Describing the readers precisely
A readership is defined by more than a label such as patients, professionals or the public. Its members differ in what they know, what they need, how they feel and how they can access information. Defining those readers at the start of each project gives the writing a specific audience.
Knowledge and experience
Understanding the audience comes first when writing anything. Knowing a person's condition is different from knowing them as a person: their age, education, reading ability, and visual or reading difficulties also matter. Sharing a characteristic does not make all members of a group alike.
Professional audiences also vary: regulatory staff differ in scientific and medical training, and ethics committees can include lay members, lawyers, scientists and clinicians. Readers' existing subject knowledge needs to be established: explaining everything can frustrate knowledgeable readers, while unexplained technical terms can quickly lose those new to the subject.
Lay audiences mix ages, cultures, professions and socioeconomic backgrounds, each with its own language; they are often poorly defined. A lay person lacks specialist or professional knowledge of a subject, but non-experts may have acquired substantial insight through patient working groups, while others are meeting the subject for the first time. Health literacy also varies with educational background and occupation. Readers learning English need to be considered explicitly when planning patient education for a multilingual population.
The range can be wide even within a small, well-educated group. In a Newcastle book group reading The Immortal Life of Henrietta Lacks in late 2011, high-achieving women with arts and science or medicine backgrounds read the same book differently: for some, the personal story brought the science to life and the ethical questions complemented it; for others, the personal tragedy was central and the science a distraction. Some skimmed or disengaged when the science went beyond a fairly basic level, although the book was written clearly for intelligent readers with or without scientific knowledge. Writers accustomed to industry insiders and scientific experts should approach lay writing with a fresh perspective and should not underestimate the breadth of the intended audience.
Needs, concerns and values
What research shows an audience needs to know may differ from its perceived health needs; both should be addressed. Literature reviews, focus groups and interviews can establish those needs before writing begins. Where a lay audience is heterogeneous, at least the information important for its readers to know should be identified and provided.
Readers' knowledge, attitudes, needs and key values should be understood before drafting, whatever the genre. The obvious audience may not be the only one: a protocol instructs the study team, but institutional review board members also read it from an ethical perspective, evaluating risks and potential benefits, and community members may not be clinicians. Research protocols, consent forms, website study descriptions and journal articles may draw on the same information while serving different readers, including regulators, specialists, general practitioners, hospital staff, patients and the public.
Access to information
A South African health communicator's 2022 account showed how infrastructure and language shaped the audience: apartheid-era settlement inequalities persisted in telecommunications and electricity access, with rural areas and townships less well served than suburbs. Rural literacy was lower than urban literacy, and people preferred their vernacular language.
During COVID-19 communication, scheduled electricity shutdowns caused people to miss radio or television broadcasts, and people who did not understand English missed messages delivered mainly in that language. Poor rural telecommunications left some people without information even when vernacular broadcasting was attempted. High data costs and unemployment also limited access to online audio and video; some people used the little data they could afford to contact family and friends instead of accessing mainly English-language educational material.
An ideal reader for each project
Ideal readers are the group a piece aims to educate or persuade, rather than everyone. They should be defined at the beginning of each project because publications have different requirements. Defining the ideal readers can improve their understanding of health content. That definition helps settle six aspects of the content.
- Set the tone: chatty, empathetic, trusted-friend, professional, scientific, humorous or sarcastic.
- Decide which kinds of content to include, such as evidence, anecdotes, stories or case studies.
- Determine the subject matter from the audience's problems, issues and concerns.
- Shape the simplicity level according to the readers' education.
- Create targeted content to improve its chance of success.
- Engage readers by answering their questions or helping with a problem or concern.
A two-step exercise can help define those readers.
- Consider basic demographics: age, gender, location, industry, income level and education.
- Consider preferences, habits and what matters to them: what else they read, like and share on social media, their health concern, and the important problem the content could help solve.
The profile can be expressed as “The content helps [who] who [situation] and are [state].” Four worked profiles connect the reader's situation to the writing.
| Project | Ideal readers | Implication for the writing |
|---|---|---|
| In vitro fertilisation (IVF) patient handout | Women trying to conceive who feel anxious. | Use empathy and reassurance. |
| Asthma infographic | Mothers of children with asthma seeking best-practice advice. | Address mothers directly and show understanding of raising a child with asthma. |
| Skin cancer prevention leaflet | Young people who spend much time in the sun and do not know the dangers of skin cancer. | Use fun, friendly language without downplaying the risk or the importance of prevention. |
| High blood pressure prevention article | Men aged 50 or over at high risk of heart disease who do not know the risk factors or consequences. | Address why they should care before seeking behaviour change. |
Without a solid understanding of the audience, the effectiveness of a message cannot be measured.
An imagined reader can help maintain the right voice, words and pitch. One clinician and columnist pictured an interested, curious 11-year-old who knew nothing about the subject, later recognising her husband as that reader; writing instead for the approval of knowledgeable doctors and scientists distracted her from the audience she intended to reach.