Helen Osborne: 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 get to listen in on my conversations with some really remarkable people.

Today, I’m talking with Karen Schriver, who is President of KSA Communication Design & Research, a Pittsburgh-based consultancy focused on making information clear, compelling and usable.

Karen helps organizations draw on the latest empirical research so that they can write and design more effective people-centered communications.

Karen is a former professor of rhetoric and information design at Carnegie Mellon University. Her book, Dynamics in Document Design: Creating Text for Readers, has been called a landmark in its field.

Winner of 14 international and national awards for her work, Karen Schriver is writing a new book about ways to reach busy readers through evidence-based information design and plain language.

I am a longtime fan of Karen’s. That’s why interviewed her a while ago for a Health Literacy Out Loudpodcast on “Using Designs to Get Readers to Read and Keep Reading.”

More recently, I read her award-winning paper, Plain Language in the US Gains Momentum: 1940-2015. That paper is so good I wanted to talk with Karen again. Thinking you will, too.

Welcome to Health Literacy Out Loud, Karen.

Karen Schriver: Hello, Helen. I am delighted to be here. Thank you for inviting me to be back.

Helen Osborne: What a delight. Let’s take it from the beginning. I know a lot of your wonderfulness and I’ve read your paper. We’ll have a link to that on your Health Literacy Out Loudwebsite. For people who may not know your work as well or understand plain language as much, can you briefly put into context what you mean when you use that term “plain language”?

Karen Schriver: Sure. Plain language has to do with communications in which the wording, structure and design are so clear that people can find what they need, understand what they find and use that information in ways that they want to.

It’s very oriented toward the reader, consumer, citizen or patient–the person to whom someone or an organization may be writing.

The real goal is to help that person achieve their goals and to do that through clear writing and clear visual design.

Helen Osborne: I’m a fan. That’s what I do. That’s why I think so highly of the leadership you have done in this field.

Your paper looked at 75 years of this. Is plain language finally catching on?

Karen Schriver: I have to say yes.

Helen Osborne: Oh, good.

Karen Schriver: It’s been catching on in so many domains. It’s exciting for me as someone who has been in the field really since 1978 when I read Patricia Wright’s first paper. She’s like the queen of information design and plain language, a professor from Cambridge University in England.

At that time, plain language was just an idea that had to do with writing clear sentences and making sure that the words weren’t too confusing.

Over the past 75 years, we’ve moved in enormous ways not only to include ideas about word choice, sentence style, structure of our sentences and so on, but rather we’re looking at whole texts, paragraphs, quantitative displays, visuals, tables and charts, everything that goes into the mix of making a good communication today.

Across many domains, people are saying, “Hey, this is great. We want to try it. Let’s see.”

Helen Osborne: That’s great. I come at this, and probably many of our listeners do, from the perspective of health literacy, which is looking specifically at health communications. But I know that plain language has taken off nationally and internationally in many spheres and domains.

This time, Karen, I really want to focus especially on the pushback to plain language, if we can. I’m really inspired about this topic. I looked at your terrific paper, and I encourage everyone to read it. You make so many good points.

One that I flagged, and this is your wording, is, “The growing empirical evidence suggests that plain language works for everyone, young and old, experts and novices, first-language readers and second-language readers.” I read that and thought, “Yes.”

I have to tell you, in my workshops and in my work, I sometimes hear from people a skepticism about that. I hate that term, but sometimes someone might say, “Isn’t this dumbing down?”

I want to hear your take on that. Am I the only one who gets pushback about plain language?

Karen Schriver: Absolutely not. I think that it’s really part of the legacy of the history of plain language. That pushback is coming from a place where people think that plain language is really only about substituting easy words for hard words.

It makes people think that if you just make the hard words go away, then that results in a text that is less sophisticated, maybe unprofessional or not smart-sounding. They think that you’re taking away the intellectual integrity of their text.

There are at least two problems with that. One is that, as I show in my paper, plain language is not just about words. It is not about dumbing down. It’s about the whole text from words to sentences to paragraphs to graphics. We’re really concerned with the whole thing.

I can give you a quick example if you’d like.

Helen Osborne: Sure. I think it’s just such an important point, that plain language is more than just choosing a simpler, two-syllable word instead of a more complicated one. Oh my goodness, we face that in healthcare all the time, but good to hear you say it’s more than that.

Yes, give us an example. Whether it’s from healthcare or not healthcare, we can all translate that into our own work.

Karen Schriver: I actually had two examples in mind. The first one is from the healthcare area, and the second is in the area of technical communication.

For the first one, I recently worked on a text for a group of medical staff, doctors who were writing a new guide about a fabulous approach that they had developed for helping people who are addicted to drugs.

