Helen: Welcome to Health Literacy Out Loud. I’m Helen Osborne, president of Health Literacy Consulting, founder of Health Literacy Month and your host of Health Literacy Out Loud.

In these podcasts you can listen in on some really remarkable conversations, hearing what health literacy is, why it matters, and ways all of us can help improve health understanding.

Today, I’m talking by Skype with Sally Bigwood, who lives in the UK. Sally has worked in a number of fields, including publishing, sales, government and the UK’s National Health Service.

What these fields have in common is a need to communicate data. Sally wanted to do that in ways everyday folks could understand, so she, along with her sister Melissa Spore, founded Plain Figures and co-authored the book A Designer’s Guide to Presenting Numbers Figures and Charts.

I’ve seen an earlier edition and the brand-new edition of it. I like that book so much that I contacted Sally and asked her to be a guest on Health Literacy Out Loud. Welcome, Sally.

Sally: Thank you, Helen. It’s good to speak to you today.

Helen: Let’s take it from the beginning. What do you mean by the term, “plain figures”?

Sally: What I mean is to just have figures presented in a way that’s as plain and simple as possible without decoration so that the numbers can speak for themselves.

Helen: When you say decoration, give us an example of what’s not plain.

Sally: With computers nowadays, things often get bogged down with things like grid lines, bolding numbers and a lot of grey background. Numbers speak for themselves. You don’t need any of that stuff just to present numbers.

Helen: I’m in your camp. I find numbers pretty overwhelming. What brought you to this realization that we’re mucking up numbers too much? Why is it important to present them so plainly?

Sally: For many years, I worked in city government in the UK. I became aware of the work of the Plain English movement, which of course wants to make anything written in English as plain as possible. From that, I accidentally fell upon some rules that statisticians had developed over the decades on how to present numbers.

Many statisticians don’t know about these rules, but a few statisticians developed them. I started looking at these rules and working out how clear they made everything. Because I worked in city government, one thing I knew was that politicians were trying to make decisions on numbers which were quite frankly impenetrable.

How could you expect good decisions to be made when the numbers were in what most people would say is a muddle? That’s how I got into it.

Helen: That’s really interesting. I’m in the healthcare world and our listeners are somehow communicating health information. Likewise to your politicians, we’re trying to explain numbers in ways so that others can make decisions. I see a lot of relevance and overlap there. What can we do?

Sally: There are a few rules the statisticians developed about plain figures. Once you know them, they’re just so obvious that you wonder why you never used them before.

The first rule is that you always list figures in some sort of a logical order. You would be surprised how infrequently that happens. Quite often people just jam numbers on a page without any thought about logic.

Helen: What would your example be? We’ve got a whole bunch of data out there because we can easily generate data. What would a logical order be like?

Sally: Often the most logical order for the reader is to present data from largest to smallest if you have a list of items or a table. Just don’t do it by the totals. That really helps the reader because if something is large, it’s usually more important than something that’s not as large. What you’ve done is you’ve ordered it by importance, which is helpful.

Helen: Could you also do first to last or newest to oldest or alphabetically?

Sally: All the rule actually says is that you have to do it in a logical way. Often the most logical way is largest to smallest, but sometimes the most appropriate way is in date order, for instance, if you’re trying to compare years.

If you’ve got unemployment rates and death rates for each of the 50 states, you might wish to just present them in alphabetical order. Because there are so many states, readers can’t find the state they want unless it’s in alphabetical order.

Helen: Sally, I often work on projects that deal with risk or what can go wrong from a certain medication or intervention. If we were presenting that in numbers, might we go from the most common thing that can happen or from the worst thing that can happen? How would you recommend doing that?

Sally: That’s a good question. I think you’d have to work from one of those two points rather than alphabetical because it is so important. The rule is just to do it in a logical order. If you’re an expert in a field, you will have a grasp as to what you want people to know first.

Helen: We don’t really have to say, “Here’s our logical order,” because it becomes pretty obvious. Is that correct?

Sally: Yes. You don’t have to tell people. It just becomes obvious.

