Anatomy of Words: Introduction

Photo of artist's performance


I say “shot,” she says “immunization.” I say “birth control,” he says “contraception.” As a communication professional working in the health sector since 2004, this type of linguistic debate is typical of my meetings with doctors and nurses. It appears that for many healthcare providers, plain language is “a bitter pill to swallow.” Despite decades of evidence that document  the importance of closing the gap between the reading levels of health information and the reading ability of adult users, healthcare providers are slow to adopt standards of plain language or use clear verbal communication with their patients (Stableford & Mettger, 2007, p. 72). I see this reluctance first-hand: even though they read the evidence, and receive training and assurances that accuracy will not be compromised, many continue to use medical jargon.


Let us address plain language and its myths. First, plain language does not mean “dumbing things down.” It means writing in a way that focuses on the audience and their needs: clear communication that is to-the-point and accessible. Plain language is also not new or experimental. Journalists and businesses have used it for years and lately, the health, government, and legal sectors have started to warm up to it as well.


Second, we need to identify its connection to health literacy. Health literacy refers to the skills people need to make informed decisions about their healthcare (Egbert & Nanna, 2009, para. 4). By focusing on health literacy, the healthcare community aims to encourage understanding between providers and their patients (Osborne, 2004, p. 2). The issue takes into account the many ways we communicate about healthcare including the text and design in printed information (plain language), documents, meetings, pictures, and websites. It is a big challenge considering that 60% of Canadians have low health literacy, meaning they do not have the skills they need to manage their health adequately (Canadian Council on Learning, 2008, p. 2). Even for well-educated people, it is not easy to access and manage your own healthcare. This is because in today’s society, you are expected to read information in various formats from many sources, understand complex verbal instructions and medical terms, and use the information to get the results you need (Rudd & Keller, 2009, p. 241). Ultimately, the stakes are high, as a mismatch between health information and a person’s literacy skills can lead to law suits, illness, injury, and death.


The question is, if the evidence shows that patients need clear information to improve their health, why are healthcare professionals choosing not to provide it? Since thousands of published studies have had a limited effect on changing doctors’ behaviour, for my research I wanted to find an alternative way to interpret the information and present my understandings. As a result, I decided to use arts-based research. With this relatively new practice, the researcher gathers and reads information about the topic and then uses an art form, such as music, visual arts, dance, and film, to portray the findings. Sullivan (2007) says that imagination— a distinctive feature of the visual arts—can reveal alternative forms of understanding that break through assumptions and preconceptions; a crucial component it shares with research (p. 1190). Unlike traditional research though, an arts-based approach can effectively connect with audiences on a deeper emotional level (Leavy, 2009; Cole & Knowles, 2008; Barone & Eisner, 2006). Leavy (2009) contends that “the arts can be highly effective for  communicating the emotional aspects of social life” and “can evoke compassion, empathy, sympathy, as well as understanding” (p. 13). Instead of continuing to appeal only to the intellect as in scientific enquiry, an arts-based approach allows the researcher to connect with both the mind and heart of the audience. 


Another benefit of an arts-based approach is that it allows research to move into alternative spaces: beyond the “elitist institutions of academe and arts museums and relocate inquiry within the realm of local, personal, everyday places and events” (Cole & Knowles, 2008, p. 73). With easier access and wider distribution in mind, I created a visual art exhibition intended for display within the halls of a healthcare setting for viewing by healthcare workers, administrative staff, patients and families. It makes sense that when addressing the problem of unequal access to health information such as the issue with plain language, my research approach should be sensitive to accessibility as well.


By working with the tools of an arts-based approach, I was able to present the data in a way that had meaning for me. Since 1990, I have worked as a visual artist, showing my paintings, drawings, and photographs in exhibitions in public and private galleries throughout Ontario. As well, my weekly columns and articles on visual art and artists have been published in newspapers and national magazines such as Canadian Art and Canadian House and Home. As Leavy (2009) says, using art as a new research tool prevents the division of the “artist-self and researcher-self,” allowing the researcher to “merge their interests while creating knowledge based on resonance and understanding” (p. 2).


For this project, I identified doctors as the primary target audience. This was the result of reading studies that showed doctors play a key role in deciding if evidence-based practices in healthcare organizations are integrated into medical practices. Dopson et al. (2010) say that doctors look to their own experience and their colleagues to determine whether or not to adopt the evidence and change their practice. And if they do decide to adopt the evidence, their high level of professional autonomy and workplace authority means their medical opinion will be unchallenged and accepted into organizational policy (p. 8). This was further supported by Apker et al. (2005) who found that within the medical hierarchy, doctors maintain a superior status and retain control of decisions (p. 100). The implication is that physicians who think plain language is not a priority or conducive to their needs, may be less likely to integrate clear communication into their practice and may deter the use of plain language by other healthcare workers and administrative staff.


With the exhibition, Anatomy of Words, the goal is for people working in healthcare—doctors in particular—to experience a creative interpretation of a familiar issue, reflect on health literacy within their own practice and experience, talk with their colleagues and healthcare teams to cultivate wider understanding, and ultimately change their behaviour. 


Next page:


Return to Anatomy of Words