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NCCMT Spotlight Webinar: Clear Communication Index


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Interested in evidence-based criteria for clear communication of public health material?

Do you develop and review public health material? Are you interested in enhancing the clarity and ease of understanding of these materials? The Clear Communication Index can help!

The U.S. Centers for Disease Control and Prevention developed the Index.

How can the Clear Communication Index help you?

The Index helps professionals develop and review public health communication materials for clarity, encourages collaboration between writers and reviewers to ensure accuracy, and assesses ease of use of communication materials. The tool consists of criteria that enhance clarity and understanding.

Use of the Index yields a quantitative score based on assessment of seven areas: main message and call to action, language, information design, state of the science, behavioural recommendations, numbers, and risk. A widget is available for placement on webpages.

This webinar includes an overview of the Index by its developers, followed by a presentation from the National Resource Center for Lupus in the Lupus Foundation of America.

To see the summary statement of this method developed by NCCMT, click here:

The National Collaborating Centre for Methods and Tools is funded by the Public Health Agency of Canada and affiliated with McMaster University. The views expressed herein do not necessarily represent the views of the Public Health Agency of Canada.

NCCMT is one of six National Collaborating Centres (NCCs) for Public Health. The Centres promote and improve the use of scientific research and other knowledge to strengthen public health practices and policies in Canada.

Published in: Healthcare
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NCCMT Spotlight Webinar: Clear Communication Index

