Besides serving as the subject of daily press accounts, what do Eastern Equine Encephalomyelitis (EEE), West Nile Virus (WNV) and H5N1 avian influenza have in common?
Birds. Wild and domestic birds play key roles in transmitting all three viral diseases to humans and other mammals. Humans get EEE and WNV from the bites of infected mosquitoes, who have picked it up from infected birds. People get avian flu directly from close contact with infected birds, although public health officials worry that the virulent H5N1 virus may mutate to enable human-to-human transmission.
Symptoms. A quick review of official information about the three viral illnesses on CDC Web sites features medical experts describing symptoms of the mosquito-borne illnesses as flu-like:
CDC’s EEE site
CDC’s West Nile site
CDC’s Avian Flu site
The combination of birds and use of the the adjective flu-like to describe symptoms of all three illnesses can lead to dangerous confusion among readers, viewers and listeners in times like these, when stories of all three illnesses appear daily in state and national press.
Even the press gets confused. In recent weeks, I’ve seen several headlines that demonstrate the confusion, such as this one: Lawmakers get briefing on triple-E and avian flu, which precedes an article in which the reporter never mentions avian flu at all, apparently having confused the news of the threatened flu pandemic with the current outbreak of mosquito-borne EEE in New Hampshire.
Two years of working the phones at Extension’s Family, Home & Garden Center Info Line taught me that busy people read headlines, hear sound bites on the fly, and fit what they read or hear into their existing frames of reference. When people take in information about simultaneous outbreaks of different insects, plant diseases, or human illnesses in the same day, not to mention the same article, information bleeds from one issue to another in their minds.
In situations like that of the impending flu pandemic, where public health officials want people to get scared enough to educate themselves about the prevention measures they can take, come up a learning curve, and stay alert for many months, even years, in the face of incredible uncertainty, officials will have a difficult time trying to help the public separate the recurrent seasonal problems from something new and far more lethal.
“Regular flu” season will come along shortly after cold weather has ended the threat of mosquito bites which transmit EEE and WNV to humans. Then people and the press will have to learn to distinguish between regular flu and pandemic flu, for which we will likely have no vaccine, and against which we have no acquired antibodies:
I offer a snippet from a February, 22, 2005, Washington Times interview with Dr. Julie Gerberding, head of the federal Centers for Disease Copntrol & Prevention:
At the same time, the agency is helping to produce the 180 million or so doses of vaccine for regular flu that are needed annually. Dr. Gerberding said the timeline for producing the regular vaccine yearly is tight, with little room for problems. To produce a vaccine in response to the sudden emergence of an [H5N1 pandemic] flu bug would require an extraordinary effort, she said.”We don't now have the capacity to do both,” she said.
“There is no wiggle room here,” she said. Making an avian flu vaccine in case of an outbreak would be faster than starting from scratch, “but we just don't have the surge capacity to produce both.”
So avian flu vaccine would be rationed.
People transmit the flu virus before they show symptoms of illness, so it would be almost impossible to stop its spread by watching or isolating sick people, Dr. Gerberding said.
Depending on the situation, Extension specialists, field staff, and volunteers at the Family, Home & Garden Center Info Line may serve as primary, secondary, or third-line risk communicators for many stakeholder groups. Risk communicators need to understand people’s common habit of mixing the facts of two or more health threats. We need to make sure we get our facts straight ourselves. Should a flu pandemic erupt, we can’t assume quick shifts of understanding within the general public distinguish between regular flu (no big deal) and pandemic flu.
We can’t assume pandemic flu’s arrival in New Hampshire wouldn’t coincide with an outbreak of regular flu or some natural disaster: a blizzard, an ice storm, a flood. What if the pandemic arrived just as another Hurricane Katrina blew through the Gulf Coast, with the same levels of National Guard troops still deployed in Afghanistan and Iraq?
I’ve begun scrutinizing New Hampshire’s official pandemic preparation documents—both state and local, along with significant press accounts, and have plans to organize and link to the important ones here at this blog in future weeks. You can form your own opinions, and maybe ask questions of state and local authorities about the details of how the important stakeholder groups you serve will receive information before and if a pandemic occurs.
If you want to plunge right in, begin here:
NH DHHS fact sheet on avian flu
State of New Hampshire Interim Influenza Pandemic Epidemiologic and Surveillance Plan (Warning: 47-page pdf file)
I see some parallels in Scientists and the Public: Barriers to Cross-Species Risk Communication, and Decision-Making Styles: A comparison of Extension Faculty and the Public from the June 2005 Journal Of Extension. In both articles, the underlying theme is the importance of recognizing that other people think, react, respond, and feel differently than scientists, Extension Specialists, Extension Educators, or any one group. That does not mean that either is "right," just different. Both articles state that many times people make judgements based on values, not only on "the facts." In our democratic society, the majority makes our decisions; this way the decisions benefit the majority of the people. In Extension, it is important that we provide the most complete information, explained in a simple manner, so the public can understand the situation before making their decisions. Extension is the link between scientific research and the public, so being able to communicate well is essential. In good communication it is important to realize and acknowledge where the other is and start there. Each of us has different life experiences that have brought us to our current beliefs.
In Cooperative Extension we are helping people learn, and to do so we need to understand how people learn. People learn best in different ways, some by seeing, some by hearing, and some by doing. Imagine a blind man insisting that a deaf man learn with the same method that works for him; the deaf man cannot learn the same way. In helping people learn, we need to keep in mind learning differences. Differences are positive when we learn from each other, because together we learn more than each could learn alone, with one style of thinking.
