Appendix E: Strategies for Providing Information to Clients

The client should receive and understand the information she or he needs to make informed decisions and follow treatment plans. This requires careful attention to how information is communicated. The following strategies can make information more readily comprehensible to clients:

Strategies for Providing Information to Clients

Educational materials should be provided that are clear and easy to understand. Educational materials delivered through any one of a variety of media (for example, written, audio/visual, computer/web-based) need to be presented in a format that is clear and easy to interpret by clients with a 4th to 6th grade reading level (1–3). Many adults have only a basic ability to obtain, process, and understand health information necessary to make decisions about their health (4). Making easy-to-access materials enhances informed decision-making (1–3). Test all educational materials with the intended audiences for clarity and comprehension before wide-scale use.

The following evidence-based tools provide recommendations for increasing the accessibility of materials through careful consideration of content, organization, formatting, and writing style:

• Health Literacy Universal Precautions Toolkit, provided by the Agency for Healthcare Research and Quality (available at http://www.ahrq.gov/qual/literacy),
• Toolkit for Making Written Material Clear and Effective, provided by the Centers for Medicare and Medicaid Services (available at http://www.cms.gov/WrittenMaterialsToolkit), and
• Health Literacy Online, provided by the Office of Disease Prevention and Health Promotion (available at http://www.health.gov/healthliteracyonline).

Information should be delivered in a manner that is culturally and linguistically appropriate. In presenting information it is important to be sensitive to the client's cultural and linguistic preferences (5,6). Ideally information should be presented in the client's primary language, but translations and interpretation services should be available when necessary. Information presented must also be culturally appropriate, reflecting the client's beliefs, ethnic background, and cultural practices. Tools for addressing cultural and linguistic differences and preferences include

• Health Literacy Universal Precautions Toolkit, provided by the Agency for Healthcare Research and Quality (available at http://www.ahrq.gov/qual/literacy), and
• Toolkit for Making Written Material Clear and Effective, Part 11; Understanding and using the "Toolkit Guidelines for Culturally Appropriate Translation," provided by the Centers for Medicare and Medicaid Services (available at http://www.cms.gov/outreach-and-education/outreach/writtenmaterialstoolkit/downloads/toolkitpart11.pdf).

The amount of information presented should be limited and emphasize essential points. Providers should focus on needs and knowledge gaps identified during the assessment. Many clients immediately forget or remember incorrectly much of the information provided. This problem is exacerbated as more information is presented (7–9). Limiting the amount of information presented and highlighting important facts by presenting them first improves comprehension (10–14).

Numeric quantities should be communicated in a way that is easily understood. Whenever possible, providers should use natural frequencies and common denominators (for example, 85 of 100 sexually active women are likely to get pregnant within 1 year using no contraceptive, as compared with 1 in 100 using an IUD or implant), and display quantities in graphs and visuals. Providers also should avoid using verbal descriptors without numeric quantities (for example, sexually active women using an IUD or implant almost never become pregnant). Finally, they should quantify risk in absolute rather than relative terms (for example, "the chance of unintended pregnancy is reduced from 8 in 100 to 1 in 100 by switching from oral contraceptives to an IUD" versus the chance of unintended pregnancy is reduced by 87%). Numeracy is more highly correlated with health outcomes than the ability to read or listen effectively (15). The strategies listed above can help clients interpret numeric quantities correctly (16–28).

Balanced information on risks and benefits should be presented and messages framed positively. In addition to discussing risks, contraindications, and warnings, providers should discuss the advantages and benefits of contraception. In presenting this information, providers should express risks and benefits in a common format (for example, do not present risks in relative terms and benefits in absolute terms), and frame messages in positive terms (for example "99 out of 100 women find this a safe method with no side effects," versus "1 out of 100 women experience noticeable side effects"). Many clients prefer to receive a balance of information on risks and benefits (29), and using a common format avoids bias in presentation of information (18,22,26,30). Framing messages positively increases acceptance and comprehension (18,22,31,32).

Active client engagement should be encouraged. Providers should use educational materials that encourage active information processing (e.g., questions, quizzes, fill-in-the-blank, web-based games, and activities). In addition, they should be sure the client has an opportunity to discuss the information provided, and when speaking with a client, providers should engage her or him actively. Research has indicated that interactive materials improve knowledge of contraceptive risks, benefits, and correct method use (33–35). Clients also value spoken information (29,36); and educational materials, when delivered by a provider, more effectively increase knowledge (10,37). In particular, presenting information in a question and answer format is more effective than simply presenting the information (10,15,37–41).

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