Helen Osborne: Welcome to Health Literacy Out Loud. I’m Helen Osborne, President of Health Literacy Consulting, founder of Health Literacy Month and author of the book Health Literacy from A to Z: Practical Ways to Communicate Your Health Message. I also produce and host this podcast series, Health Literacy Out Loud.

Today, I’m talking with Paula Worby and Miriam Lara-Mejia, who both work at Hesperian Health Guides, a non-profit publisher best known for the book Where There Is No Doctor that is used throughout the world.

Hesperian currently has more than a dozen books on a broad range of health topics, and almost all of the content is available for free online in multiple languages through its HealthWiki platform at www.Hesperian.org. It also has three mobile apps focused on reproductive health.

Miriam is the Spanish Content Manager and co-author of Hesperian’s Worker Guide to Health and Safety. Paula is also a Hesperian editor and is project coordinator for The NEW Where There Is No Doctor that is expanding with new topics and new languages.

Paula and I are both active participants on the online health literacy discussion list. I always like seeing what she posts and responds to for our questions and queries on that list. She’s always adding something about the artfulness of health writing and ways to make our materials so much more relatable to our readers.

Welcome to you both to Health Literacy Out Loud.

Paula Worby: Thank you so much, Helen. We’re so happy to be here with you.

Miriam Lara-Mejia: Same for me.

Helen Osborne: That’s great. I’m just tickled about this. I interviewed somebody from Hesperian more than 10 years ago, and I think it’s time to do that again.

But for our listeners who may not know a lot about it, can you just put it into context for us? Tell us a little bit about Hesperian and all the great work that it does.

Miriam Lara-Mejia: Thank you, Helen. Hesperian Health Guides has been developing popular health education materials for almost 50 years. We’re reaching our 50-year anniversary in a few years.

Helen Osborne: Oh my goodness.

Miriam Lara-Mejia: It’s a testament to the longevity of our materials that they’ve been and currently are still used because of our model of how we develop them and how we field-test them. We have shared a lot of resources and we pride ourselves in creating different avenues to be able to access our research.

We have print books. Many people who do know Where There Is No Doctor probably encountered it in the field as a book in many of the languages we have. Probably also Donde No Hay Doctor.

We have a fantastic digital platform that has over 7,000 content pages in over 18 languages for free and available. We wanted to make it really easy to search and really easy to find the information we want.

We have our three mobiles apps that are also free. We really wanted to make sure that they were apps that people could use offline that did not save your data.

Helen Osborne: On their phone.

Miriam Lara-Mejia: Yes, when people access mobile apps.

We have a very big social media presence also trying to reach people with actionable health information on social media.

We have a variety of topics. People do know us for Where There Is No Doctor, but we have topics on women’s health, children’s health, HIV, disability, worker health and environmental health.

We continue to develop them in-house in English and in Spanish and sometimes other languages. We have them in a lot of different languages available for purchase and for download.

The idea is we believe health information can be a key element for people to take action around their health for their families and their communities. We believe in making it as widely available as possible.

Helen Osborne: Can I tell you a little bit of a story here? I’ve been so fond and such a believer of Hesperian for quite a while. I went to South Africa a few times and I met with village health workers there.

This was a long time ago, before people had a lot of mobile phones. I knew that your books would be really treasured and useful for this community that didn’t have any extra resources, for sure.

The second time I came back, I brought many of your titles with me. I remember handing them over. They did this ceremony, and I handed them over to the mayor of this village. She was so grateful for them.

When I went back, I also noticed a big difference in the community. I gave them the print books, so they had those, but I noticed a difference in that time. People were also having access to their phones, which they didn’t have before.

I’m delighted to hear that you’re doing a lot of mobile apps, too, because I think that’s where other places around the world people are getting their information.

Thank you for sharing a little bit about what Hesperian does. Paula, I was intrigued by all that you posted on the listserv about how to make more materials more relatable and the artfulness of the writing. Can you address that a little bit?

Paula Worby: Sure. What caught my attention with that conversation we were having online with people who think about this all the time, how to make their information easier for people to use and useful for people to use, is that is something at Hesperian we think about all the time.

But in that trading of tips and tricks that people have, a lot of it is how to be more concise and how to choose words that everyone can understand. We do that as well. But then someone had brought up this issue. I think the term was warmth and compassion. I had not thought about that.

It wasn’t until I was working at Hesperian for a bit that one of my colleagues, and it could have been Miriam, mentioned another writer on the team and said, “You should read her work because she really knows how to make it warm.” It was just a term that had not occurred to me.

Since then, I’ve thought a lot about it, so I do have some. I could just start to list them.

Helen Osborne: I want to talk about that. I do a lot of plain language writing and editing, too. You probably do more, because it’s not what I do full time. But I know that it’s not a matter of just finding that simpler word or making a shorter sentence.

