Plain Language and text accessibility in health communication: The case of Layperson Summaries of clinical trials

Language plays a major role in the healthcare setting. Yet, health communication is characterized by epistemic and thus power asymmetry (Heritage 2012; Magris 2018) between communication act participants, i.e. expert and layperson. Such asymmetries may lead to both the so-called Fachbarriere and Fachsprachenbarriere, according to the terminology used by Schubert and Rink in a categorization of communication barriers (Rink 2018: 29-65). However, the concept of patient empowerment (or autonomy, cf. Schulz & Hartung 2014; Magris 2016) and plain language movements are now changing these dynamics. An example of plain language requirement is provided by EU Regulation 536/2014 concerning clinical trials, which foresees the uploading of their results on the EMA (European Medicines Agency) portal in a public-friendly version, the layperson summary. After an introduction to this innovative text genre, two examples in English and German taken from the websites of Roche and Grünenthal, respectively, will be analyzed qualitatively on the textual, syntactic, morphological and lexico-terminological levels. A comparison will be drawn between the two language versions and the corresponding specialized text, in order to highlight the main differences and successful choices of simplification leading to enhanced accessibility. The contrastive analysis, although performed on a small sample, is representative in its attempt to highlight critical points and comprehensibility difficulties inherent in special languages and the way they are tackled in summaries for laypeople, and provides a starting point for further reflections. To evaluate simplification, inter alia de-terminologization strategies were analyzed accurately, and readability formulas (the Flesch-Index and the Gunning Fog Index) were used. Concerning acceptability, we considered whether text characteristics tended more towards Easy or expert/standard language in the continuum and whether some traits (e.g. potential excessive explicitation) could lead to stigmatization based on previously conducted studies (e.g. Maaß 2020). Starting from the lexico-terminological level, which is arguably the most important one in expert-lay-communication, since difficulties arising from technical terms are particularly evident (cf. Magris 2009: 89; Jahr 1993: 10; Wichter 1983: 74), the categorization of de-terminologization strategies put forth by Resurrecció and Davies (2007: 251-253) was followed. According to these scholars, de-terminologization may occur in four ways: 1] by providing an explanation of the term after its introduction, 2] by introducing a parenthesis with the term after its explanation, 3] by replacing the scientific term with its popular counterpart, 4] by avoiding the term through a paraphrase. The most frequent strategies in the analyzed texts were the omission of terms and, secondly, the recourse to terms of Germanic origin, which are more transparent and understandable than those of Greek-Latin origin (e.g. “red blood cells” for “erythrocytes” or “Blasenschmerzsyndrom” for “interstitielle Zystitis). Other frequent critical points of specialized texts whose potential presence was examined are acronyms, initials, abbreviations, as well as eponyms and loanwords. From the morphological point of view, these texts’ mood and tense system is limited in variety (and frequency) compared to standard texts due to their belonging to the medical field (cf. Serianni 2004: 255; Scarpa 2008: 47), although it is wider than what is suggested for Easy Language (Bredel & Maaß 2016); the same goes for the syntactic level. As for the textual and paratextual level, both texts have a clear structure with respect to information distribution, they generally have few intertextual and intratextual references and tend towards redundancy. On the whole, the level of acceptability was higher than the level of comprehensibility if the needs of Easy Language primary target groups are considered, but specialized terms and concepts were explained successfully to a non-expert audience.