Helen: I’ve seen it done on websites where they almost have an information hierarchy. It’s like if you go looking for hotels at a website, you might get from the nearest to your destination to the farthest or from the least expensive to the most expensive or the reverse. That’s very similar, correct?

Sally: Yes, it is. You know how much that helps you when you’re trying to book a hotel or look at death rates for 50 states.

Helen: Yes, it does. What else can we do to present numbers plainly?

Sally: The second rule of plain figures is that you need to keep comparisons close. This is a basic design principle that goes back hundreds of years.

For instance, if a Renaissance painter wanted the viewers of his painting to compare the Virgin Mary and the dove, he would put them close together. He wouldn’t put them on opposite sides of the canvas and just hope for the best. He would put them close together.

How this applies to numbers is if you’ve got two columns of numbers, let’s say they’re male and female death rates from cancer, you would want to put those two columns of numbers close together. Quite often if you see them on a website or in a book or something, they will be spaced out across the whole page. They don’t need to be.

Helen: Do you mean on the left side and the right side?

Sally: Frequently you see them that way, but I actually think you can just align them to the left of the page and leave a lot of white space. It doesn’t matter, as long as the numbers are fairly close together.

Of course, I hope I needn’t tell people that clearly you need to align the numbers themselves to the right.

Helen: By aligning them to the right, do you mean right justification?

Sally: Yes.

Helen: When we go to our word processing, it’s one of those options where everything is aligned on the right. That’s really interesting because writing in plain language, I always align things on the left.

Sally: I don’t think you would on a table because you would want people to be able to tell the difference between hundreds and thousands and ten thousands. Within a cell, you would always align to the right.

Helen: Should we have those gridlines lining things up?

Sally: Yes. On most computer software programs you can use the gridlines in designing the table, but you don’t need to show it to anyone. You can turn off the gridlines so they don’t appear. That’s what I would recommend.

Helen: Why is that?

Sally: Gridlines are just a bit of junk. They don’t help people see the numbers. The most important thing in any presentation of numbers is that people are able to see the numbers. Gridlines just add a bit more ink when you don’t need ink. Gridlines tell you nothing on their own. The numbers tell you information.

Helen: That’s neat to know because I think that the default is, “Let’s have those gridlines,” or, “Let’s use that shading,” or something. You’re saying that as long as each number is aligned on the right, it will be clear unto itself. Just use plenty of spacing around it.

Sally: Yes.

Helen: What else should we know and do? I’m finding this so fascinating.

Sally: That’s good. Probably the most important rule of plain figures is to round numbers. You need to round them whenever you can. Rounded numbers are easier to understand, compare and to recall later. What I love about rounding is that it just makes everything look simpler.

Helen: That’s really interesting because in healthcare we have so many numbers. Epidemiology figures can be so big. How would we go about rounding, and when is it okay and not okay?

Sally: I’m not a mathematician, so I wouldn’t tell people how to round. Most of us learned how to round in elementary school. That’s the correct way of doing it. Very few people were misled in elementary school about rounding.

Helen: If it’s five you round up and if it’s four or below you round down?

Sally: That’s the way I was taught. There are several different types of rounding.

The reason it’s important is because it just makes everything look simpler. If I say $14 million, they’ll have an idea of what that means. If I say $13,671,412, they’re lost by the time I get to the end and they can’t remember where I started from.

Helen: Absolutely not.

Sally: $14 million actually covers it.

Helen: What if you’re adding that $13,671,412 to $11 million and something? Do you round each one and then add it to come up with your bigger figure? How do you do it if you’re adding some numbers together?

Sally: There are very strict rules on rounding added numbers. Rounding has to be your last step. It cannot be done earlier than the last step because you come up with the wrong answer. If you do come up with the right answer, it’s coincidental.

What I would say is that if you buy the book, all of the information is in there about this.

Helen: I do love your book. We will have the name of it on the Health Literacy Out Loud website, but I’ll just mention it again. It’s The Designer’s Guide to Presenting Numbers, Figures, and Charts. I look at that a lot. I have it marked up all over the place.

