A qualitative case study of implementing Easy Language policies at a public hospital in Finland

Authors

  • Ulla Vanhatalo University of Helsinki, Finland
  • Tiina Valkendorff University of Helsinki, Finland

DOI:

https://doi.org/10.7146/qhc.151446

Keywords:

customer orientation, Easy Language, health communication, linguistic simplification, organizational health literacy, patient instructions

Abstract

Background: The need for accessible communication in health care is rapidly growing. Easy Language has shown to be an effective means of simplifying information. Aim: In this qualitative study, we examined why a Finnish public hospital started using Easy Language in its consumer communication, and what exactly this process required. Methods: The qualitative data consisted of six semi-structured theme interviews with management-level personnel. Results: Easy Language was seen as one way to address consumers' needs in the hospital. The use of Easy Language in consumer communication was justified by values, consumer orientation in particular. Using difficult language was seen as harmful to consumers. Organizational benefits were not reported to be the motivation for using Easy Language, although they were one result comprehensible communication. Linguistic expertise and strong management support were considered the most important requirements for the successful use of Easy Language.  Discussion: Easy Language may be a practical means for simultaneously realizing health care values and improving consumer experiences. Conclusions: Understandable language is vital for good customer experience in health communication. Our research showed how the hospital’s value of consumer orientation was put into practice. Future studies could examine consumer experience and the impact of Easy Language usage.

Author Biographies

Ulla Vanhatalo, University of Helsinki, Finland

Ulla Vanhatalo is a docent in general linguistics at the University of Helsinki. Her research interests are lexical semantics, accessible communication, and Easy Languages. 

Tiina Valkendorff, University of Helsinki, Finland

Tiina Valkendorff is Doctor of Social Sciences and Senior Lecturer at the University of Helsinki. Her research interests are sociology of health, sociology of education, social and health care, communication, youth work, civil society, and cultural diversity.  

References

Act on the Provision of Digital Services 306/2019. https://finlex.fi/en/legislation/2019/306?language=fin#chp_1__heading

Act on the Status and Rights of Patients 785/1992. https://www.finlex.fi/fi/lainsaadanto/saadoskaannokset/1992/eng/785

Act on the Status and Rights of Social Welfare Clients 812/2000. https://finlex.fi/en/legislation/2000/812?language=fin

Administrative Procedure Act 434/2003. https://www.finlex.fi/fi/laki/kaannokset/2003/en20030434

Ahrens, S., Schulz, R., Kröger, J., Garrido, S.H., Keller, L., & Rink, I. (Eds.). (2022). Accessibility – Health Literacy – Health Information. Frank & Timme.

Bartlett, G., Blais, R., Tamblyn, R., Clermont. R.J., & MacGibbon, B. (2008). Impact of patient communication problems on the risk of preventable adverse events in acute care settings. Canadian Medical Association Journal, 178(2), 1555–1562. https://doi.org/10.1503/cmaj.070690

Bohman, U. (2021). Easy Language in Sweden. In C. Lindholm, & U. Vanhatalo (Eds.), Handbook of Easy Languages in Europe (pp. 527–567). Frank & Timme. https://doi.org/10.26530/20.500.12657/52628

Brach, C. (2017). The Journey to Become a Health Literate Organization: A Snapshot of Health System Improvement. Studies in Health Technology and Informatics, 240, 203–237. https://doi.org/10.3233/978-1-61499-790-0-203

Brach, C., & Harris, L.M. (2021). Healthy People 2030 Health Literacy Definition Tells Organizations: Make Information and Services Easy to Find, Understand, and Use. Journal of General Internal Medicine, 36, 1084–1085. https://doi.org/10.1007/s11606-020-06384-y

Bugge, H. B., Berget, G., & Vindenes, E. (2021). Easy Language in Norway. In C. Lindholm, & U. Vanhatalo (Eds.), Handbook of Easy Languages in Europe (pp. 371–400). Frank & Timme. https://doi.org/10.26530/20.500.12657/52628

Chinn, D., & Homeyard, C. (2017). Easy Read and Accessible Information for People with Intellectual Disabilities: Is it Worth it? A Meta-Narrative Literature Review. Health Expectations, 20(6), 1189–1200. https://doi.org/10.1111/hex.12520

Cohen, A.L., Rivara, F., Marcuse, E.K., McPhillips, H., & Davis, R. (2005). Are language barriers associated with serious medical events in hospitalized pediatric patients? Pediatrics, 116(3), 575–579. https://doi.org/10.1542/peds.2005-0521

Constitution of Finland 731/1999. https://finlex.fi/en/legislation/translations/1999/eng/731

Eurostat. (2023). Demography of Europe – 2023 edition. European Commission. https://doi.org/10.2785/083

Elo, S., Kääriäinen, M., Kanste, O., Pölkki, T., Utriainen, K., & Kyngäs, H. (2014). Qualitative Content Analysis: A Focus on Trustworthiness. SAGE Open, 4(1). https://doi.org/10.1177/2158244014522633