I think something else had intrigued me about other correspondence I had with you. It was looking at the artful side. Not just the things you’re supposed to do to make things easier, but how do you write in ways that people really want to read and engage in the material? Warmth is certainly part of that.

I’d love to hear stories from both of you as you write for an international audience. What’s this like? Can you give us an example?

Paula Worby: Yes. One of the stories that comes up for me, especially now, is we are thinking a lot about how to communicate around vaccines in the context of COVID.

But it was just a few years back that I was working on a chapter for this resource we call The NEW Where There Is No Doctor, which is all online and we’re publishing it as we go. I was working on a resource there that is about routine childhood immunization.

Something came up, a dialogue, with a team of people who were based in mostly Mozambique, but a few other countries in southern Africa, about how health workers do that work.

They pointed out that in their own research and experience, this issue of families having bad experiences with health workers is often because they are in low-resource settings and people are underappreciated and underpaid. It’s just not ideal conditions.

Something that we wove into that chapter kind of put forth a model of how sensitive health workers might be in that situation when they’re in conversations with families and when they’re trying to encourage children and make it a pleasant experience. But we didn’t want to say, “Don’t do this. Don’t do that. Don’t be mean.” Because who needs that?

While addressing the underlying need that people have, the way we wrote it is a way that encourages, models or shows ways of being that are upbeat and positive.

We have ways of saying, “Your clinic might not have all the resources it needs, but the more that you can make it a good experience for the families who come in, the more likely they’ll come back for that second vaccination.”

Helen Osborne: Thank you. For issues like vaccines, there must be so many other topics that sometimes are controversial. We as health professionals know certain things are probably a good idea, but not everybody agrees with us. You have an interesting and international audience. How do you approach topics like that, where you may not have consensus on the recommendation?

Miriam Lara-Mejia: One of the things that we do at Hesperian is our field-testing process. Part of what that allows us to do is put in a whole platter, a whole menu of different perspectives from professionals in the field to people who are practitioners to people also elevating community experience and expertise.

We sit with this whole information and we discuss, “As a resource that’s based on primary health and popular education, what is the information that would help someone take action?”

The piece of “take action” or being able to understand to take action is a key part of what we do. We believe that people have the capacity no matter where they are and what background they have to learn about health and be able to be promoters of health.

We do sit with all this information, and it’s part of our really grueling process of our field-testing. It means that we have to balance what information we want to put that we feel will help someone take action.

At the same time, because we are a primary health focus, we do focus on the essential information. We have our little bull’s eye. What is the most important information you need to know about this?

At the same time, we do try to incorporate through images or stories other perspectives that might expand people’s capacity and people’s understanding of the variety of things that are happening, and giving tools to be realistic.

We want to make sure people have tools that they can use. Not pretending that there are not these battles, but acknowledging them in some ways, but not centering them.

The center of our work really is the essential information someone needs to know about a health issue to be able to promote and talk about it in their communities and families, and then to take action. We really stay focused and driven in the relatability of our materials in that way.

I don’t know, Paula, if you want to add more.

Helen Osborne: Thanks.

Paula Worby: Just these concepts of trying to be very non-judgmental, very straightforward, but not interject terms that people might take the wrong way, to say it like that. That’s why we have this field-testing.

We have a whole book called Health Actions for Women that is all about ways people in the community can tackle taboo subjects, many around reproductive health.

In there, there are those techniques embedded that people in your community might not have the same opinion. Young people versus older people. Women versus men. How do you open those conversations?

We, again, model that in our own writing, and we actually have materials that help people think about, “What’s an exercise we could do? What’s a popular education technique? What are the words we can use? What are the words we can avoid? How do we recognize embedded stigma in certain ideas?”

Sometimes we just explain that straight out, and then sometimes we show it by using it in a certain way.

Helen Osborne: Wow. I’ve been making notes as you’re talking about this, and there are so many strategies.

One of my questions was going to be “What do you want listeners to know?” Our listeners for this podcast are clinicians, public health folks, educators and anyone interested in communicating health information clearly and simply.

The strategies you’re talking about go beyond those basics of plain language. I’m going to read them back to you, just some that you were talking about.

You focus on action and how people can take action. Field-testing is a very important part of what you’re doing. You whittle it down to the most essential information. You have images, and I’d love to hear a little bit more, bringing in other perspectives. You’re realistic. You make it relatable, and you’re non-judgmental. Then you’re also offering ways that you might incorporate this in community education.

Did I cover some of those tips there that you think others might be able to use in our writing even if we’re not writing for an international audience?

Paula Worby: Exactly. I think you’ve picked up on a lot of the words that we use and that reflect some of these tendencies.

