On Call Magazine
May 29, 2007

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

Oddly enough, health literacy came to mind when I recently visited the elephant house at the Chicago Zoological Society’s Brookfield Zoo. I had a question about the exhibit and then suddenly noticed the answer on a sign right in front of me. It was so well placed it made me wonder what we in healthcare might learn from signage at zoos.

To find out, I contacted Jo-Elle Mogerman, vice president of planning and community relations for the Chicago Zoological Society, and Andre Copeland, the society’s public programs manager, and asked if we could discuss how what they do with signs might be adapted for a healthcare setting.

Mogerman and Copeland told me that “signage” is a term used for both “wayfinding” (signs that point people to specific places) and “interpretives” (short, explanatory statements). They then explained the role of design, wording, and placement of signs in helping zoo visitors get where they want to go and learn while they’re getting there. Here are some key concepts we discussed, along with suggestions for how they might be applied in healthcare.

Take care of the basics first

Consider Maslow’s hierarchy of needs. When planners think about what signs to place where, they ask what is most important to a visitor at any particular point. For instance, when people enter the Brookfield Zoo, two of the first things they want to know are where are the bathrooms and where can they get something to eat. Consequently, the zoo places signs directing people to these facilities right at the entrance. “Once their basic needs are met,” Copeland says, “people can enjoy themselves and have a good time.”

The same principle—considering what is foremost on someone’s mind—will work in healthcare settings. When new patients come into a hospital, for instance, they want to know where to go to register or check in. Families and visitors are likely to have questions about visiting hours and finding a patient. But the principle applies to more than just placing signs. A patient who comes to a clinic because of a new health concern might have specific questions about what’s going on. Once those basic questions are answered, that patient will be far more receptive to other information you may want to present.

Make information personally relevant

How would you explain the importance of spiders to someone who may be averse to seeing them up close? Keep in mind people come to zoos mainly to have fun, not necessarily to learn. Also keep in mind that many people feel uneasy around arachnids. Here’s how Copeland demonstrated the approach they use at the zoo.

First, he asked me, “Do you like wheat?” I told him yes, and then he asked, “What kind?” “Cereal and bagels,” I said, wondering what this had to do with spiders. Then he said, “Did you know that the Brookfield Zoo is located in the heart of the U.S. grain capital? If you like cereal and bagels, you should definitely find a place in your heart for spiders.” He followed that up by explaining that spiders eat about 1 billion crop-destructive insects per acre of farmland each year. “Without spiders,” he said, “there would be more crop destruction resulting in either less grain or greater pesticide use.”

Now, after this digression, you may be wondering what spiders and crop economics have to do with healthcare. Consider how Copeland made useful information personally relevant by asking a few questions that got my attention. He then used my appreciation of bagels to explain why I should care about spiders.

In a similar way, much of what we talk about with patients can be unfamiliar or even frightening. By framing information in a familiar context, one that interests and is important to them, we can make what we have to say easier for them to hear.

Communicate clearly, simply, and in a variety of ways

BrookfieldZoo aims to have signs and interpretations written at a fourth- or fifth-grade reading level. Generally, this means using common, easy-to-understand words rather than complex scientific language. But sometimes more difficult words are needed. This is when they adopt other modes of educating. For instance, when Copeland teaches children about “metamorphosis,” he might add humor by asking if they know that frogs lead “double lives.” He then explains that frogs start out as tadpoles and demonstrates this concept by showing a puppet that flips from tadpole to frog.

The same principles can apply in healthcare. While we should use common words whenever possible (such as “cancer” instead of “oncology”), sometimes a more complex term is needed (like “metastasis”). In these instances, the provider needs to teach a patient what the term means and then follow up with diagrams or models to make the concept clear.

Combine color, images, and other design elements

Mogerman says that people retain information best when it is communicated in multiple ways. She mentions parking-lot signs that use colors, images, and numbers. “ ‘I parked on the third floor in the yellow section near the picture of a penguin’ is an easy way for people to find their cars,” says Mogerman.

Using a combination of design elements can make healthcare settings and healthcare information easier to navigate. For example, combining icons (like a picture of the heart), colors (perhaps red, green, and yellow meaning “don’t enter,” “enter,” or “ask first”), numbers, or even soothing sounds can make complex information easier to understand. And when it comes to healthcare, we can all use better navigation systems.

Helen Osborne, M.Ed., OTR/L, is President of Health Literacy Consulting at http://www.healthliteracy.com. Her column appeared regularly in On Call. You can contact her by e-mail at Helen@healthliteracy.com.