Decision-Making Styles states, "Most important, specialists can anticipate that their rational-decision making style will be off-putting to a large portion of the public that cares more about who is affected. To feelers, the thinkers can appear 'cold blooded' and indifferent to less tangible or less measurable concerns. Where the specialist uses the developed thinking function to assess risk inherent in decisions, some of the public will use a developed feeling function to assess risk. The two assessments, thinking/feeling, of the risk in a decision--the human, economic, social, or environmental values--can be very far apart. Thus, a specialist's thinking (T) point of view when measuring the value of a stand of trees may be hotly debated by those whose feeling (F) preference measures the value of trees in more subjective ways." Rather than either group believing there is "one right way of thinking," it is helpful for both to realize the other has a different decision-making style. A quote by Dandemis says, "Do not condemn the judgement of another because it differs from your own. You may both be wrong." Decision-Making Styles concludes that "one of the possible outcomes of misattribution is that the 'other' is considered ignorant or difficult. The more defensible argument is that the public [, or the Specialist] is simply using a different decision-making style."
Decision-Making Styles proposes that Cooperative Extension should "assess the type of those with whom they are communicating and [...] have the knowledge, skills, experience, and motivation to shape their communication and programs to be more effective. We see this training as a fundamental part of what Extension must do to adapt to the challenges and changes the Cooperative Extension System now faces as it strives to remain relevant in a changing world."
Family & Consumer Resources educator Thom Linehan, who has an office down the hall from me, rose early this morning, switched on the local TV news, and heard this message (which I later confirmed by getting a transcription from the Channel 9 newsroom):
Manchester officials are warning city businesses to be prepared for a possible flu pandemic. They say there is no cause for concern, but a pandemic is overdue and a particular strain of the avian flu is something health officials are concentrating on. Projections from the CDC say a serious outbreak of influenza could infect thousands of Granite Staters who have no antibodies against it.
A call to Richard DiPentima, Manchester’s Deputy Public Health Director, who said he’d seen, but hadn’t hadn’t talked to the WMUR reporter himself, told me the health department had organized the meeting with local business leaders to distribute information about ways to keep essential services—food supply, banking, etc.—during a pandemic.
DiPentima said not many business representatives showed up for the meeting, at which he urged attendees to think about how to keep operating if they had a 40 percent absentee rate. He said he’d stressed “no need for panic, but we certainly have cause for concern. That’s why we organized the meeting.”
We can’t blame Channel 9 reporters for underwhelming viewers with their brief reporting on this event, or the Manchester business community for not turning out in greater numbers.
Words like pandemic and antibodies haven't made their way into our daily lexicon, especially in conjunction with the term “influenza.” We speak casually of having “a touch of the flu,” or “getting a flu shot.” Like black flies, black-legged ticks, mosquitoes, colds and stomach bugs, the flu comes through town every year. Nasty, but no big deal, really.
Few Americans alive today remember the pandemic influenza of 1918-1919, before the era of global travel. That influenza outbreak killed as many as 50 million people worldwide, half of them healthy adults.
For some straight talk on the subject from one high-ranking public figure, read the August 3 speech by U.S. Senate Majority Leader and medical doctor Bill Frist, calling for a 21st-century Manhattan project to research and combat potential epidemics/pandemics. A snippet:
But we will not be able to sleep through what is likely coming soon -- a front of unchecked and virulent epidemics, the potential of which should rise above your every other concern. For what the world now faces, it has not seen even in the most harrowing episodes of the Middle Ages or the great wars of the last century. We are unprepared for rampant epidemics. And even worse, we haven’t taken sufficient note of the fact that though individually each might be devastating, they are susceptible of either purposeful or accidental combination, in which case they could be devastating almost beyond imagination...In 1918 - 1919 the mortality rate was 3 percent, which seems merciful in comparison to the 50 percent mortality rate of today’s highly pathogenic H5N1 avian flu. In just the last 18 months, avian flu has caused the death or destruction of over 140 million birds in 11 Asian nations. And, most alarmingly, in 4 of those nations, H5N1 has taken the worried jump from birds to infect humans.
Should the virus shift and human-to-human transmission become sustained, imagine how many human lives avian flu will take. How then would a nation greatly moved and touched by three thousand dead, react to 5 or 50 million dead?
Even though it appears in a paper aimed at business communicators who manage both public relations and risk communications for their firms, I like Peter Sandman’s distinction between publics and stakeholders:
Publics are people who don’t care much. There are a lot of them, and one of PR’s two key skills is figuring out how to grab their attention, which usually requires grabbing the media’s attention first. The other essential PR skill is figuring out what to do with the infinitesimal amount of attention you’re likely to get: What to say in that precious eight-second sound bite. The essence of PR is overcoming apathy.Stakeholders, on the other hand, are just what the word suggests: people who have a stake in the issue, and who know it. (You probably deserve to be called a stakeholder if you have a stake but don’t know it, or if you think you have a stake but really don’t — but let’s stick to the easy cases for now.) At a minimum, stakeholders are interested, so getting their attention isn’t a problem. Typically they are concerned. Sometimes they are really upset, skeptical, hostile, or outraged: You have more attention than you want, and it’s unfriendly attention. They may even be terrified.
Both public relations and stakeholder relations are important tasks. One of the problems in risk communication is that they call for radically different skills and strategies, yet they must often be done simultaneously… —from Stakeholders
Later in the same paper, Sandman writes, “Once in a while, the distinction between stakeholder relations and public relations disappears, and everyone becomes a stakeholder. This is what happens in a crisis, of course…”
UNH Cooperative Extension programs target dozens, perhaps hundreds, of both loosely constructed and well defined “publics.” For the most part, we tend to think of and describe them all as stakeholders, although we do invest time and worry envisioning ways to reach out and get more of the “don’t care much” public to understand and benefit from all we do.
But in the case of a major health or other crisis, all our publics would become stakeholders in need of massive amounts of information. We ourselves would become stakeholders.
The empirical data on the situation would change from day to day, perhaps hour by hour. Many aspects of the situation might lack a research base on which to ground decisions.
Major crises have many dimensions, which may include economic, political, moral, cultural, geographic, and environmental. They have age and gender aspects. Major crises ruthlessly ignore our carefully constructed boundaries academic disciplines, socio-economic classes and geographic boundaries.
