Whom are we communicating for? a call for plain language, cultural humility, and increased specificity

There is a lot of talk on improving the quality of our relationships with a variety of groups and stakeholders by promoting meaningful dialogue, building or restoring trust, and empowering communities to effectively participate in the design, implementation and evaluation of all kinds of interventions and policies. Our Journal has been advocating for this approach for almost a decade and is part of a growing movement in support of community and patient engagement and participatory design to achieve health, racial and social equity.

Communication is foundational to all kinds of relationship-building and/or community engagement interactions. In fact, not only is communication part of everyday life [1] but the way we communicate, whether in interpersonal, community or population settings, has an impact on people’s emotions, feelings, stress levels, and also brain development in the case of early childhood [2,3,4]. It also affects people’s ability to react to disease and emergencies and/or to understand complex concepts, as well as their willingness to support, adopt or maintain specific health behaviors, social norms and policies [1].

In 2010, the government of the United States adopted The Plain Writing Act [5,6], a law that reinforces previous guidelines, and requires that ‘federal agencies use clear government communication that the public can understand and use [6].’ Presumably, the law also helped increase awareness among other types of organizations and professionals of the importance of clear and jargon-free language that would help communities and groups with limited expertise in any specific subject matter make sense of complex concepts and use that information to their benefit. (Note: This is not the same as simplifying concepts and recommendations by omitting or de-prioritizing some of the information. This is about providing the full information on health or social issues by describing complex concepts in clear and easy-to-understand terms that are part of everyday language). Globally, organizations such as Plain Language Association International [7] and the World Health Organization [8] have also been providing many resources and guidelines on this important topic.

Unfortunately, despite existing resources, the call for plain language by advocates and communicators, and the ‘widespread scientific illiteracy [9]’ in our society, many communication interventions and research studies do not reflect plain language. This means that those in our communities who did not have an opportunity to develop science and health literacy skills – because of conflicting priorities, professional preferences, or other social factors - cannot make evidence-based decisions on science topics that may affect their health and well-being. ‘Plain language is one of our best tools for improving scientific literacy and encouraging wise decision-making by the public on science-based issues [9].’

Cultural humility is an important precursor to the kind of plain language that would resonate with patients and communities. It has also been long recognized as a key contributing factor to the quality of our communication efforts and relationships [9]. While many definitions of cultural humility have been offered by numerous authors and organizations, cultural humility always ‘incorporates a lifelong commitment to self-evaluation and critique [10]’ so that we can address power imbalances and establish long-term partnerships [10]. Cultural humility is at the core of cultural competence (a set of skills versus ‘a lifelong commitment to self-evaluation [10]’) and cultural safety (healthcare or public health or other kinds of practices that are defined as feeling safe and bias-free by patients and/or communities and implemented in clinical or community settings [11]).

Cultural humility should also be at the core of our interactions with communities, patient groups, professionals and many other key stakeholders. When we practice cultural humility, we are able listen, empathize, communicate such humility, and speak about our process of self-reflection and evaluation. We are also able to reassess our assumptions, break down barriers to partnerships, and integrate the values, ideas, and preferred ways of saying things of the groups we seek to reach and engage. After all, what may be plain language for us may not be plain language for other groups and communities.

Finally, communication is about specificity. There is no such thing as a magic bullet in reaching and engaging a variety of patient groups and communities. Each communication intervention or research study is specific to a given group, community or population [1]. This is a key mantra in health and risk communication [1]. By engaging communities, patients, and other stakeholders in developing concepts, interventions, messages, and media, [1,12] we can ensure communication efforts reflect the community’s culture and worldviews, define action steps in the words of patients and community members, use their own everyday language, consider local contexts and information ecosystems [13], and help enhance understanding of scientific matters and related decision-making processes. This would also help improve the specificity of our communication efforts, promote healing and long-term partnerships, and increase the sustainability of all kinds of behavioral and social outcomes.

To do so, we need a more humble, empathetic, and community-driven approach to both programming [13] and research design. Such an approach should also inform our own actions when we engage with patients, communities, or other groups. Plain language is just the start but it’s a good start.

In this issue

In this issue we are pleased to feature an article collection on Addressing misinformation: The role of health communication - a key topic in today’s global health environment - which we will continue to explore as part of the Journal’s broader ‘Science of Trust’ initiative. The collection was proposed by editorial board member Dr. Julia Kish Doto of Marymount University who also authored a commentary on Shifting the misinformation perspective: From combatting, challenging, and fighting to acknowledging, advocating, and communicating. Articles in this collection explore lessons learned at the intersection of infodemic management, social contagion, and the public health response to COVID-19 in Nigeria; strategies to inoculate against COVID-19 vaccine misinformation; the impact of an anti-vaccine propaganda documentary on students’ perceptions about MMR vaccination; and design thinking as an approach for digital health innovation as well as to mitigate online misinformation among older adults communities. Of great importance, the collection seeks to highlight that while misinformation has been rampant during the ongoing pandemic, this is an issue that pre-dates COVID-19 and affects a variety of health and human rights topics, groups, and populations.

Outside of the article collection, topics featured in the articles we publish here include information-seeking barriers and strategies in maternity care; racial and ethnic differences in cost-of-care conversations among older adults; the role of sympathy and fear in mediating the interplay between benefit and scarcity appeal of organ donation messages; and insights on smokers from Indigenous populations in South Australia who have been exposed to anti-smoking marketing. We are grateful to all of our authors for their commitment to advancing health communication research, policy, and practice and for the diversity they bring to our Journal.

As we are preparing for the launch of new initiatives, calls for papers, and resources, we invite you all, our readers, to write with suggestions and ideas. We also always look forward to learning about your work and to receiving your submissions. Thank you for your readership!