Health Literacy Guidelines

 Enhancing Health Equity Through Inclusive Health Literacy and Communication

A central component of Duke Cancer Institute’s mission to enhance cancer health equity across our clinical, research and training missions involves a focus on health literacy. Below are resources and guidelines to ensure that all DCI education materials are inclusive, succinct, easy to read and understand, engaging and convey key information

Goal: The “golden-standard” for patient- and community-facing clinical and research writing is to achieve a 5th grade or below reading level, present information in clear logical sequence, and provide the most important information first. This requires paying attention to content, style, grouping and graphics. This document is intended to provide general principles, resources, and suggestions to inform an inclusive approach to communicating with patients, research participants and community partners

  1. Content: Review all content and provide a clearly stated purpose at the beginning of the document
  • Consider: “What would my audience want/need to know” & “What would my audience not know?”
  • Keep points clear andlogical; emphasize the most important points and summarize the key take-aways
  • Avoid using different words to describe the same thing; consistent terminology enhances clarity
  • Repetition of important words allow for the document to be memorable and easy to interpret
  • Frame information about disparities with a health equity lens. Use gender-neutral terms to be more inclusive of all readers. Consider using person-first language and avoid unintentional blaming
  1. Writing Style: Ensure that all writing is in plain language; plain language is easy to read, easy to understand and easy to use. It does not mean ‘dumbing down’, being imprecise, or leaving out necessary technical terms. In a document written in plain language, readers can: find what they need, understand what they find, and use what they find to meet their needs
  • Refer to resources from the CDC, Department of Defense, and Center for Medicare and Medicaid Services for trainings, toolkits and tips on writing in plain language
  • Consider mostly using an active, conversationalWrite the document as if you were speaking to your audience in person. Prioritize familiar or commonly used words over the unusual or obscure. Avoid the ‘Dirty Dozen
  • Check out another resource for simple wordsand a resource for health care terms
  • Consider using short sentences (10 words or less). Are there sentences can be broken up into 2-3 sentences? The simpler the sentence, the easier it is to explain.
  • Define all acronyms at first use and ensure that all medical terms are defined. For instance, DCI employees understand that DCI means Duke Cancer Institute, but external partners may not
  1. Grouping: Organize writing into themes that follow a logical sequence to enhance understanding
  • Consider breaking down sentences with >2 items into a bulleted list
  • There should be no more than 7 items in a list
  • Use tables to present comparative information so it is easier to understand
  1. Graphics: Clear and appropriate use is important for visual appeal or aid. When done incorrectly or poorly, graphics can look messy, undesirable, and even offensive. Depending on the organization you are working with, there are always guidelines to follow to ensure company policy and proper representation of the organization’s visions.
  • When using a Logo, make sure they are approved, used in the original state, space and or placed in an appealing manner.
  • Follow guidelines for Primary & Secondary color schemes approved by organization, DON’T overuse, only use, or make your secondary color a predominate color.
  • Photos should have high-resolution, modern photography style, and diverse representation of races, ethnicity and genders when appropriate. Avoid using collages, black and white photography, highly edited or filtered images.
  • Further guidelines or examples of graphics appropriateness regarding matrix, items, infographics, icons, and illustrations can be found
  • Consider using an image library offered by your institution for resourcing health images.


Resources and Weblinks


Check the readability of your writing in Microsoft Word:

Open your document→Choose Files Options  Proofing check off “Show readability statistics” to give you Flesch-Kincaid Readability


Additional Resources:  

Principles and Preferred Terms for Non
Stigmatizing, BiasFree Language 



Resource on Health images

Pictogram best practices

Pictogram “Worth A thousand Words”

Copyright: Relax, Relate, Release…

 Resources at Duke


Margaret Sturdivant  Administrative Director Patient Care Technology Education

Carolyn Krisko Program Manager Duke Center for Cancer Survivorship

Mary Susan Moss  Clinical Nurse Educator DUHS Clinical Education & Professional Development