Medical concepts and language are very complex. People need easily understandable health information regardless of age, background or reading level. Here are guidelines to help you create easy-to-read health materials.

What are easy-to-read (ETR) materials?
ETR materials are written for audiences who have difficulty reading or understanding information.

How can you create easy to read materials?
Writing ETR materials for MedlinePlus is a process involving several important steps:

Step 1: Plan and Research

Know your target audience. Consider reading level, cultural background and attitudes, age group and English Language Proficiency (ELP).

  • Include your target audience. Bring members of the audience into early planning stages, if at all possible. This is especially important in cross-cultural communication.
  • Research your target audience. Use tools such as surveys and interviews to learn about the need of the target group. If extensive research is not feasible due to time or budget constraints, contact other organizations who communicate regularly with similar target audiences.
  • Determine objectives and outcomes. What do you want your target audience to learn? For example, if your objective is to show the proper use of asthma inhalers, emphasize the outcome of their proper use. A sample sentence might be: "Following the directions for your asthma inhaler may help you to breathe easier."

Step 2: Organize and Write

General Points

  • Keep within a range of about a 4th to 6th grade reading level.
  • Focus on a few key concepts.
  • Use a clear topic sentence at the beginning of each paragraph. Follow the topic sentence with details and examples. For example, "Proper use of asthma inhalers helps you breathe better. Here are reasons why." Then give reasons.
  • Examples and stories may help engage readers.
  • Use the "you" attitude. Personalization helps the reader understand what he or she is supposed to do.
  • Structure the material logically. Some users prefer step-by-step instructions. Others may find concepts arranged from the general to the specific easier to understand.
  • Emphasize benefits of adopting the desired behavior. For example, "Following these directions will help you get enough medicine from the inhaler.".
  • Do not make assumptions about people who read at a low level. Maintain an adult perspective.
  • Many who are challenged by English are extremely fluent in a different first language. Is your school French or Spanish or German good enough to read medical instructions?

Language and writing style

  • Find alternatives for complex words, medical jargon, abbreviations, and acronyms. When no alternatives are available, spell complex terms and abbreviations phonetically and give clear definitions.
  • Keep most sentences short. Use varied sentence length to make them interesting, but keep sentences simple.
  • Use the active voice and vivid verbs. Here's an example:
    Active: Amanda used her inhaler today.
    Passive: The inhaler was used by Amanda today.

Visual Presentation and Representation

  • Use colors that are appealing to your target audience. Be aware, however, that some people cannot tell red from green.
  • Use pictures and photos with concise captions. Keep captions close to graphics.
  • Avoid graphs and charts unless they actually help understanding.
  • Balance the use of text, graphics, and clear or "white" space.
  • Avoid words or sentences in all capital letters.
  • Avoid italics.
  • Use bolded subheadings to separate and highlight document sections.
  • When possible, use graphics or spell out fractions and percentages.

Step 3: Evaluate and Improve

Always test your materials on a sample group from your target audience. Evaluate the feedback and revise your material if necessary. Testing during the writing process can help ensure your audience is getting the message. For more information, see the pretest and revision section from the National Cancer Institutes "Clear and Simple" publication.

Following are samples of readability assessment tools:

  • Fry Readability Graph. A commonly used readability assessment tool. See, for example, .
  • SMOG. Less frequently used than the Fry Graph, but still widely used. See, for example, the University of Utah Health Science Center's Smog Readability Formula page.
  • Gunning FOG. One of the first readability tools. It is widely used.
  • SAM (Suitability Assessment of Materials). A tool created by Cecilia and Leonard Doak. SAM assesses not only readability, but also usability and suitability elements.
  • Flesch Reading Ease / Flesch-Kincaid Grade Level. Used in the Microsoft Word grammar checker.

For more information on readability, see Harvard School of Public Health's Assessing Materials page.

Readability software programs

These are examples of software programs. Other programs exist.
Readability software may not be suitable for every ETR project.
Note: NLM makes no endorsements in displaying these examples.

Step 4: Inform Us and Stay Informed

After you create ETR materials, we suggest you label them "easy-to-read." MedlinePlus will display materials as easy-to-read only if the sponsoring organization labels them. NLM does not evaluate materials for reading level.

Other Resources

Here are some lists of other materials that may be helpful.

Sites with easy-to-read health materials

Guidelines and bibliographies for developing easy-to-read materials