What they wanted to do was create a guide for other doctors, clinicians and addiction counselors on how they could do just what they did, so that they could have a success story like these folks who had created the text.

Helen Osborne: It’s professionals writing for other professionals.

Karen Schriver: That’s right. When I looked at the content, I thought, “Wow, this is fantastic, but unfortunately the key points about how wonderful their interventions were, were buried and not presented in a way that would be persuasive.”

They had headings like “Our Story,” “Our Approach” and “Our Goals.” Over 25 headings, there was only one that was oriented toward the reader, which said “Engaging Your Community,” with one pronoun — your. I said to myself, “Oh my goodness, this is such a missed opportunity.”

You could take, for example, a heading like “Our Approach,” which is very generic and bland, and if you were reading along, you would say, “Skip that. That’s boring.”

Following “Our Approach” was three pages without any subheadings. What I did was to say, “What’s the key idea here? Let’s put a colon after ‘Our Approach’ and something like ‘reducing harm can make a difference for patients at risk.’”

Helen Osborne: You’re making a compelling case right there, right from the header.

Karen Schriver: Right there, right in the header, and trying to push the key content up to the top of the structure so that when people peruse the document, they can get an idea right away of what it is that they’re going to do and how it’s taking the picture from what somebody else did to feeling as though I could do this too.

Helen Osborne: Karen, that is a great example. You know your readers already understand the basic concept. They can master the more complicated words. You’re still making it more accessible and inviting. I think that was a term I learned from you. In fact, we did our last podcast on that. You’re bringing in the reader and helping them want to read that right from the beginning. That’s plain language.

Karen Schriver: That’s right.

Helen Osborne: Did you get pushback on that from your writers? We were talking about that, how people pooh-pooh this and say, “That’s dumbing down.” Did anyone balk at what your recommendations were?

Karen Schriver: In this case, I wasn’t taking complex language and making it simpler. I was taking complex ideas and making them apparent in the structure of the text.

They didn’t push back on the idea of making that structure more clear, but they had a little bit of a reluctance to the idea of shifting the text from, I would say, an organization-centric point of view, or an I- or us-centered, to the reader.

It’s a really natural impulse. It’s their baby. When we develop knowledge over time, we get attached to it. If we have developed an intervention, for example, that works, we’re very excited to tell everyone about what we did rather than about how they can do. It made them say, “We forgot to tell them what to do.”

Helen Osborne: What a beautiful example. You said you had one other example from technical communication.

Karen Schriver: Yes. I was just reviewing an article about Rudolf Flesch.

Helen Osborne: The Flesch-Kincaid?

Karen Schriver: That’s right.

Helen Osborne: The Flesch-Kincaid Readability Assessment Tool, or Grade Level Tool, or something like that.

Karen Schriver: Exactly. He invented one of the very first readability formulas. The idea was to elaborate Flesch’s ideas and to show how he used both scientific and rhetorical methods in his famous book, The Art of Plain Talk.

When I started reading this article, I said, “Oh my, this is going to be good.” But then I ran into sentences like this one. I’ll just read you one sentence from this.

“Founded on the messy, tensional flux of competing perspectives rather than their tidy synthesis, the indeterminate dialectic represents a different epistemological tool for technical and professional communicators that can produce insight of equal or greater rigor than that produced under the rubric of teleological dialectics.”

Helen Osborne: Was he kidding or did he mean it?

Karen Schriver: I’m tripping over this 42-word sentence packed with insider jargon from philosophy and cultural theory. I just thought, “Oh my goodness. This person is trying to write to a practicing communicator who may be writing a manual about how to use your cell phone.”

Helen Osborne: I’m so glad you shared that.

Karen, I love both of those examples. Your whole premise is it’s all about the reader/user/consumer, and in this case we’re talking about the podcast listener. What can they be doing to make this compelling case that plain language is not about dumbing down, but it’s about making your texts, words and concepts clear? Give us some how-tos, guidelines or strategies.

Karen Schriver: I’ve been thinking about that. To me, the best way to help another person or organization move toward a plain language perspective has to do with showing them explicitly what you can do with a text.

I would take one of their prototype bad texts or something that needs revision, and I would go through the following procedure.

First, I would read the whole text and try to understand what the author, writer or organization is trying to accomplish. Many times, plain language people, because they often are trained in editing, are compelled to begin editing on the first sentence and first word. My feeling is that’s a mistake. What we need to do is step back.

Like I did in the example with the medical group, if I had just started revising right away, I would not have been able to really understand what it was they were trying to accomplish and what the main points were.

Helen Osborne: Look at the whole or the entirety. Don’t just start substituting words.

Karen Schriver: That’s right. Then try, if you can, to either meet with the author or authors and stress the value of what you see there and your respect for their knowledge of the content.

