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: http://www.nccmt.ca/resources/search/247 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.

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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

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Clear Communication Index
http://www.nccmt.ca/resources/search/247
Episode 31
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Presenter
Lourdes M. Martinez, PhD
Health Communications
Specialist, Centers for
Disease Control and
Prevention

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Presenter
Sarah Gilman, MPH
Director, National Resource
Center for Lupus, Lupus
Foundation of America

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. 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. 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. 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. 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. 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. 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. 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. 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. 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. https://www.ncbi.nlm.nih.gov/pubmed/24951489

22. CLEAR COMMUNICATION INDEX:
4 QUESTIONS AND 20 ITEMS

23. How can you use the Index?
• Design and develop new communication products
• Assess existing communication products
• Foster discussion before and during review processes
https://www.cdc.gov/ccindex/pdf/full-index-score-sheet.pdf

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. 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?

31. 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 = ______

32. 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.

33. EXAMPLES

34. Thimerosal - Original Main
message
?

35. 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

36. Language of Primary Audience
Original
Revised

37. Heart Disease - OriginalAre these numbers
the audience uses?
Is a lay explanation about what these
numbers mean provided?

38. Heart Disease - Original
Numbers
audience
uses?
Lay explanation of
what numbers
mean? Is this
relevant to the
users?

39. 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

40. Heart Disease - Revised
Explains what
the risk means
to the user

41. Lmartinez@cdc.gov
Visit our websites for more resources:
www.cdc.gov/ccindex
www.cdc.gov/healthliteracy
Office of the Associate Director for Communication

42. Lupus Foundation of America
User Story
Sarah Gilman, MPH
Director, National Resource Center on Lupus
February 1, 2017

43. 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

44.  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

45.  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:

46. 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

51.  Education & Research + Marketing &
Communications
 2 writers
 Graphic designer
 Digital marketing manager
 Communications director
 Marketing director & content director oversee
the team jointly
The Content Team

53.  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

54. 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

55. 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

56. Thank You
Sarah Gilman
gilman@lupus.org

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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
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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 www.nccmt.ca
Contact: nccmt@mcmaster.ca