Program for Readability In Science & Medicine (PRISM): A Model for Sparking Culture Change Around Clear Communication

Background:  “We must find a way to make clear communication standard—so that it’s a forethought, not an afterthought,” challenged U.S. Assistant Secretary for Preparedness and Response Nicole Lurie, MD, MSPH, keynote speaker at the 2010 Health Literacy Annual Research Conference. She was concerned that health information provided during recent tragedies in Haiti and the Gulf of Mexico was too complex for a public audience. The reason? Subject matter experts who prepared it resisted “dumbing it down” into plain language. We address this challenge by presenting strategies that have helped Group Health Cooperative and its research center implement successful plain language initiatives. Given the allotted time, we focus on our area of greatest success: consent forms.

Program background:  The Program for Readability In Science & Medicine (PRISM) began in 2005 as a short-term, internal initiative to boost the readability of research consent forms. It is now an enduring plain language program led by communication specialists with help from researchers and the Group Health institutional review board (IRB)—our key subject matter experts. PRISM resources for the research community include a public-domain readability toolkit and online training program, plus plain language editing services and writing workshops. See http://tinyurl.com/prismtoolkit for more information.

Evaluation Methods and Results: 

• Before PRISM, research consent forms averaged near a college reading level. Of more than 40 consents edited since 2005, the average reading level is below 8^th grade. A PRISM-edited clinical consent won a ClearMark award from the Center for Plain Language in 2010 for its transformation from a 15^th-grade to a 7^th-grade reading level.
• A 2007 grant-funded toolkit evaluation showed that 88% of respondents rated it as “useful” or “very useful.” More than 10,000 toolkits were downloaded from our website the following year.
• Five months after its launch in October 2010, more than 550 people have registered for or completed PRISM Online Training. Of 129 users who answered the built-in evaluation, more than 95% say they learned helpful plain language strategies and would recommend the course to others.
• PRISM writing workshops receive consistently high ratings from attendees.

Conclusions:  PRISM has helped shift the communication culture at Group Health and elsewhere toward Dr. Lurie’s ideal. Plain language principles are now embedded into our routine processes around research consent form development and review. We attribute this success to three factors:

• PRISM builds a trusting partnership between plain language experts and subject matter experts—meaning readability edits are expected.
• It provides a range of complementary resources: training to build skills, a toolkit to support post-training success, and expert editing advice.
• It aligns well with existing initiatives related to patient-centered care, health literacy, and ethical research.

Implications for research and/or practice:  PRISM provides highly rated readability resources that may be useful across diverse health care settings. More important, it suggests a three-tiered model to encourage health care professionals to embrace plain language: a partnership between editors and subject experts, a complementary range of tools, and a favorable alignment with existing initiatives. We believe this model merits further exploration as a strategy for standardizing clear health communication.