Each of us stakeholders would approach and pass through the crisis with somewhat different interests and concerns, levels of preparation and understanding, needs, and expectations of ourselves and our public institutions. Each of us would also possess strengths, such as knowledge, coping skills and access to other knowledge.
Coming up the learning curve as I’ve explored available information about the threatened pandemic of avian flu has forced me to think about and seek out the kinds of risk communication I need for myself and my loved ones. It’s forced me to consider the kinds of self-talk (interior risk communication) I know I need to practice to avoid dangerous emotional states: denial, magical thinking, terror, over-reaction, helplessness.
I recommend these exercises. They've brought me comfort and have deeply influenced how I now think about communicating risk to other stakeholders.
Government communication about pandemic influenza continues to be generally disappointing….too many national and local governments have had little to say, and too much of that little has been over-reassuring bordering on misleading.So we have been keeping an eye out for good examples. We’ve found a few, most of them local. But by far the best example comes from Australia’s national government, in an early May speech by Health Minister Tony Abbott. —from Superb Flu Pandemic Risk Communication: A role Model from Australia, by Jody Lanard and Peter M. Sandman
Examples of best practices help guide writers faced with important communications projects and educators reviewing communications produced by others.
In this extraordinary paper, the authors annotate, paragraph by paragraph, a speech delivered by Australian Health Minister Tony Abbott in May, in which he warns his nation about the risk of N5H1 avian flu and details the official Australian planning efforts.
I encourage you to read it, not only as an exemplary instance of an “official” risk communication, but also as a first-rate example of how to conduct a close, critical textual review.
Also valuable in this paper: a list of 25 recommendations for risk communicators, which the authors (a medical doctor and a risk communication specialist) reference by number throughout their lengthy annotation of Abbott's speech. I’ll repeat the list here: 1. Don’t over-reassure.
2. Put reassuring information in subordinate clauses.
3. Err on the alarming side.
4. Acknowledge uncertainty.
5. Share dilemmas.
6. Acknowledge opinion diversity.
7. Be willing to speculate.
8. Don’t overdiagnose or overplan for panic.
9. Don’t aim for zero fear.
10. Don’t forget emotions other than fear.
11. Don’t ridicule the public’s emotions.
12. Legitimize people’s fears.
13. Tolerate early over-reactions.
14. Establish your own humanity.
15. Tell people what to expect.
16. Offer people things to do.
17. Let people choose their own actions.
18. Ask more of people.
19. Acknowledge errors, deficiencies, and misbehaviors.
20. Apologize often for errors, deficiencies, and misbehaviors.
21. Be explicit about “anchoring frames.”
22. Be explicit about changes in official opinion, prediction, or policy.
23. Don’t lie, and don’t tell half-truths.
24. Aim for total candor and transparency.
25. Be careful with risk comparisons.
Although people have always tried to figure out how to communicate about risks, the field of risk communication dates back only to the 1980s, evolving from health education, public relations, psychology, risk perception, and risk assessment. —Risk communication specialist Peter M. Sandman
As a longtime, serious student of health communication, for the past year I’ve followed intently various international sources of news and information about the virulent H5N1 avian flu virus now endemic in domestic poultry in Southeast Asia despite programs that have exterminated tens of millions of domestic birds in that part of the world.
Humans in close contact with infected birds have fallen prey to this illness. The World Health Organization reports 112 laboratory-confirmed human cases. More than half of those infected have died, including many healthy young people. Scientists fear mutation of the virus to allow human-to-human transmission may trigger the next global pandemic in which millions will die.*
Since I’ve established this blog to support Extension writers, I want to use the extraordinary and extreme example of a possible pandemic of avian flu to post this week on various aspects of risk communication.
In the case of an influenza pandemic, or even discovery in the region of birds infected with the H5N1 strain, UNH Cooperative Extension will almost certainly—willingly or not—play a variety of critical roles in communicating with the general public, both in the preparation and in the coping phases of the crisis.
Consider:
• Hospital networks and medical professionals will likely find themselves overwhelmed with direct caregiving responsibilities.
• State and local authorities will have to focus mainly on maintaining essential services.
• We work with diverse populations in every community in the state. We operate 10 fully-staffed county offices where live people answer the telephone. We maintain a statewide tollfree Info Line and a Web site. People trust Extension as a source of information. Our professional staff have connections to experts throughout the nation’s land grant university system and other academic/research institutions.
• A lot of the risk communication work will fall naturally to us. A few examples: The Ag Resources and Family, Home & Garden Education Center staff will get questions about domestic poultry and pets, the forestry and wildlife folks about wild birds. Families and communities may need preparation for long periods of legally-imposed quarantine. Parents will want information on how and when to prepare and what to tell their children. Families will have questions about the safety of their food and water supplies.
I want to introduce you to the risk communication approach offered by Dr. Peter Sandman, a renowned risk communication specialist and Rutgers University professor since 1977. Sandman founded the Environmental Communication Research Program (ECRP) at Rutgers in 1986, and served as its director until 1992. Now a full-time consultant, Sandman maintains academic affiliations as Professor of Human Ecology at Rutgers and as Professor of Environmental and Community Medicine at the Robert Wood Johnson Medical School.
The Pan American Health Organization, the regional office of the World Health Organization, offers as its the lead article in the latest issue of its online magazine, Perspectives in Health, to the article entitled Bird Flu: Communicating the Risk, by Sandman and his wife, Jody Lanard, a medical doctor.
I urge you all to read it (click on the pdf version in the right-hand navigation bar to get a printable version). Then open and read Pandemic Influenza Risk Communication:The Teachable Moment, also by Sandman and Lanard.
Even if you believe you’ll never have to develop risk communications materials yourself, you’ll find these documents invaluable for evaluating the communications coming from other sources.