  1. 1. Follow us @nccmt Suivez-nous @ccnmo Funded by the Public Health Agency of Canada | Affiliated with McMaster University Production of this presentation has been made possible through a financial contribution from the Public Health Agency of Canada. The views expressed here do not necessarily reflect the views of the Public Health Agency of Canada.. Clear Communication Index Presenters: Lourdes M. Martinez, PhD Sarah Gilman, MPH February 1, 2017 1:00 – 2:30 PM ET
  2. 2. Follow us @nccmt Suivez-nous @ccnmo 2 Housekeeping Use Chat to post comments and/or questions during the webinar • ‘Send’ questions to All (not privately to ‘Host’) Connection issues • Recommend using a wired Internet connection (vs. wireless), • WebEx 24/7 help line • 1-866-229-3239 Participant Side Panel in WebEx Chat
  3. 3. Follow us @nccmt Suivez-nous @ccnmo 3 After Today The PowerPoint presentation (in English and French) and English audio recording will be made available. These resources are available at: PowerPoint: Audio Recording:
  4. 4. Follow us @nccmt Suivez-nous @ccnmo 4 How many people are watching today’s session with you? Poll Question #1 A. Just me B. 1-3 C. 4-5 D. 6-10 E. >10
  5. 5. Follow us @nccmt Suivez-nous @ccnmo Your profession? Put a √ on your answer (or RSVP via email) / Epidemiologist Management (director, supervisor, etc.) Allied health professionals (nurse, dietician, dental hygenist, etc.) Librarian Physician / Dentist Other 5
  6. 6. Follow us @nccmt Suivez-nous @ccnmo Clear Communication Index Episode 31 6
  7. 7. NCC Infectious Diseases Winnipeg, MB NCC Methods and Tools Hamilton, ON NCC Healthy Public Policy Montreal, QC NCC Determinants of Health Antigonish, NS NCC Aboriginal Health Prince George, BC NCC Environmental Health Vancouver, BC 7
  8. 8. Registry of Methods and Tools Online Learning Opportunities WorkshopsMultimedia Public Health+ Networking and Outreach NCCMT Products and Services 8
  9. 9. Follow us @nccmt Suivez-nous @ccnmo 9 Poll Question #2 How familiar are you with the method or tool we are discussing today? A. I am not familiar with the method or tool B. I have heard of the method or tool C. I have used the method or tool
  10. 10. Follow us @nccmt Suivez-nous @ccnmo 10 Presenter Lourdes M. Martinez, PhD Health Communications Specialist, Centers for Disease Control and Prevention
  11. 11. Follow us @nccmt Suivez-nous @ccnmo 11 Presenter Sarah Gilman, MPH Director, National Resource Center for Lupus, Lupus Foundation of America
  12. 12. CDC’s Clear Communication Index Lourdes M. Martinez, Ph.D. February 2017 Office of the Director Office of the Associate Director for Communication
  13. 13. Overview  Background on creation  Need for creation  How the tool was developed  Who was involved in development  Describe the tool and how to use it  CDC examples using the tool
  14. 14. Why Do We Need to Focus on Clarity?  Clarity is foundational for communication effectiveness  Communication science and related disciplines should inform practice  Implement the Plain Writing Act
  15. 15. How Was the Index Developed?  CDC staff and contract team  CDC: Cynthia Baur and Chris Prue  Contractors: RTI International and CommunicateHealth Inc.  Multi-step process  Questions and items based in scientific literature, staff and consumer testing
  16. 16. Expert Panel Areas of Expertise  Social cognition, persuasion, and cognitive and informational processing  Adult literacy and education  Social psychology, message framing, role of emotion  Social networks, media, and marketing  Scientific literacy measurement, science communication  Cross-cultural communication  Health literacy  Visual communication & design  Numeracy, risk communication, medical communication  Linguistics, language in health communication messages
  17. 17. Developing the Index Review of existing health literacy guidelines to identify items (n=205) Input from expert panel on items and evidence Search and review of evidence to support items (n=43) Create draft index (n=36) Expert panel reviews and rates items and evidence Use of findings: We developed numerous drafts of the index, last one with 23 items.
  18. 18. Testing the Index at CDC • Pilot tested draft index (study team) • 7 materials scored by two people each • Expert panel review • Cognitive interviews with CDC communicators • 8 staff (6 health communication specialists, 1 Public Health Analyst and 1 Associate Director for Communication Sciences • Given user guide and scoring sheet • Scored a material that they worked on and a preselected material • “Think aloud” technique with observer and note taker • User testing (including inter-rater reliability study) • 67 staff invited to participate • Sent user guide, score sheet, 3 materials, and a web link to survey • 28 staff responded within 2 week time frame
  19. 19. Testing the Index at CDC  Focus groups with the 8 members of the dyads (matched pairs)  Communication staff and subject matter expert pairs recruited from four national centers • Environmental Health • Infectious Diseases • Immunization and Respiratory Diseases • Chronic Diseases  Given user guide and score sheet to use on a project of their choosing and 2 weeks to try it out
  20. 20. Refining the Index  Initial index had 22 items – current has 20 items  Eliminated 1 item that seemed to not apply to CDC work  Combined two items into one (describing nature of risk)  Initial user guide  Didn’t have definition of risk – there are many different meanings of risk in public health so this was added to new guide  Initial score sheet  Required users to do math  Now there is a fillable form that calculates the score  Widget available  Initial trainings were 4 hour workshops  Trainings now are 1 ½ hours long and tailored for programs  Pre-recorded webinars for CDC staff
  21. 21. Testing the Index with Consumers (n=870)  More consumers could  Identify the main message  Find information of interest to them  Use the information to decide when they viewed materials designed using the Index versus CDC’s usual practices Source: The CDC Clear Communication Index is a new evidence-based tool to prepare and review health information. (2014). Health Promotion Practice, 15(5):629-37. doi: 10.1177/1524839914538969l.
  23. 23. How can you use the Index? • Design and develop new communication products • Assess existing communication products • Foster discussion before and during review processes