What else would you like listeners to know or do? We’re communicating numbers all the time.

Sally: If you’re going to create a line graph or a bar chart, first of all you need to think, “Is it actually going to be more convenient for the reader if I keep this in a table?” Tables are often going to tell people more than a graph.

Helen: Explain the difference. Is a table just one of those things that we often see in word processing with those gridlines with sheer numbers and words? Does the chart or graph have some visual image too?

Sally: Yes, like a bar chart, line chart or pie chart.

Helen: You like just the straight numbers and words.

Sally: Not always. Some graphs are really good. Line graphs are particularly helpful at showing people patterns over time. Sometimes scatter plots are useful and sometimes histograms are useful.

I think graphs are used far too much now because of what you can do on computers. People have tended to go for a graph, when in fact a table can often give people more information more clearly. Tables have been with us since the Babylonian times. For about 4,000 years they’ve been giving us really good information and we should keep using them.

Helen: You have so many recommendations, and so many more than we’ve even discussed. How can we as communicators know that whatever we come do with data works?

Sally: That is a good question. There is an overarching principle, and that is that you always present data for the convenience of the reader. That’s how you do it. If you’re unsure what is going to be most convenient to the reader, you can always fall back on the principles in the rules of plain figures. They will help you a long way.

The other thing you can always do is just ask a colleague, a spouse or a friend, “What does this table mean?” or, “What do you think this graph means?” Just ask them and see if you have actually gotten your ideas across.

Helen: That’s a really strong principle of health literacy. It’s always to confirm understanding. Ask at least a few people who represent your intended audience. That’s the best way of knowing what works. You offer a lot of possibilities, but we as communicators need to make some choices. If we team up with our readers and users, we can make sure that those choices are the effective ones.

Sally: Indeed. User testing is great.

Helen: Do plain figures work for everybody? Is there an audience that you think could most benefit by this or not benefit by this?

Sally: Certainly in management, and I’ve also trained public health people before. I think most people can benefit from it just by understanding the rules and then applying them.

It’s like everything to do with numbers and information. You have to engage your brain when you’re doing it. Just because something is a rule doesn’t mean it’s going to work 100% of the time. It’s really just a guidance that should get you through.

Often people find rounding a challenge. They don’t wish to round because it seems too scary. As a general rule, it’s an excellent principle because it makes things look simpler.

However, there are times when people can’t round. For instance, cashiers at supermarkets cannot round up or down about how much money they take in. They’ve got to come up with a precise amount of money.

Pharmacists cannot round up or down the dosages without poisoning people. Civil engineers need to be quite precise about the centimeters they’re dealing with.

Helen: If not, all buildings will look like that leaning Tower of Pisa.

Sally: Yes, that’s right. There are times when you cannot round, but most of the rules apply to most of the people most of the time. Numbers should always be in a logical order no matter what you’re doing in the world.

Helen: Sally, I think that’s what I like most about your work. It just makes good sense. You have a lot of examples. I see and feel the relevance. Let’s communicate numbers in ways that have the most meaning to the most people.

Thank you so much for doing all you do and sharing that with listeners of Health Literacy Out Loud.

Sally: Thank you. It’s been a pleasure.

Helen: I learned so much from Sally Bigwood about plain figures and how to communicate data clearly, simply, and in ways nearly everyone can understand. But health literacy and communicating clearly isn’t always so easy.

For help clearly communicating your health message, please visit my Health Literacy Consulting website at www.HealthLiteracy.com. While you are there, sign up for the free monthly enewsletter, What’s New In Health Literacy Consulting.

NewHealth Literacy Out Loud podcasts come out every few weeks. Subscribe for free to hear them all. You can find more information, along with important links, at the Health Literacy Out Loud website at www.HealthLiteracyOutLoud.org.

Did you like this podcast? Did you learn something new? If so, tell your colleagues and friends. Together, let’s let the whole world know why health literacy matters. Until next time, I’m Helen Osborne.