Sandman’s approach to risk communication emphasizes candor, transparency, early and direct involvement of stakeholders, erring on the alarm side rather than taking a zero-fear approach, and paying close attention to emotional needs and reactions (both the communicators’ and those of their audiences). He suggests that risk communicators emphasize scary information over reassuring information, tell people what to expect, acknowledge ignorance and opinion diversity, ‘fess up to errors, and ask more of people.
In short, he asks risk communicators to reach out to the mature and resilient side of their readers or listeners:
In a crisis, the public — which means most of us, most of the time — is in a state of ambivalence. On the one hand, we long for reassurance, for easy and quick answers, for magic bullets. We want to be passive and taken care of; we want to be told everything will be okay. These yearnings are a kind of regression to a less mature coping level than our normal adult selves. This is an understandable and inevitable reaction to a crisis — but it is only half of our reaction.Finally, I hope all of you can find time to read Sandman's and Lanard's potent essay, Scientists and the Public: Barriers to Cross-Species Risk Communication. From the intro:The other half of our ambivalence in a crisis is our resilient desire to take charge, to be involved, to have input, to learn how to help ourselves and others, to be altruistic, to fight the problem. This half of our ambivalence represents our desire to respond on a more mature coping level, as adults.
If they understood normal people better, scientists (and officials) could choose consciously which side of this ambivalence to ally with. Instead, they typically see only one option. They see only the immature half of the public’s ambivalence, and almost automatically they collude with that half, representing themselves as overly confident, overly reassuring, and overly wise. When they turn out wrong, this approach backfires, of course. But even when they turn out right, this approach does not help inspire the public’s optimal mature coping abilities.
With some stunning exceptions, the vast majority of scientists are notoriously poor communicators, except when talking to each other. Since scientists are often the only people around who actually understand technical data, this deficiency makes risk communication more difficult than it would otherwise be. This column will discuss some reasons why scientists typically use poor communication techniques when talking with nonscientists.
*Off topic: Below, I’ve listed links to a few of my sources for those of you who want to learn more about the H5N1 avian flu.
Foreign Affairs: Special on Avian Flu July/August 2005. This offers free access to Michael Osterholm's Preparing for the Next PandemicNature: Warnings of a Flu Pandemic Avian Flu/pandemic issue, May 26, 2005. — A massive collection of articles by top experts—free access.
H5N1: News and Resources about Avian Flu Crawford Kilian’s excellent, up-to-the minute blog of news/information sources around the world.
Flu Wiki Developed and maintained by public health scientists, this wiki http://isp.webopedia.com/TERM/W/wiki.html contains huge amounts of information about H5N1, as well as a lively discussion forum open to all.
Fluwiki’s Basic Science Information page
University of Minnesota’s Center for Infections Disease Research and Policy (CIDRAP): Pandemic Flu Page The best of the land grant university information sources. (Sadly, I haven’t found any good avian flu information on Extension sites, including EDEN resources, most of which I found woefully out of date.)
Someone asked me recently what it means when she sees [sic] in the middle of a direct quotation.
“Sometimes there seems to be something wrong with the sentence being quoted, so I’ve always thought it was a snide comment, as if the writer is implying the person being quoted is sicko or something,” she said.
Writers have an obligation to quote others accurately, even when the quotation contains a spelling, grammatical, or other error. Adding [sic]—a Latin word meaning “thus,” and usually enclosed in brackets and italicized—directly after the error alerts readers to an error in the original speech or text. For example, “Bloom wrote to Fielding last July, ‘I feel like I’m living on barrowed [sic] time.’”
Use [sic] sparingly and with care. Don’t deliberately use quotes that contain mistakes to make fun of a speaker or writer.
I will tell you something about stories. They aren’t just entertainment. They’re all we have, you see, all we have to fight off illness and death. You don’t have anything if you don’t have the stories.Leslie Marmon Silko, from the homepage of the Center for Medical Humanities and Ethics, Health Science Center, University of Texas in San Antonio
I hope most of you will find the time to print and read Dr. Jerald Winakur’s essay, What Are We Going To Do With Dad?, published last month in the policy journal Health Affairs. Read it if you provide, or have ever provided unpaid care for an elderly parent. Read it for the wealth of empirical, economic, medical and political information it offers. Read it as the work of a fine writer.
But read it mostly for the power of its narrative voice. Use it as a model for finding your own voice and helping others find theirs.
For all of his clinical knowledge and training, his connections, and his years of experience as a geriatrician, Winakur can’t “answer” his title question, What are we going to do with Dad?
I do not know the answer. I do not have a pat solution for my father or yours—neither as a son, a man past middle age with grown children of his own; nor as a doctor, a specialist in geriatrics, and a credentialed long-term care medical director.
He discovers simple storytelling as the most powerful tool for facing and living with the decline of his 86 year-old father. Here’s another excerpt:
It’s rarely talked about, but acute hospitalizations are the most dangerous times for the elderly. Even if they have never before manifested any signs of confusion or disorientation, it is in the hospital—in a new and strange and threatening environment, under the influence of anesthetics, pain pills, anti-emetics, and soporifics—where the elderly (competent or not) will meet their match. Add to this the iatrogenic mishaps (caused by the "normally expected" side effects and complications of standard medical procedures) and the human errors (mistakes in drug dosing, the right medication given to the wrong patient)—now multiplying in our modern hospitals like germs in a Petri dish—and it is almost a miracle that any elderly patient gets out of the hospital today…After four days and nights in the hospital, I knew I had to get my father out of there. His doctor came by and told me that his heart failure was better and that his dementia evaluation did not show a treatable or reversible cause. But he didn’t like the way my father looked—he was agitated and sleep-deprived and deconditioned, a perfect candidate for some time in the SNU [skilled nursing unit]. And, after all, here I was, his senior associate, the medical director of the SNU. Surely my dad would get good care there.
I took my father home. I knew if I didn’t get him home at that moment, he would never come home again.
In addition to his medical practice, Winakur teaches at the Center for Medical Humanities and Ethics at the San Antonio Medical School. The Center uses film, poetry, and fiction to teach medical students languages other than science, to “ground our discussions in an emotional reality and promote truth-telling…not so much to inculcate empathy, humanity and ethical conduct in the students, but simply to keep alive their innate humanity, integrity and empathy.”
