The Value in Speaking to a Few, Not All

By / February 24, 2017

Illustration of crowd of people with two highlighted

By Kyle Schruder and Shelley Chen | Illustrations by Shelley Chen

Miguel sits in his doctor’s office, receiving instructions in a language he only somewhat understands. He can tell that this is an important message–the bold text and strict icons on the brochure his doctor hands to him suggest as much. But what is he supposed to do?

The Spanish translator on the phone chimes in: “Miguel, the physician says that you have Type 2 Diabetes. You need to start insulin injections immediately. You will also need to modify your diet to lower your carbohydrate consumption drastically. The doctor suggests cutting rice out of your diet and eating lean chicken.”

Change what he eats? But rice is a staple of his family’s meals. And eating lean chicken is expensive when you’re on a tight budget!

Besides, he feels fine… who is this doctor to tell him he is sick and needs to use needles? Needles spread HIV, everyone knows that!

Patient education materials contain many assumptions about the people who read them. Agencies craft them to speak to as broad an audience as possible, usually writing them in plain English and using multi-cultural photography. But what about the people who these materials don’t speak to? Often they are the ones who need to hear the message the most.

The Montefiore Health Centre in the Bronx is dealing with this very problem. Their new diabetes clinic bustles with patients like Miguel— people with low health literacy and low income. Patients who speak only a little English, or sometimes none at all.

We collaborated with professionals at Montefiore to create a new tool to help their clinical staff communicate with their patient demographic that has very specific needs. We leveraged the clinic’s deep understanding of their patients to craft a set of principles to guide our work.

Here are some of the ways you can use these same principles to communicate more effectively in your work:

Illustration showing poor patient engagement because of information not being relevant to patient

Principle: Make material relevant to increase engagement

The first step in effective patient communication is to increase engagement. How useful is a brochure if the patient doesn’t feel they need to read it? If your material isn’t speaking directly to the patient, if it doesn’t feel relevant to them, they will likely tune your message out.

Stock photographs of multi-cultural groups don’t feel relevant to anyone. Using other types of graphics, such as illustrations, that are culturally relevant or accurately depict the audience makes them feel engaged and invited. The US Department of Health agrees, stating: “If you show people in your visuals, try to make them of the same racial or ethnic group as your intended audience. Select images that are familiar and that the audience will be able to relate to.”

Inappropriate instructions alienate the people receiving them. Patients with lower incomes feel mistrustful when given advice such as “sign up and go to the gym”. They might give up on exercise entirely since they feel the advice doesn’t apply to them. Instead, providing thoughtful and appropriate advice builds trust between patient and practitioner.

There are also cultural complexities to consider. Asking patients to drop rice from their diet outright when it’s their cultural staple requires a delicate touch, not a bullet on a brochure. When you have a better understanding of your patient’s context — their environment and lifestyle — you can create customized and engaging patient-facing materials that truly feel relevant to your audience.

Patient resource illustration showing how decisions around food impact health

Rice and beans make up a large part of our target population’s diet. Rather than telling them to stop eating these foods outright, our resource explains how their decisions around food will impact their blood sugars.

Illustration showing poor patient engagement because of patient not understanding information

Principle: Make sure information is easily understood

Using patient-friendly language is an obvious way to increase patient comprehension—the consensus recommendation is that the readability of patient materials be no higher than a 5th-grade level. However, a 2008 study found that conventional patient materials range anywhere from 5th-grade to higher than postdoctoral education!

Patient materials need to be carefully edited to remove these harsh spikes in language. Scrutinize each word to make sure they are simple, clear, and appropriate for the patients you are speaking to.

Relatable visual analogies are another way to increase patient comprehension. Some cultures have a strong visual storytelling tradition, and embracing this goes a long way towards comprehension. When explaining how insulin works in the blood stream, we used a simple traffic analogy that our audience would understand.


An illustration of roads and cars, providing an analogy of how insulin works in the body.

We used a relatable traffic analogy to explain how insulin works in the body. In this example, cars and roads represented blood sugar and blood vessels.

But honing your message to be relatable is only one aspect you need to nail. The right message in the wrong format is doomed to failure. Some people learn better when given instructions in video or audio, rather than text. Offering alternative learning options to those with different learning styles increase the chance for better comprehension.

Illustration showing poor patient engagement because of patient not understanding why instructions are important

Principle: Don’t just give instructions—explain the why

Patients understanding what they need to do, and actually doing it, are two very different things. Forgetting to take medication and not following treatment instructions lead to patients having to return to receive further care. By reducing these costly readmissions and increasing follow-through, hospitals can free up resources for those who need them.

Patient education materials often list instructions with little context. Materials instruct patients to follow steps 1–4 exactly but don’t tell them why. This causes some patients to skip instructions or even entire treatments if they don’t see the value of doing each step. Providing the why for each step helps patients see its value and remember why they need to do it.

In our instructions for insulin injections, patients may be unsure why they still need to clean the injection area with an alcohol swab if they already cleaned their hands in an earlier step. By providing the why, we avoided patients jumping to undesirable conclusions and encouraged them to follow through with the step.

An illustration of someone cleaning an injection location


By explaining the “why” behind instructions, we give patients a clearer picture of why each step is important and necessary.

Illustration showing poor patient engagement because of patient believing myths

Principle: Meet patients where they are by addressing misconceptions

Imagine you visit your physician for a checkup, and she informs you that you have diabetes and must begin taking insulin injections. You’re worried because your aunt recently told you about her cousin who was told to take insulin, but then died three months later. Isn’t taking insulin a big risk?

There are many myths to debunk when it comes to patient misconceptions. Writing at a basic level helps to ensure patients understand the material, but does nothing to dispel falsehoods they internalize through their social circle. When you focus your message on a specific patient population, you can better identify and address their most common misconceptions. You’re able to anticipate and offer a counter against often unspoken or subconscious resistance to treatment.

An illustration showing someone believing a diabetes myth

By addressing specific and common misconceptions that our target patients had about diabetes, our resource may help to change patient perspectives that can lead to more positive behaviours.

In the healthcare setting, a misconception can be the difference between life or death. It’s imperative that we be conscious and intentional in addressing these misconceptions. The fact is some people still believe the myth that all needles may spread HIV. In the case of the Montefiore diabetes clinic, that can be a huge problem.

Patient-centricity is only the beginning

Focusing your message is about inclusion and forming connections, not exclusion. Patient-centricity is a great goal, but what if you focused that concept? Culture-centricity, age-centricity, there are many ways to customize your message to increase patient engagement and comprehension. By focusing your message, you’re able to speak directly to the patients who may feel excluded from generic patient materials.

For many industries, these principles are nothing new. Marketing uses segmentation to tailor messages to the audience that will be most receptive, thereby increasing the effectiveness of the campaign. By applying these principles to healthcare, patient communication can be just as effective.

Click here to view the entire diabetes patient resource on Issuu