May 1, 2018

Health Literacy Design Principles – Spacing and Image Selection

Whether a health educator, communication specialist, or health care provider, the understanding and use of health literacy are required to better serve the patient population across demographics, social-economic barriers, and literacy levels. There are many components to designing for health literacy. In this article, we will briefly discuss spacing and imagery selection.

We will explore spacing and imagery using a one-page hypothetical patient-centric piece specifically focused on a diabetes management initiative. The goal is to present what can be a complicated topic (diabetes management) in an attractive and reinforced way so that it enables the reader to change behaviors and engage in their healthcare challenge. Using the hypothetical diabetes example, “Managing Type 2 Diabetes— What you can do at home”, the utilization and goal of health literacy design principles are to assist the reader by helping them understand what kind of health habits improve health outcomes and how to incorporate them into their daily lifestyle.

Before we break down the essence of the spacing and use of imagery, let us revisit the definition of health literacy.

Health literacy is the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.

While at first glance, there may not be any noticeable flags of concern in example (A), the spacing and selection of imagery are NOT of health literacy value. Example (B), on the other hand, presents the information for the patient utilizing both appropriate spacing and imagery selection to assist them in understanding the content that is being read and to contribute to changing behaviors.

Utilizing the health literacy guidelines for spacing and imagery selection, example (B) illustrates the correct patient-centric approach and design approach necessary to lean towards a health literate design solution.

Example A
bad health literacy example

Example B
good health literacy example


There is a science behind having the proper amount of white space surrounding the content with regards to page margins. The goal is a primary text block element to maintain a width of approximately five and a half inches. Why? For regular text in materials written for low literacy level readers, it often works best to create lines of text that are on average, about five or five and a half inches in width. The research has shown that reader retention drops significantly if the paragraph width goes wider. In addition, example (B) utilizes bulleted items to break lengthy content and create simplified behavior modification points.

Keep in mind that during the early years of health literacy guideline development and research, the extensive use of mobile devices was in its infancy. So with technology continuously changing, it is essential that the goal of your primary content blocks respond to the mobile device maximum width. If we were to use the example that is letter size of 8 1/2 inches in width, the goal would be to have the main content block be about 60-65% of the maximum width of the device screen size. So if we were to use these guidelines when stying Cascading style sheet (CSS) code for a responsive mobile environment, the same principle applies but obviously the inch dimension is no longer valid as we are using pixels dependent upon the screen size of the device.

Imagery Selection

Utilizing visual elements and the necessity of plain language, help bring an individual with lower literacy and numeracy skills to an outcome that equates to better health behaviors and practices.

Keep in mind; an individual can interpret a visual just as they would words, meaning in different ways. So the goal is to choose a visual that will accomplish and support the message “visually”. Again the goal is to enable the reader to understand and “act” upon what they see. Demographics, age, culture, attitude, and economic contexts all play a part in determining the best visual fit for your piece.

If your initiative’s goal is to change behaviors at home when managing Type 2 Diabetes, utilizing imagery such as in example (A) will not enable the reader to “process” the message as effectively as in example (B). A common mistake when looking for stock imagery is using photographs that depict “happy, exuberant” faces that do not seem real within the context of their daily life. Also, while using scientific images might be appropriate for the healthcare professional audience, in health literacy they do not, unless you are explaining a condition or procedure that “requires” visual explanation to better serve the “improved health behavior outcome”.

In subsequent articles, I will delve more into some of the other aspects of these examples such as the use of color and typography.

Gilbert Velazquez (Health Literacy Designer)

health literacy designerAllow me to bring my medical and healthcare communication design experience to your next healthcare initiatives. I look forward to taking part as a health literacy designer to better serve “your” audience by helping them reach their goals to understand their own healthcare needs.

It is all about individuals taking control of their healthcare over time, and a health literacy designer can help.

Call me at 732.996.6328 to learn more about what GV CERV Communications health literacy design and development services can do for your next communication challenge.

732.996.6328 (Mobile/text)
732.918.1061 (Office)

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