The power of narrative prose—storytelling—takes both writers and readers into psychological terrain where how-to instructions, scientific explanation can’t go. In the large matters of human life: birth, coming of age, love, suffering, pain, hate, death, the voices we speak with and hear through our stories inform, provoke, reward, soothe and connect us to each other like nothing else.
Yesterday I made reference to an unfamiliar term—concept noun—as one of the culprits that “depopulates” prose, increasing its abstraction and making it more difficult to read. A few people asked about it.
I wrote:
Characterized by passive verbs, absence of personal pronouns, and an abundance of abstract concept nouns, depopulated prose, written in that fourth voice Bresler calls the “non-person,” has become so common it now serves as the default style for academic, science, and business writing.
I learned about concept nouns from Bill Zinsser’s 1976 classic book On Writing Well: An informal guide to writing nonfiction. Zinsser defines concept nouns as “Nouns that express a concept…commonly used in bad writing instead of verbs that tell what somebody did.” He gives a few examples, which include these two:
The common reaction is incredulous laughter.Bemused cynicism isn’t the only response to the old system.
“What is so eerie about these sentences is that they have no people in them [italics added],” writes Zinsser. “They also have no working verbs—only “is” or “isn’t.” The reader can’t visualize anybody performing some task. The meaning all lies in impersonal nouns that embody a vague concept: “attitude, hostility, “tension,” symptom.”
Zinsser’s rewrites:
Most people just laugh with disbelief.Some people respond to the old system by burning cynical; others say…
We encounter concept nouns every day in academic, bureaucratic and business writing. Most of us unwittingly pepper our own prose with them, too. We choose concept nouns because they give us a quick way to encompass a lot of compressed technical terrain. But in the process, they create such high levels of abstraction they can render the prose incomprehensible.
For example, notice how the abstract concept nouns in this passage, chosen at random from a paper* aimed at professional risk communicators, depopulate and contribute to the overall confusion in this text:
This initial finding was further reinforced by studies which concluded that personal influence was both more frequent and more effective than any of the mass media, and influence in primary groups is effective in maintaining a high degree of homogeneity of opinions and actions within a group. There are instances, however, when face-to-face communication breaks down due to some barriers such as low self esteem, inappropriate choice of words, incongruity of verbal and non verbal messages, predispositions that take people in other directions, and inappropriate place for communication.
Try rewriting this passage so it makes sense and delivers concrete meaning. Put people in. Choose vigorous verbs and more precise nouns.
*From Issues in Planning & Designing Risk Communication, Clifford W. Scherer and Napoleon K. Juanillo, Jr., Cornell University Department of Communication, Risk Communication Workshop Background Paper, 1991.
But first person, second person, and third person are not the end of it. Some people are so trained to delete references to people in their writing that they depopulate their sentences. They write in what I call the non-person. –Ken Bresler, Depopulating Sentences and Writing in the Non-person
I urge you to read Ken Bresler’s excellent essay on depopulated prose linked in the quotation above.
Characterized by passive verbs, absence of personal pronouns, and an abundance of abstract concept nouns, depopulated prose, written in that fourth voice Bresler calls the “non-person,” has become so common it now serves as the default style for academic, science, and business writing.
Depopulated prose invariably bogs down readers and can leave them feeling exhausted from the effort of trying to suck some meaning from the words. Bresler notes that writers themselves often have to work harder to remove all references to people than if they had allowed references to themselves and to other real people flow naturally into their prose.
I recently read an article in my local paper about the evolution of al-Quaida, in which the writer dropped a direct quotation attributed to “the final slide in a PowerPoint presentation about Al-Quaida presented at numerous U.S. Government forums this year.”
Yikes! Talk about writing in the non-person. I find it scary enough that speakers would use PowerPoint presentations to inform government forums on an important topic, but even scarier to see a journalist quoting a PowerPoint slide as a source.
As a reader, I deserve to know the name of the person who spoke or wrote the words appearing on that slide, the names of the person who developed the presentation, the person who gave the presentation, and the main categories of officials who attended the “numerous government forums.”
Vilest of all is the habit of throwing together several nouns into one ghastly adjectival reticule: Texas millionaire real-estate developer and failed thrift entrepreneur Hiram Turnipseed...
From the style guide used by journalists contributing to the British Economist.com comes this page of warnings against using “Americanisms”
Salty, dry, and pithy, the page makes a great read. American writers would do well to take much of the advice it offers British journalists. Especially the injunction not to “verb nouns or adjective them”:
So do not access files, haemorrhage red ink (haemorrhage is a noun), let one event impact another, author books (still less co-author them), critique style sheets, host parties, pressure colleagues (press will do), progress reports, trial programmes or loan money. Gunned down means shot. And though it is sometimes necessary to use nouns as adjectives, there is no need to call an attempted coup a coup attempt or the Californian legislature the California legislature.
Thanks to Steve Judd for sending me the URL for the style guide.
Headline from the Concord Monitor, Sunday, August 8:
Did friction among two elderly sisters result in murder?
Yikes!
“Among” refers to the interaction of three or more entities: Friction among the three adult siblings resulted in the murder of one. It can also mean “in the midst of or part of a group”: The reporter wandered among the delegates on the convention floor.
Use “between” to describe the interaction of two entities: Friction between two sisters may have resulted in the murder of one. “Between” also describes an interval or distance that separates two entities: She lives somewhere between Concord and New London.
Writers who’ve labored days, weeks, or even months over a big project –a grant application, an instruction manual, a series of fact sheets, a final report—often become fiercely attached to their products.
Opening a piece of writing to critical review by editors or representative readers takes courage. It takes even more courage to resist defending, explaining or justifying what you’ve written.
Readers process information through many filters; pay special attention to comments that reflect readers’ discomfort with beliefs, values, and power relationships you may not realize have come through your words and images.