European Union. (2019, April 17). Directive (EU) 2019/882 of the European Parliament and of the Council of 17 April 2019 on the accessibility requirements for products and services (Text with EEA relevance) (OJ L 151, 7.6.2019, pp. 70–115). https://eur-lex.europa.eu/eli/dir/2019/882/oj

Farmanova, E., Bonneville, L., & Bouchard, L. (2018). Organizational Health Literacy: Review of Theories, Frameworks, Guides, and Implementation Issues. INQUIRY: The Journal of Health Care Organization, Provision, and Financing, 55, 0046958018757848. https://doi.org/10.1177/0046958018757848

Federal Plain Language Guidelines (2011). https://www.plainlanguage.gov/media/FederalPLGuidelines.pdf

Finnish National Board on Research Integrity TENK. (2019). Ethical Review in Human Sciences. tenk.fi https://tenk.fi/en/ethical-review/ethical-review-human-sciences

Graham, S., & Brookey, J. (2008). Do Patients Understand? The Permanente Journal, 12(3), 67–69. https://doi.org/10.7812/TPP/07-144

Guest, G., MacQueen, K., & Namey, E. (2012). Applied thematic analysis. Thousand Oaks, California: SAGE Publications. https://doi.org/10.4135/9781483384436

Hurtig, R. R., Alper, R. M., & Berkowitz, B. (2018). The Cost of Not Addressing the Communication Barriers Faced by Hospitalized Patients. Perspectives of the ASHA Special Interest Groups, 3(12), 99–112. https://doi.org/10.1044/persp3.sig12.99

Juusola, M. (2019). Selkokielen tarvearvio 2019 [Estimate for the need of Easy Language 2019]. Selkokeskus, Kehitysvammaliitto ry. Viitattu, 15, 2022. https://selkokeskus.fi/wp-content/uploads/2019/02/Tarvearvio-2019.pdf

Kutner, M., Greenburg, E., Jin, Y., & Paulsen, C. (2006). The Health Literacy of America's Adults: Results from the 2003 National Assessment of Adult Literacy. NCES 2006-483. National Center for education statistics. https://nces.ed.gov/pubs2006/2006483.pdf

Leskelä, L. (2021). Easy Language in Finland. In C. Lindholm, & U. Vanhatalo (Eds.), Handbook of Easy Languages in Europe (pp. 149–189). Frank & Timme. https://doi.org/10.26530/20.500.12657/52628

Leskelä, L., Mustajoki, A., & Piehl, A. (2022). Easy and Plain Languages as Special Cases of Linguistic Tailoring and Standard Language Varieties. Nordic Journal of Linguistics, 45(2), 194–213. https://doi.org/10.1017/S0332586522000142

Leskelä, R-L., Silander, K., Komssi, V., Koukkula, L., Soppela, J., & Lehtonen, L. A. (2015). Paljon Erikoissairaanhoidon Palveluja Käyttävät Potilaat. [Patients Who Use a lot of Specialised Medical Care Services]. Suomen Lääkärilehti, 70(43), 2865–2872. http://www.fimnet.fi/cl/laakarilehti/pdf/2015/SLL432015-2865.pdf

Lindholm, C., & Vanhatalo, U. (Eds.). (2021). Handbook of Easy Languages in Europe. Frank & Timme. https://doi.org/10.26530/20.500.12657/52628

Liu, C., Wang, D., Liu, C., Jiang, J., Wang, X., Chen, H., Ju, X., & Zhang, X. (2020). What is the Meaning of Health Literacy? A Systematic Review and Qualitative Synthesis. Family Medicine and Community Health, 8(2). https://doi.org/10.1136/fmch-2020-000351

Maaß, C. (2020). Easy Language – Plain Language – Easy Language Plus. Frank & Timme. https://doi.org/10.26530/20.500.12657/42089

McColl-Kennedy, J. R., Snyder, H., Elg, M., Witell, L., Helkkula, A., Hogan, S.J., & Anderson, L. (2017). The Changing Role of the Health Care Customer: Review, Synthesis and Research Agenda. Journal of Service Management, 28(1), 2–33. http://dx.doi.org/10.1108/JOSM-01-2016-0018

OECD Skills Outlook (2013). First Results from the Survey of Adult Skills. OECD Publishing. http://dx.doi.org/10.1787/9789264204256-en

Perego, E. (2020). Accessible Communication: A Cross-country Journey. Frank & Timme. http://dx.doi.org/10.26530/20.500.12657/50590

Plain Writing Act of 2010, Pub. L. No. 111–274. https://www.govinfo.gov/content/pkg/PLAW-111publ274/pdf/PLAW-111publ274.pdf

Põder, J. (2023). Selkokielisen Potilasviestinnän Ulottuvuuksia. Kyselytutkimus Satasairaalan Henkilökunnalle. [The Effects and Experiences of Easy Language in Patient Work. Survey for the Employees of the Satasairaala Central Hospital]. Master Thesis. University of Helsinki, Faculty of Social Sciences. http://hdl.handle.net/10138/564648