We know people are hurried and they’re busy. A few tenets, I think, are to try it out on people and remember that the way you read it is not the way someone else may read it. You don’t have to do an elaborate field-testing, but there are always ways to get input from a variety of people.

Another thing we’ve learned is most of our materials are never done. We’ve been around long enough that they’re always getting updated and edited.

We have a big . . . Disclaimer isn’t the word. On all of our web pages and in our books, you’ll open to a page where it says, “We need your help to make these materials better. Please contact us.”

Any clinic, anybody anywhere can just make themselves open to getting feedback. Those are some of the ways we approach it, that flexibility, the willingness to evolve and to listen.

Helen Osborne: I’m seeing this as really almost a conversation. Yes, you can bring the core health content, but you’re trying to make it more interactive and, as you said, dynamic and flexible.

What would it look like for those of us doing this work without all the resources of Hesperian? What do you recommend someone might be able to do on a limited budget and with limited time who can’t dedicate themselves to being a full-time editor?

Paula Worby: Some of the tips I mentioned, I think, you can incorporate into your daily practice. When you’ve done a draft to your own satisfaction, who else are you running it by?

If you’re an institution that has produced some materials, how are you going to build in revisiting it periodically? How are you going to know the impact it has on people if you don’t ask? Those are a few things I think anyone can do.

For anyone who doesn’t know Hesperian, people think we’re an enormous organization, and we’re not. We’re a very small organization.

Helen Osborne: Oh, really?

Paula Worby: We do rely on a lot of volunteers all over the world, but our core staff is quite small. We’ve had these long-standing, decades-old partnerships with people in many other parts of the world, and that carries a lot of the weight of what we do.

I think it’s attitude about what people bring to the work they do. Of course, having an adequate budget and time helps, but your deep thinking and willingness to be wrong, I think, sometimes is part of it as well.

Helen Osborne: Thank you. I love hearing that, that attitude there.

It is interesting for me to hear that you are a small organization on a shoestring, which I never had that impression at all. I thought I was talking with this great big international publishing company that has unlimited resources. I think that makes me feel that more of this is even doable on an everyday basis for all of us.

It’s really that attitude in there, working together with your audience, getting feedback, developing materials, as well as, of course, the health content.

Miriam Lara-Mejia:  I wanted to end with something. One of the commitments that Hesperian has is to have an open copyright. We always invite people to come and look at our resources and think about how they can be used.

We even have this graphic that we are very proud of that is basically a person taking parts of the book and either using them as they are, ripping them apart or adapting them for what they need. We really believe in the partnership of connecting with others doing this work.

We have a lot to learn, we have a lot to share, so definitely come and visit our website. See if you’re interested. We will definitely share our emails. We are very welcoming for that.

Helen Osborne: That’s great. We’ll have those resources on your Health Literacy Out Loud web page. As the grand finale, please say again the URL for Hesperian.

Paula Worby: The name of the organization is Hesperian, and our main website is www.Hesperian.org. When you’re on that website, if you look for something called the HealthWiki, which is all of our digital information under the tab called Books and Resources, you’ll quickly start to get an idea of all the information that’s there.

Helen Osborne: I thank you for sharing this with all of us on Health Literacy Out Loud. I certainly have learned a lot. You’ve made me feel warm and fuzzy inside, like I’m going along the right path. It’s not always just the syllable count in a word or the number of words in a sentence. It is so much more that makes materials relatable, actionable, warm and meaningful to our audience.

Paula Worby: Helen, I wanted to thank you again for inviting us. You mentioned it’s not all about word count. One of the examples I had written in that conversation we had before was I found a sentence where we say, “Children need loving care.” Instead of saying, “Children need care,” which is a shorter way to say something, that word “loving” gives it a whole different feeling.

Helen Osborne: It does.

Paula Worby: That’s a very short example of more is more, or more helpful.

Helen Osborne: More is more. Thank you both for doing all you do and sharing it with us. I hope that a lot of listeners take advantage of your resource and keep this conversation going. Thank you for being guests on Health Literacy Out Loud.

Paula Worby: Thank you.

Miriam Lara-Mejia: Thank you, Helen.

Helen Osborne: As we just heard from Paula Worby and Miriam Lara-Mejia, it is important to write not only great content, but to do so in ways that our readers can really relate to and take action. But doing so is not always easy.

For help clearly communicating your health message, please take a look at my book, Health Literacy from A to Z. Feel free to also explore my website, www.HealthLiteracy.com, or contact me directly at helen@healthliteracy.com.

New Health Literacy Out Loud interviews come out every few weeks. You can get them all for free by subscribing at www.HealthLiteracyOutLoud.com, or wherever you get your podcasts.

Please help spread the word about Health Literacy Out Loud. Together, let’s tell the whole world why health literacy matters.

Until next time, I’m Helen Osborne.

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