Take responsibility for every instance of reader confusion. Say to yourself, “Hmmmm. I need to take a look at that,” and to your critic, “Hmmm. Thanks for bringing that to my attention.” If you have time after the reader has completed the review, ask for suggestions about how to fix this or that problem in your document.
Then take a step back and examine each comment in turn. Become your own critical reader. Remember, even though you’ve asked for feedback, you don’t have to follow through on every criticism. Just pay attention to all of it.
Freewriting your early drafts and using branching exercises to help organize your work will help keep you from becoming too attached to your work at the front end of the writing process.
Research has shown that readers struggling with badly written or poorly designed documents have an overwhelming tendency to blame themselves for their confusion, especially when the document comes from a source perceived as authoritative.
Over many years of conferring with writers and designers about text and visuals I or other readers found confusing, I’ve found many all too willing to blame readers, too, instead of themselves. “Yeah, I suppose it’s too technical for average readers, but I didn’t want to dumb it down.” “I was trying to educate them. They have to be willing to work harder to understand.” “It’s the best I can do. I just don’t have time to work on revising it.” “At least a dozen colleagues read my final draft and nobody had any trouble with it.”
As someone who earned her living for many years as a freelance magazine and newspaper writer, I learned early and painfully to assign all errors of reader comprehension to myself or the graphic designers responsible for the visual display of what I’d written.
Readers may experience a wide range of problems—with texts, layout, visual elements and the rhetorical interplay between and among them—that pass right by writers and designers. Getting uninvolved readers to engage with your drafts or finished products can help you identify the most serious flaws in your document from a reader’s point of view.
Next time you have an important writing project completed or in the works, consider learning how real readers perceive your work. Conduct a “think-aloud” session in which they tell you what they think. This doesn’t have to take much time or forethought.
• Recruit two or three people who don’t know much about your topic to read your draft.
• Carefully explain your single purpose: to improve your product for readers. Make sure to note that your project will in no way test the tester him/herself.
• Tell your test readers you won’t use what they say in any way that could identify them, or for any purpose but improving your document.
• Ask the reader to summarize his or her overall impression of the document.
• Then ask the reader to “think aloud” as he/she interacts with your text, by saying whatever comes to mind while reading through it.
• Take careful notes or tape-record what each reader says. Ask for clarification if you have trouble understanding something the reader says, but don’t prompt him or her with questions or comments.
• Consider getting informed written consent if you tape readers’ remarks. You may want to use this approved consent form.
In her pioneering work Dynamics in Document Design: Creating Texts for Readers, Karen Shriver summarizes three separate, approaches to audience analysis:
The classification driven approach emerged in the 1960’s to help professional communicators profile and segment “target audiences.” This method usually begins with communicators brainstorming a list of demographic and “psychographic” (e.g., beliefs and values, work and spending habits, lifestyle) characteristics of the people they hope to reach with their publication.
While the classification-driven approach helps move writers away from the comfortable writer-centric approach to their writing by considering the needs and expectations of their readers, the approach has serious pitfalls. These include what Shriver calls the tendency to “fossilize the reader” as a static compilation of demographics and psychographics, as well as the risk that writers will mischaracterize their readers. This approach also glosses over the how-to steps and techniques writers and designers might use to translate their analyses into text and image.
The intuition-driven approach has communicators mentally constructing one or more readers, constructing or imagining real human readers as they write. With this approach, writers imagine themselves dynamically involved with the imagined reader or readers, conversing back and forth, mentally playing the role(s) of readers.
Shriver notes that, as with the classification-driven approach, intuitive-model theorists rarely offer explicit instructions for how to invoke that mentally constructed reader using textual and graphic clues. The model also offers little encouragement for writers and designers to question their own mental models of readers.
Like the romantic vision of the craft of writing, this model tacitly assumes an inborn talent for writing, coupled with appropriate doses of inspiration that guide the writer’s talent.
The feedback-driven approach seeks to overcome the major limitation inherent in the classification- and intuition-driven models—namely, that the analytical or intuitive images writers construct of readers may or may not correspond well (or at all) with the needs, expectations, values, beliefs and experience of real readers.
Feedback-driven readership analysis takes advantage of the strengths and techniques of classifying and imagining readers, but then engages real readers in conceiving, drafting, reviewing, evaluating, and updating documents. This participatory design approach, pioneered since the 1980’s, draws upon research from many disciplines, including cognitive psychology, reading comprehension, psycholinguistics, discourse analysis, linguistics, neurobiology, rhetoric, ergonomics, organizational behavior, anthropology, and others.
The first assumption of the feedback-driven approach to readers, that readers should become part of the document design process early and often, leads to a second assumption: When writers, engage readers at any stage of the writing and document design process, they must listen empathically and attentively, taking care not to challenge, judge, criticize, or otherwise attempt to modify readers’ responses.
When subject matter experts prepare to write, they may review relevant research, look at academic and even popular writing on the topic, and consult professional colleagues or experts in disciplines that touch the topic at hand.
But many expert writers ignore the fuller contexts in which their readers might absorb and use written information.
In many instances, writers could save themselves a lot of time and produce much better material if they conducted informal consultations with a few prospective “readers” before they sat down to write and considered this exercise as important to writing a good informative piece as getting the science right.
How do you do it? Just find two or three folks you think of as part of the audience for your text. Say, “I’m planning to develop a Web site/write a fact sheet/produce a user manual on (West Nile virus, raising grass-fed beef, safe weight loss, the effects of divorce on children, caring for an aging parent, what to do if you lose your health insurance…) and I need your help framing it. What do you think people want and need to know about the subject? You’ll find many people feel honored that you asked for their help.
Now just sit back, listen and maybe take notes. Ask for clarification or elaboration if you need to, but try not to correct or challenge the speaker.
