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Karen Lawrie is a research associate in the Cancer Health Literacy Research Centre at the Princess Margaret Cancer Centre. Janet Papadakos is the centre’s co-director, the provincial head of patient education at Ontario Health and an assistant professor at the University of Toronto’s Dalla Lana School of Public Health. This article reflects the views and conclusions of the author and does not necessarily reflect those of Ontario Health. No endorsement by Ontario Health is intended or should be inferred

It’s hard to follow instructions if you don’t understand what they mean.

We’ve all had firsthand experience with this through the COVID-19 pandemic, with various officials alternately pleading with or chastising the public for not abiding by ever-shifting recommended measures to curb the spread of the novel coronavirus. The pandemic has forced us all to learn a new and complicated language: the language of epidemiology. Last year, few people knew what epidemiology was, never mind terms like asymptomatic, viral load, reproductive rate and vaccine efficacy.

In addition, public health information about the virus has been complex, rapidly changing and sometimes contradictory. The latest example arrived thanks to the National Advisory Committee on Immunization, which declared this week that they “preferentially recommend” mRNA vaccines such as the Pfizer and Moderna shots over AstraZeneca ones. These recommendations contradict messaging from most other government and health officials, potentially creating confusion, distrust and more fodder for the vaccine-hesitant.

Effective public health communication is meant to support and improve public health literacy by developing and disseminating information that is timely, relevant, easily understood and accurate. The purpose of such communication is to increase individual knowledge and promote behavioural change, a key objective of communication around COVID-19.

So while the need for effective public health communication has proven critical in the past year, a chorus of public health experts have stressed that clear communication has been lacking. The result: a “misinfodemic” that has repeatedly revealed that low health literacy is an underestimated public health problem. One glaringly obvious reason for why communication around COVID-19 has often failed to get the desired result is that so much public health material is not written using plain language.

For those unfamiliar with the term “plain language,” the International Plain Language Federation defines it as material in which the “wording, structure, and design are so clear that the intended audience can easily find what they need, understand what they find, and use that information.”

The Plain Language Movement was formed in 1975 in the United States as a way of reducing ambiguity of government and legal documents. The goal of this early campaign was not to “dumb down” government messaging, but to provide clear, to-the-point writing that is accessible to the intended audience. Vague and nuanced writing may be desirable in other types of communications, but it’s not when you’re trying to book a COVID-19 vaccine.

Former U.S. president Barack Obama understood the importance of plain language, and in 2010 he signed into law the Plain Writing Act, which requires federal agencies to write “clear government communication that the public can understand and use.” One of the more pragmatic reasons for signing the use of plain language into law is the belief that it allows government agencies to save time and money while also providing better service to the public. Given the benefits of plain language, it is surprising that its use isn’t mandated in Canada’s publicly funded health system.

There is also a more compelling reason for mandating the use of plain language: It serves as an important tool to help address health disparities. Substantial evidence shows that one of the major barriers to equitable health care access is communication that does not account for varying levels of health literacy and English proficiency among the public. Plain language helps mitigate this. In March, U.S. Vice-President Kamala Harris raised the profile of the issue of limited health literacy by announcing the launch of a US$250-million grant program to improve public health literacy as it relates to COVID-19.

When the COVID-19 pandemic became a reality in the spring of 2020, information about the novel coronavirus was shrouded in uncertainty. Information evolved quickly, knowledge changed rapidly and there were often no clear answers. In such a climate, public health officials should clearly acknowledge the uncertainty of the situation, and also clearly communicate the rules as they evolve.

Plain language isn’t a panacea for all the factors that contribute to limited health literacy, but it is an important tool in the provision of health information that people can understand and act upon. That’s just as true now, as we move ahead: As the vaccine rollouts begin in earnest, it remains essential that the public receives clear, unambiguous messaging to build trust, dispel myths and misinformation, and encourage people to roll up their sleeves.

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