Nothing is more important during a pandemic than ensuring that the public consistently receives accurate information that they can understand. But even government websites designed with the intent to reach people with low literacy levels appear to be falling short of their guidelines for accessible text, according to an August research letter in JAMA Network Open.
The authors, one from Dartmouth College and one from Madras Medical College in India, analyzed randomly pulled pages from 18 websites. Three were public health agency sites, including the CDC and WHO, and 15 were official government sites, all from countries with at least 5,000 cases of COVID-19 as of April 5.
Since multiple measures of readability exist, they used five different ones, including the Flesch-Kincaid grade level and Gunning Fog Index commonly used in U.S. education. Information about COVID-19 on every single site exceeded an eighth-grade reading level — the recommended level by the CDC, NIH and American Medical Association — on at least one of the indices. In fact, 95% of the pages exceeded an eighth-grade reading level on all five indices.
The CDC pages failed to meet its own guidelines: an eighth-grade reading level, 1-2 syllables per word, 8-10 words per sentence, and use of everyday synonyms for 121 difficult public health terms. Text analyzed from 68 pages on the CDC site did meet the syllable requirement (an average of 1.7) but exceeded the maximum words per sentence (average 15.6 instead of 8-10). All but one of the CDC pages also used at least one difficult public health term.
As Charlotte LoBuono reports at The Doctor Will See You Now, “the lack of easily-understood information from official sources is of particular concern for vulnerable communities with low health literacy.” Unclear or confusing guidance could worsen the impact of the pandemic on these communities, senior author Joseph Dexter, told her.
Admittedly, it’s not easy to write at an eighth-grade reading level with short sentences, short words, and few clauses. I’ve authored several science children’s books where I have to write to even lower levels, and it’s more challenging than many might expect until they try it. But not having information about COVID-19 available for low literacy levels can be a matter of life and death.
So what’s the solution? I know it’s a long shot, but I would love to see a section at every major publication designed explicitly for people with very low literacy levels. Not every story, or even most stories, need to be published there, but for the stories or information that’s essential for people to know, it could be tremendously helpful.
I am reminded of a CNN tip sheet I saw very early in the pandemic that used lots of spacing and bulleted items for older adults. I didn’t run the page through a reading level analyzer, but at a glance, it looks pretty good.