Do you have to incorporate everything people say they might need to know or want to learn into your document? Of course not. But just listening to people outside your area of expertise may help you remember important details of an instruction sequence you’ve long since forgotten, discover an important reader-centered angle on the topic at hand, or an emotional concern you’ve never considered.
Extension writers have special vulnerability when we offer generic, context-free information about a situation with which have no direct experience, or when our gender, economic class, family situation, community setting, differs dramatically from that of our readers.
By listening to prospective readers, you might learn that, despite credentialed expertise, you lack the direct experience to appear credible to your intended readership. That might lead you to change your approach to the subject, giving voice to your readers’ interests and concerns by stepping out of the picture yourself entirely, and deciding to help people with direct experience speak for themselves to their peers.
A working assumption of feedback-driven methods [of document design] is that audiences should be part of the document design process as early and as often as possible during planning and revising. Karen Schriver, Dynamics in Document Design: Creating Texts for Readers
How does a busy writer bring readers into the writing and visual design processes, “early and as often as possible”?
The simple answer: Find one or more willing readers and ask them to help you. Then listen closely.
But even before you begin to write, ask yourself a few questions to help unearth your own assumptions:
Start with yourself as writer. How do you want to present yourself in this document?
• Authoritative single source of information? (a common UNHCE persona)
• Subject-matter expert who collects and organizes a range of others’ professional knowledge and opinion on various dimensions of the topic?
• Thinker who challenges the current state of knowledge on the topic?
• Fellow-traveler trying to make decisions based on imperfect understanding?
• Someone who values the experience and background readers bring to the document?
• Someone who understands that facts don’t exist independent of context?
• Someone who understands that the topic may have moral, emotional, political, economic, and social aspects?
• Many or most of the above and more?
Many writers don’t realize they have many choices about the “voice” they will choose to present factual information in writing. Understanding the persona you intend to project through your writing will help you understand (a) the image real readers may say they form of you (the writer) as they read, and why (b) readers do or don’t see you as having the necessary experience, skills, or sensitivity to address this particular readership on the topic at hand.
Research shows that readers’ needs, beliefs, values, culture, age, gender, and experience condition what they will take away from a document, or even whether they will bother to read it at all.
Research also shows that people who do read what you’ve written most likely will form images of you and your character, how you visualize them, whether you even “qualify” to speak to them on the topic at hand, how you expect them to behave towards what you’ve written, as well as of themselves.
Interview research Holly and I conducted last year with 24 UNHCE administrators and other leaders revealed that, with rare exceptions, CE units don’t pre-test or evaluate the quality or impact of their written materials directly, as separate from other programming components.
Instead, leaders told us they and their staffs tend to rely on informal feedback from professional colleagues (“I usually grab someone in the hall and ask them if they have time for a quick review.”) or indirect post-publication feedback (“We get the grant.” “We have a good turnout.” “We make changes when clientele complain about something.”)
UNHCE professional and support staff collectively spend thousands, probably tens of thousands, of hours each year writing, editing, revising, designing, printing, mailing, displaying or posting to the Web tens of thousands of written communications products—our survey revealed more than 50 different formats, from newsletter articles to fact sheets, reports, briefing books, posters, training manuals, policies and procedures, career guides and meeting minutes.
With all of the other planning and evaluation requirements of the job, pre-testing and post-evaluating your important written materials looms as a terrifying prospect for most of you, especially when I suggest that you not only need to deliver facts clearly, precisely and comprehensibly, but that you should consider evaluating your persona and the image of UNHCE your documents project, the beliefs, values and culture of your primary audience, and how you expect your readers to interact with the facts and ideas they present.
But the prospect appears time-consuming and terrifying only if you think you have to do all or most of the work yourself. I’ll spend next week blogging about a new model of collaborative writing and document design, one that brings readers themselves into the process early on.
When people experience difficulty in understanding either texts or technology, they tend to blame themselves…. Unfortunately, this tendency appears…resilient even in the face of the real culprit: poorly designed texts and/or poorly designed technology…. Learners…need better ways to distinguish problems that are their own fault from those that are not. They need better ways to recognize when they are learning and when they are not. Karen Schriver, Dynamics in Document Design
Substantial research with students, consumers and others reveals that readers who can’t understand a text blame themselves much more often than they blame the writer, graphic designer, or, in cases involving products such as VCRs and telephones, the product designer or manufacturer. Shriver writes:
People’s bias towards blaming themselves has potentially serious long-term consequences—perhaps leading them to believe that they are incapable of dealing with complex technology and reducing their interest in new technology. This is a serious worry in documents and technologies designed for the elderly or the physically challenged. A wider problem…is the real possibility that students of any age may be led to believe they are too incompetent to understand either the subjects they study in school or the topics and technologies they must learn on the job.
The situation goes beyond frustration over learning to operate a VCR, understand a geology text, or understand a workplace procedure. Last year, the Institute of Medicine (IOM), a branch of the National Academies, issued a report entitled Health Literacy: A Prescription to End Confusion, which stated that half of all American adults—90 million of us—have difficulty understanding and using health information, a collective illiteracy the IOM suggests “may lead to billions of dollars in avoidable health care costs,” not to mention the toll in emotional and physical suffering, adverse health effects, and lost workplace productivity.
The IOM report defines health literacy as:
the degree to which individuals have the capacity to obtain, process, and understand basic information and services needed to make appropriate decisions regarding their health. At some point, most individuals will encounter health information they cannot understand. Even well educated people with strong reading and writing skills may have trouble comprehending a medical form or doctor's instructions regarding a drug or procedure.
I contend that most of the blame for health (and other forms of) illiteracy rests squarely on the shoulders of writers and documents designers.
What if teams of writers and the people who design graphic displays for texts worked from the assumption that they, and not their readers, must take responsibility for any failure of comprehension on the part of readers?
Furthermore, what if the situation at hand requires that readers gain a full comprehension of a technical procedure or scientific process? This would mean writers couldn’t “dumb down” their texts, but would have to ramp up the quality of their verbal and visual rhetoric, and the interplay between them.