One thing we know about experts is they know a lot of stuff. We’re not here to trivialize or take away that knowledge. But rather to help them, or in a sense pump up the value of their text through a clear structure and a clear, engaging prose style.

We might take a hard part of the text and use the technique of paraphrase and say something like, “I thought what you said about X was really interesting. By that, did you mean Y?”

What you do is you get the expert to translate on the spot. Most times, what they say for the answer is better than what they said in the original.

Helen Osborne: I found that too. I ask people to explain something and I might be taking notes, especially when I do this from a distance. I’m writing down what they say. When I read it back to them they say, “Yes.” It’s their very own words, just simpler.

Karen Schriver: Sometimes they won’t even believe that they said it, but later on when they read it in context, they say, “That makes perfect sense. That’s just what I wanted to say. Thank you.”

I would focus on the macro level of the text first, and then the micro. Notice in the first example about the medical group I worked with that I went after the headings first.

What we want to do is try to go after the big picture of the content, asking how the headings and visuals talk to one another. This is what people notice first.

If they are not engaged at the macro structure, and in rhetoric we would call this the macro level of the text, and you don’t get them there. They’re not going to read. They don’t go further. They typically just stop, so it’s important to get all your ducks in a row so that the message is really clear.

This becomes so important when your message is online because people are only reading a very little of what you say. They may only see two paragraphs at a time.

Helen Osborne: Karen, these are great tips. I’m sure you have a wealth more, but I know listeners don’t listen very long. It’s all about the other person.

I have another question for you. You’re addressing and talking about possible pushback and ways to overcome it from the writers or content experts. Does anyone who gets something in plain language feel resentful, like, “Why are they giving me something so simple?” Do you ever see that?

Karen Schriver: It depends on the reader. There have been some readers who wonder if the text is leaving out critical information.

For example, if you were to talk to a person who is an expert in climate science, they might not really respect an article that they read in Discoverabout climate science.

Helen Osborne: In a journal?

Karen Schriver: Yes, in a journal or popular magazine. “Oh, that’s just a popularized version of it. It doesn’t have any scientific merit or weight.”

That is actually not such an illegitimate complaint because in a real sense, in order to make that content accessible, some things have to be dropped out. That’s often the technical detail.

Helen Osborne: That doesn’t sound like a common occurrence, though.

Karen Schriver: Not really, actually. The legal scholar Joe Kimble studied that with judges and lawyers from all over the US.

Helen Osborne: I have a podcast with Joe, too.

Karen Schriver: Fantastic. He’s great.

He found that even judges like and prefer plain language. Even the late, great Supreme Court justice Antonin Scalia said explicitly that plain language was the way to go for the legal community. As you may know, they’re kind of a stuffy group.

I think that people are beginning to come around, even, for goodness sake, the medical community. If you asked the question “What’s a hot new area in medical writing?” it would be plain language summaries.

There are a lot of high-level journals, over 60 medical journals, related into sciences that are now requiring plain language summaries.

This goes back to your very first point. When they create their abstracts using plain language, they not only are capturing the audience they intended, which is other experts and other medical people, but they’re also capturing patients, clinicians, nurses and folks who are all around the periphery of the medical field and who want to know more.

They found that they increased their readership by so much after they started these plain language summaries. They said, “Wow, this is dynamite. This is exactly what we wanted. Plain language is for everyone.”

Helen Osborne: Karen, you make such a compelling case. I could talk to you for hours and hours. I hope that our listeners keep learning from you.

Can you just tell us the highlight of your paper? We will have that on your Health Literacy Out Loudweb page.

Karen Schriver: The highlight of my paper is that plain language has been around for the past 75 years and I think it’s getting stronger, both in the United States and around the world.

We find it flourishing, for example, in the areas of medicine, the sciences, technology and government. In many cases, people are feeling as though plain language is actually a right, that we have a right to understand what we are being told, whether that’s from government, industry, medicine or some educational institution. I happen to agree with that, as you might suspect.

Helen Osborne: So do I. I encourage everyone to access your paper, Plain Language in the US Gains Momentum: 1940-2015.

Karen, thank you so much for all you do, and for sharing it with us yet again on Health Literacy Out Loud.

Karen Schriver: Thank you, Helen. It was a pleasure.

Helen Osborne: As we just heard from Karen Schriver, plain language really matters. But it’s not always easy to incorporate all those principles in how we communicate.

For help doing so with your health message, please visit my Health Literacy Consulting website at www.HealthLiteracy.com. While you’re there, please sign up for the free monthly e-newsletter, What’s New in Health Literacy Consulting.

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Until next time, I’m Helen Osborne.

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