should only ask for basic information. It should be designed simply enough so that all readers, even those with mild cognitive impairments, can complete the log accurately. Make sure, too, that any fill-in-the-blank activity is designed large enough so that people with limited dexterity can easily write in the allotted spaces.

To Learn More

Carolyn Bottum, MPH, is a consultant who develops elder health programs and materials. You can reach her by e-mail at cbottum@aol.com

Sources of Information For and About Older Adults

• The Massachusetts Department of Public Health, Office of Elder Health Web site has free healthcare materials you can download and distribute. These materials include “Elder Health Tips” and an “Elder Health Alert” newsletter.  www.state.ma.us/dph/bfch/chp/oeh/ehp.htm
• The Massachusetts Health Promotion Clearinghouse Web site provides free health promotion materials for Massachusetts residents and health and social service providers in the Commonwealth. www.maclearinghouse.com
• National Institute on Aging offers “Age Pages” which you can order from: NIA Information Center, P.O. Box 8057 , Gaithersburg, MD 20898-8057