And of course, it would require the collaboration of real readers, early and often in the project development process.
Through a writer’s tone, attitude, style, choice of words and graphics, and other features of a document, readers understand how the writer expects them to behave toward the written material.
Think about this the next time you begin reading something. Does the writer (and the designer, if the document contains graphic elements that interact with text to deliver essential meaning) see you as a passive, non-critical receiver of information offered in absolute, context-free statements? As an active, curious co-learner? As a sparring partner, daring you to read critically and challenge their statements of fact? As a partner in applied research, expected to try things out in your own life?
Writers can and should examine their drafts, asking: How will a reader imagine me? How does she think I imagine her? How do I expect her to respond to this material?
To practice on someone else’s writing, consider the opening paragraph from this Ohio State University fact sheet, titled Gardening with the Elderly.
Many changes occur as a person ages. These changes impact a person's physical, emotional and cognitive abilities as well as social roles. Gardening can be used in a therapeutic way to address these issues and improve the elderly person's physical and emotional conditions, cognitive ability and social interactions. However, many of the changes involved in aging must be addressed by modifications in gardening practices, situations and tools. Changes that occur with age are listed in the following chart as well as the impacts of the changes and the gardening adaptations that can result in continued participation.
Consider this paragraph (and take a gander at the chart that follows) from the perspective of a robust, 75-year-old Master Gardener who has a part-time job with the city parks and recreation department teaching horticulture to young children, and competes in short-course triathlons for fun. Now ask:
What persona does the writer assume? What assumptions does the writer make about his readers? How does the writer expect his readers to engage with this material?
Although worry over issues of writing and design are crucial, a key to composing persuasive [or informative] documents may lie in anticipating readers’ perceptions of who may be speaking, of the persona projected through the text. Karen Schriver, Dynamics in Document Design: Creating Texts for Readers
As you read a draft of something you’ve written, can you identify the stance you’ve assumed towards your readers (your “rhetorical stance,” “persona,” or “voice”) and towards the topic at hand. Can you identify any underlying political, cultural, or moral assumptions in this stance, the worldview and power relationships it projects?
Your readers can.
Research indicates that readers engaging with a document typically construct an image of its author (even about the author’s character) and the institution or company he/she represents. Notes Schriver, “It is reasonable to assume that the persona projected by a document may play a powerful role in readers’ acceptance of the message.”
No matter how clearly and eloquently I express myself in writing, if readers feel annoyed, enraged, insulted, or intimidated by the persona I project in my writings, I won’t make much headway towards my intended goal of informing, persuading (or dissuading), or engaging them. Readers may even form a negative image of me and the organization I represent that carries over to other documents I and the organization publish.
Many writers have difficulty understanding that they even take a stance toward their readers and the topic at hand, especially if they follow the conventions of scientific/academic writing: using passive verb constructions, avoiding personal pronouns, peppering their text with abstract “concept nouns,” and perhaps doing their best to eliminate people entirely from their prose (a style someone has dubbed “writing in the non-person”).
The next time you toss off a draft of an important communication, consider inviting a couple of people (not professional colleagues or people you supervise) to read your document. But instead of asking them to proof it for spelling and grammar, ask: As you read, did you form an image of the person who wrote this? Can you describe him or her? Then ask what clues in the text and page design the reader used to form that image. What you hear may surprise you.
Learning to see yourself through readers’ eyes won’t by itself improve your writing, but it marks an essential starting point. The next step involves identifying the persona you want to project and learning what devices of word and visual design to use.
Consider the ways communicating in writing differs from communicating face-to-face (f2f). F2f communications take place in a rich physical context that engages all the senses to deliver meaning.
Communicators can “read” the inflections, the slight hesitations, the changes in speed, pitch, tone, and volume in other people’s voices. You can observe (or communicate via) changes in body language: a raised eyebrow, a quizzical expression, a smile, a nod of assent, a scowl of disagreement.
Formal f2f communicators can manipulate many features of the physical layout, including seating arrangements, relative comfort of the chairs, lighting, room décor. They can add the smells of flowers, the tastes of good food, musical interludes or background sounds. All these and other elements of context contribute to the quality and substance of the communicative exchange.
Creators of written texts have to deliver all their context through their skill with words, page design, and understanding of the technology used to produce and deliver the text.
I consider Karen Shriver’s Dynamics in Document Design: Creating Texts for Readers (Wiley Computer Publishing, 1997) essential reading for anyone serious about communicating through writing or designing print pages or computer interfaces.
Schriver, formerly co-director of Carnegie Mellon’s Communications Design Center and pioneer in the field of document design, currently works as an independent scholar.
Rigorous scholarship and a researched-based orientation make Schriver’s work particularly valuable, in particular her focus on research that brings real readers into the writing process to evaluate what a document actually communicates (intended or unintended).
Until very recently, Schriver notes, most writing instruction focused on (1) the craft of writing: the prescriptive, technical how-tos and how-nots, the grammar, the sentence structure, the organization and flow—devoid of what Shriver calls “rhetorical context” or (2) the romance of writing, which focuses on developing the inner vision of the writer and designer. Shriver notes that the romantic tradition considers writing as involving talent, or “special gifts,” unanalyzable and unteachable.
In the Dynamics of Document Design, Shriver revitalizes and expands upon the rhetorical tradition.
Popular images paint rhetoric as the art of deceit. However, these images of double-talk and deception have almost nothing to do with the rhetorical tradition that has come down to use from classical Greece and Rome.Rhetoricians are concerned with understanding all facets of communication…Rhetoric deals with improving the quality of human communication through the ethical use of language. Rhetoricians abhor the idea of using visual or verbal tricks to take advantage of the audience.
“More than anything else, it is the explicit attention to the needs of the audience that separates the rhetorical tradition from the craft and romantic traditions,” Shriver writes.
Over the next few posts, I’ll write about some of the research Shriver cites that involves engaging real readers in the writing process.