Reichrath, E., & Moonen, X. (2022). Assessing the Effects of Language for All. Nordic Journal of Linguistics, 45(2), 232–248. https://doi.org/10.1017/S0332586522000142

Satakunta Hospital District (2019). Satakunta Hospital District to the finals at the international IHF Awards. innolink.fi. Retrieved May 22, 2025 from https://www.innolink.fi/wp-content/uploads/2019/09/Satasairaala_IHFn_finaaliin_ENG.pdf

Satakunta Hospital District (2022). Arviointikertomus 2022. satakunnanhyvinvointialue.fi. Retrieved May 22, 2025 from https://satakunnanhyvinvointialue.fi/wp-content/uploads/2024/03/Arviointikert2022.pdf

Satosuo, S. (2023). Selkokielinen Viestintä Terveydenhuollossa. Asiantuntijoiden Kokemuksia Selkokielen Käyttöönottoprosessista Satasairaalassa. [Easy Language communication in healthcare. Experiences of expert and management level empolyees on the Easy Language implementation process at the Satasairaala] Master Thesis. University of Helsinki, Faculty of Social Sciences. http://hdl.handle.net/10138/359410

Schiavo, R. (2014). Health Communication: From Theory to Practice (2nd ed.). Jossey-Bass, an Imprint of Wiley.

Schiavo, R. (2022). Whom are We Communicating for? A Call for Plain Language, Cultural Humility, and Increased Specificity. Journal of Communication in Healthcare, 15(3), 155–157. https://doi.org/10.1080/17538068.2022.2123676

Selkokeskus (n.d.). The Finnish Centre for Easy Language. selkokeskus.fi. https://selkokeskus.fi/in-english/

Selkokeskus. (2022, 12 September). The Easy Finnish Indicator 2.0. selkokeskus.fi. https://selkokeskus.fi/in-english/easy-finnish/the-easy-finnish-indicator-2-0/

STM, Ministry of Social affairs and Health (n.d). Hospitals and Specialised Medical Care. https://stm.fi/en/hospitals-and-specialised-medical-care

Sutherland, R.J., & Isherwood, T. (2016). The Evidence for Easy-Read for People With Intellectual Disabilities: A Systematic Literature Review. Journal of Policy and Practice in Intellectual Disabilities, 13(4), 297–310. https://doi.org/10.1111/jppi.12201

Sørensen, K., Pelikan, J.M., Röthlin, F., Ganahl, K., Slonska, Z., Doyle, G., Fullam, J., Kondilis, B., Agrafiotis, D., Uiters, E., Falcon, M., Mensing, M., Tchamov, K., van den Broucke, S., Brand, H., & HLS-EU Consortium (2015). Health Literacy in Europe: Comparative Results of the European Health Literacy Survey (HLS-EU). European Journal of Public Health, 25(6),1053–1058. https://doi.org/10.1093/eurpub/ckv043

The European Association for the Education of Adults. (2018). PIAAC - OECD Survey of Adult Skills: A WAKE-UP CALL FOR EUROPE! [EAEA Analysis paper]. eaea.org. https://eaea.org/wp-content/uploads/2018/01/piaac-analysis_wakeup-call-for-europe.pdf

Thomas, D.R. (2006). A General Inductive Approach for Analyzing Qualitative Evaluation Data. American Journal of Evaluation, 27(2), 237–246. https://doi.org/10.1177/1098214005283748

Tiililä, U. (2015). Mitä on asiallinen, selkeä ja ymmärrettävä virkakieli? [What is proper, clear, and comprehensible official language?]. Kielikello. Kielenhuollon Tiedotuslehti, 3. https://www.kielikello.fi/-/mita-on-asiallinen-selkea-ja-ymmarrettava-virkakieli-

Valkendorff, T., & Vanhatalo, U. (2024). Hospital personnel’s experiences of using Easy Language in healthcare. A qualitative case study at a public hospital in Finland. Journal of Communication in Healthcare, 18(1), 47–54. https://doi.org/10.1080/17538068.2024.2431771

WHO (2013, 2 December). People-Centred Health Care: A Policy Framework. World Health Organization. https://www.who.int/publications/i/item/9789290613176

Williams, M. V., Parker, R. M., Baker, D. W., Parikh, N. S., Pitkin, K., Coates, W. C., & Nurss, J. R. (1995). Inadequate Functional Health Literacy Among Patients at Two Public Hospitals. JAMA, 274(21), 1677-1682. https://doi.org/10.1001/jama.1995.03530210031026

Ylikoski, P., & Zahle, J. (2019). Case study research in the social sciences. Studies in History and Philosophy of Science Part A, 78, 1-4. https://doi.org/10.1016/j.shpsa.2019.10.003

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Published

2025-09-03

How to Cite

Vanhatalo, U., & Valkendorff, T. (2025). A qualitative case study of implementing Easy Language policies at a public hospital in Finland. Qualitative Health Communication, 4(2), 18–33. https://doi.org/10.7146/qhc.151446

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