Designing persuasive health materials using processing fluency: a literature review <s> Discussion <s> Literacy has recently emerged as a key item on the research agenda in medicine and public health. Researchers and practitioners are grappling with evidence that the reading ability of the average adult falls well below the reading level of educational materials, directives, forms, and informed-consent documents commonly used in the health field. The threats to effective communication and efficacious care have spurred interest in exploring strategies for more effective communication. In addition, increased attention to literacy may be driven by legal concerns for adequate protection of human subjects and ethical concerns for patient autonomy in informed-consent procedures. Methodological strides made since 1992, particularly in the form of new tools for rapid literacy measurement, have enabled a number of researchers to explore links between the literacy level of patients and health outcomes that will have critical policy implications. These investigations can best be undertaken through collaborative efforts between educators who understand the learning process and health professionals who understand the protocols used in health care and public health education. Findings will serve to enrich policy and practice. <s> BIB001 </s> Designing persuasive health materials using processing fluency: a literature review <s> Discussion <s> Every year, new public health mass media campaigns are launched attempting to change health behavior and improve health outcomes. These campaigns enter a crowded media environment filled with messages from competing sources. Public health practitioners have to capture not only the attention of the public amid such competition, but also motivate them to change health behaviors that are often entrenched or to initiate habits that may be new or difficult. In what ways are public health mass media campaigns now attempting to succeed in a world crowded with media messages from a myriad of sources? What are the conditions that are necessary for a media campaign to successfully alter health behaviors and alter outcomes in the long term? To what extent can the successes and failures of previous campaigns be useful in teaching important lessons to those planning campaigns in the future? In this chapter we attempt to answer these questions, drawing from recent literature on public health mass media campaigns. <s> BIB002 </s> Designing persuasive health materials using processing fluency: a literature review <s> Discussion <s> OBJECTIVE ::: To describe physicians use of jargon with diabetes patients with limited health literacy. ::: ::: ::: METHODS ::: We audiotaped 74 outpatient encounters and coded unclarified jargon, assigning each term a clinical function. We administered telephone questionnaires to determine if comprehension of diabetes-related jargon varied with context. ::: ::: ::: RESULTS ::: Eighty-one percent of encounters contained at least one unclarified jargon term (mean of 4/visit). Thirty-seven percent of jargon use occurred when making recommendations, and 29% when providing health education. Patient comprehension rates were generally low and never reached adequate thresholds. ::: ::: ::: CONCLUSION ::: Physicians caring for patients with limited health literacy employ unclarified jargon during key clinical functions. <s> BIB003 </s> Designing persuasive health materials using processing fluency: a literature review <s> Discussion <s> There is no consensus on how best to assess the health literacy demands of health information materials. Comprehensive, reliable, and valid assessment tools are needed. The authors report on the development, refinement, and testing of Health Literacy INDEX, a new tool reflecting empirical evidence and best practices. INDEX is comprised of 63 indicators organized into 10 criteria: plain language, clear purpose, supporting graphics, user involvement, skill-based learning, audience appropriateness, user instruction, development details, evaluation methods, and strength of evidence. In a sample of 100 materials, intercoder agreement was high: 90% or better for 52% of indicators, and above 80% for nearly all others. Overall scores generated by INDEX were highly correlated with average ratings from 12 health literacy experts (r = 0.89, p < .0001). Additional research is warranted to examine the association between evaluation ratings generated by INDEX and individual understanding, behaviors, and improved health. Health Literacy INDEX is a comprehensive tool with evidence for reliability and validity that can be used to evaluate the health literacy demands of health information materials. Although improvement in health information materials is just one aspect of mitigating the effects of limited health literacy on health outcomes, it is an essential step toward a more health literate public. <s> BIB004
Studies have shown that evaluating information and making decisions depend not only on the presented information itself but also on the information's PF. As described in this review, high PF of information generates positive judgment among recipients. The implications of this cast new light on the importance of designing readable health materials. Traditionally, health materials have been difficult to process because of excessive jargon  BIB003 , excessively high reading levels BIB001 , and dense presentation of information BIB002 BIB004 . In recent years, low health literacy has been recognized as one of the barriers to understanding and using health information in making appropriate decisions about one's health and health care  . It is also recognized that health literacy is a result of interactions between an individual's skill and the demands of the society in which the individual lives, including the manner in which health information is communicated  . Accordingly, in recent years, efforts to make health information easy to read have become recognized as more important. However, relevant efforts in health care have focused on lowering the barriers to health information for those with low literacy skills. In contrast, as indicated in this review, fluency research has the active goal of focusing on increasing positive judgments and enhancing behavioral willingness. Studies of PF indicate that easiness to read, recall and imagine (i.e., high PF) can contribute to enhancing both the perspicuity and persuasiveness of health materials. Based on this review, we suggest five practical implications for designing effective health materials that generate positive judgment and enhance recipients' willingness to follow healthy behavior.