  24. 24. What is the Clear Communication Index (Index)? • 4 questions and 20 items based in communication and related sciences that staff can use to develop, assess and score communication products • Assesses materials in these 7 areas – Main Message and Call to Action – Language – Information Design – State of the Science – Behavioral Recommendations – Numbers – Risk
  25. 25. 4 Questions Before Scoring  Who is your primary audience?  What do you know about the health literacy skills of your audience?  What is your primary communication objective?  What is the main message of the material?
  26. 26. Calculate the Score for the Material Step 1: Add up the total points that the material earned (this is the numerator). Step 2: Add up the total possible points that the material could have earned (this is the denominator). Step 3: Divide the numerator by the denominator and multiply by 100 to get the total score. ______ / ______ X 100 = ______
  27. 27. How to Interpret Your Score If the total score is 90 or above: Excellent! You have addressed many items that make materials easier to understand and use. If the total score is 89 or less: Note which items scored 0 points. Use the descriptions and examples in the User Guide to revise and improve the material. Then apply the Index again to check your work. You can use the Index as many times as you need to revise the material to get a score of 90 or above.
  28. 28. EXAMPLES
  29. 29. Thimerosal - Original Main message ?
  30. 30. Thimerosal - Revised Language of primary audience One main message & located at the top of the first page Visual supports main message Active Voice Most important information summarized on the first page
  31. 31. Language of Primary Audience Original Revised
  32. 32. Heart Disease - OriginalAre these numbers the audience uses? Is a lay explanation about what these numbers mean provided?
  33. 33. Heart Disease - Original Numbers audience uses? Lay explanation of what numbers mean? Is this relevant to the users?
  34. 34. Heart Disease - Revised Lay explanation of what numbers mean presented in numbers used by audience. Numeric probability of risk explained with both text and numbers
  35. 35. Heart Disease - Revised Explains what the risk means to the user
  36. 36. Visit our websites for more resources: Office of the Associate Director for Communication
  37. 37. Lupus Foundation of America User Story Sarah Gilman, MPH Director, National Resource Center on Lupus February 1, 2017
  38. 38. 1. The Foundation 2. Clear Communications Index a. Timeline - How we learned to use the CCI b. Writing Guidelines and how we use CCI c. Recommendations for using the tool Overview
  39. 39.  We are dedicated to improving the quality of life for all people affected by lupus through programs of research, education and advocacy.  We serve adults and children with lupus, caregivers, loved ones and health care providers. Our Mission Lupus Foundation ofAmerica
  40. 40.  Website = 8 million visits per year  Social media posts receive hundreds of interactions from followers  Health educators regularly refer constituents to our online content as a source of education Our content is a key education tool:
  41. 41. 1. A digital home for the lupus community. 2. A living source of health information, empowerment and support for anyone with questions about lupus. 3. Dynamic, broadly focused content that draws people in and encourages higher levels of interaction and stronger relationships. Funded by CDC-PULSE Grant National Resource Center on Lupus
  42. 42.  Education & Research + Marketing & Communications  2 writers  Graphic designer  Digital marketing manager  Communications director  Marketing director & content director oversee the team jointly The Content Team
  43. 43.  January 2014 - Health Literacy Campaign  October 2016 - CCI Training for LFA Content Team - 2 hour training with actual-use samples  October 2016-Present - Regular use of the CCI in education content Our timeline
  44. 44. Writing Guidelines  Writers keep tool handy in desktop shortcut or physically at their desks  Expectation for writers and editors: - Every piece in production will be measured against the tool - Every piece under review will be measured against the tool  At minimum: - 4 preliminary questions - Section A
  45. 45. Recommendations  Learn about health literacy + plain language  Take CCI training or self-teach  Get organizational buy-in  Designate an owner that can enforce CCI use  Require all writers and editors to keep it handy  Require, at minimum, first 4 questions and part A  Plan for (at least) yearly refreshers and new staff trainings  Success is in the long-game
  46. 46. Thank You Sarah Gilman
  47. 47. Follow us @nccmt Suivez-nous @ccnmo 57 Your Comments/Questions • Use Chat to post comments and/or questions • ‘Send’ questions to All (not privately to ‘Host’) Chat Participant Side Panel in WebEx
  48. 48. Follow us @nccmt Suivez-nous @ccnmo 58 Poll Question #3 Could this method or tool be useful in practice? A. Very useful B. Somewhat useful C. Not at all useful D. Don’t know
  49. 49. Follow us @nccmt Suivez-nous @ccnmo 59 Your Feedback is Important Please take a few minutes to share your thoughts on today’s webinar. Your comments and suggestions help to improve the resources we offer and plan future webinars. The short survey is available at: qy5zFLv5p4Dr
  50. 50. Follow us @nccmt Suivez-nous @ccnmo 60 Poll Question #4 What are your next steps? (Check all that apply) A. Access the method/tool referenced in the presentation B. Read the NCCMT summary about the method/tool described today C. Consider using the method/tool in practice D. Tell a colleague about the method/tool
  51. 51. Follow us @nccmt Suivez-nous @ccnmo 61 Join us for our next webinar NCCMT Spotlight on Methods & Tools: MetaQAT Date: Tuesday, March 21, 2017 Time: 1:00 – 2:30pm EST Interested in a tool to appraise all types of public health evidence? Do you appraise public health evidence? Are you interested in a single tool that can appraise many different types of evidence and study designs? Join us for a webinar to learn about the MetaQAT. Register at: evidence/onstage/g.php?MTID=e096a1f507835d52365f5c9c3a6f397be
  52. 52. Follow us @nccmt Suivez-nous @ccnmo Funded by the Public Health Agency of Canada | Affiliated with McMaster University Production of this presentation has been made possible through a financial contribution from the Public Health Agency of Canada. The views expressed here do not necessarily reflect the views of the Public Health Agency of Canada.. For more information about the National Collaborating Centre for Methods and Tools: NCCMT website Contact: