A qualitative case study of implementing Easy Language policies at a public hospital in Finland
DOI:
https://doi.org/10.7146/qhc.151446Keywords:
customer orientation, Easy Language, health communication, linguistic simplification, organizational health literacy, patient instructionsAbstract
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.
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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