Age-Friendly Communication: Facts, Tips and Ideas – Choosing the communication medium

Reaching a wider audience, including seniors, means thinking broadly about what constitutes communication and how best to communicate. A first step is to define the means or "medium" you should use to reach senior clients and customers—choosing those that will best reach your audience.

Communication "Medium" Defined

When developing communications to include a senior audience, think broadly about all the potential vehicles and means of communication. Businesses, financial institutions and governments may think they communicate largely through advertising and written information. But they also communicate each time they answer the telephone, greet clients in an office, branch or store, or broadcast over a public address system. The design, organization and content of their Web sites also give strong messages to potential users, letting them know whether the site was set up with them in mind.  

• Example: In a medical clinic, pay attention not only to written or illustrative material handed out during a visit, but also to the telephone answering system, the directional signage, the comfort of the seating, the acoustics of the waiting room, and the interpersonal listening and communication skills of doctors, nurses and reception staff.^{Footnote 28}
• Example: Providing current information about a product or service on your Web site will mean that many members of your audience will have access to it. But, has your Web site been designed to meet the needs of older users—who might not be as experienced with navigation, and who might have visual impairment? Plan to design for all users, test the results and be prepared to make adjustments.

What Are Your Choices? An Overview of Key Media

The medium should suit not only the audience but also the nature of the message. All media are not created equal, and research shows that success in reaching target audiences and getting the message across effectively varies widely.

Personal Communication

Face-to-face or telephone contact is often the first, and sometimes the only, communication between seniors and health and social services professionals. This contact can have far-reaching consequences on health, and is especially critical for people with low literacy. Some research has suggested that personal contact is seniors' preferred source of health information, even for skilled readers,^{Footnote 29} and this finding could well extend to any type of information with the potential to affect seniors' well-being and quality of life, such as information about pensions and other entitlements, investment options, and travel and recreation opportunities.

Personal communication is also important for customer relations and client service staff in large corporations, retail stores and service businesses. For these organizations, that first contact may mean the difference between a sale or a lost customer. The bibliography at the end of this publication offers valuable sources for providing quality verbal contact and information (see Advice from the Experts). Several of the sidebars also offer tips and checklists for anyone serving a senior clientele.

In some circumstances, communicating through people that seniors trust and pay attention to (they are sometimes referred to as "key informants") may be more effective than formal communication techniques. Research has found that when older people need help with a problem, they often turn to informal information networks such as family members and trusted friends and neighbours. Researchers speculate that reluctance to use formal sources to find needed information or services may relate to communication barriers like these:

• frustration using an automated telephone system
• difficulty hearing over the telephone
• the impersonal nature of dealing with someone over the telephone, particularly if required to give personal information
• difficulties interpreting printed material that might be offered through formal sources^{Footnote 30}

Web sites can cause frustration and other difficulties for seniors as well. Sites that use small type, drop-down menus and unforgiving forms that require information to be entered in one way only can prove to be unusable by seniors who are not experienced Internet users or whose vision and fine motor skills are reduced as the result of normal aging.

Checklist for Professionals

Verbal Communication

• Ask the person to list questions or concerns before an office visit
• Ask the person how they prefer you to address them (Mrs., first name, …)
• Use open-ended questions to elicit information
• Summarize information provided by the client to check your comprehension or the facts
• Avoid formality and professional jargon; speak to the person's level of vocabulary and understanding
• Offer checklists or other plain-language material to back up oral instructions
• Make sure your client has understood you by asking that he/she summarize what was said
• If the client doesn't understand, rephrase the sentence; don't just repeat the same words or say them louder

Non-Verbal Communication

• Avoid establishing physical barriers (across desk) between you and the client
• Remain seated during the conversation
• Show courteous attention; demonstrate interest in what they're saying
• Show (don't just tell) the client how to do something
• Maintain eye contact; communicate occasionally through touch if appropriate
• Avoid doodling or fiddling
• Stay alert to non-verbal clues that contradict or supplement verbal communication
• Stay focused on the client; don't consult your schedule or watch

Many Aboriginal cultures (First Nations, Inuit and Métis) are based on an oral tradition. Aboriginal seniors have told researchers that their preferred information source is word of mouth. In many Aboriginal communities, therefore, print is the least effective means of reaching a senior (or any other) audience. Instead, methods that emphasize personal contact, social connections and oral transmission of information are preferred.

The best way to communicate varies from one community to another—because trusted information sources and channels of communication vary from one to the next—but the experience of various communities across the country has demonstrated the value of some methods.^{Footnote 31}

The message from Aboriginal communities is clear, and it applies equally well to many other groups of seniors (for example, those with limited vision or hearing): no single medium or information distribution strategy works in every situation. Communicators must be prepared to consider a range of methods if they want to reach all members of a senior audience.

Interpersonal communication should also be a two-way street—not just a way to distribute information but also a means of checking for comprehension and letting clients clarify or enhance their understanding. Medical, legal, counselling and other professionals in particular need to be skilled in responsive listening.

Communicating with seniors is not simply a matter of conveying your own messages. It should involve an exchange of information, allowing clients or customers to express thoughts and feelings as well as to convey objective information about their situation. The listener must be skilled in interpreting gestures, words and behaviour, observing verbal and non-verbal messages, allowing enough time for communication to occur, and providing the appropriate responses.^{Footnote 32}

Telephone

Use of the telephone to find and convey information is a highly personal choice. Many seniors find the telephone essential for staying in touch with family and friends and maintaining social networks. But many also find it less satisfactory as a means of obtaining information if they can't speak to a real person or can do so only after negotiating an automated answering system. In addition, some seniors have problems using the telephone because of hearing loss.

This raises serious considerations about whether the telephone is an appropriate choice for communicating with a senior audience and, once chosen, about the design of a system intended to serve senior users. A toll-free number as a source of information about government programs or services may not be effective, for example, if it connects to a pushbutton-activated voice message system that does not accommodate callers with rotary phones or those who prefer to speak to a real person.

Telephone System Checklist

• Does your phone system invite callers to talk to a real person without waiting for endless messages and menu choices?
• Does the system accommodate rotary phones?
• Are the instructions on your automated answering system spoken clearly and slowly, with options to repeat a menu?
• Does your message start by advising callers to have a pen and paper handy?
• Does your system provide for TTY/teletypewriter users, to accommodate callers who are deaf or hard of hearing?
• Does the system give callers the option of leaving a message and having someone return the call?

Meeting

If arranged with thought and care, meetings and similar gatherings can be a practical way to convey information to groups of seniors—for example, at a seniors' centre or in an apartment building with a large senior population. This may be the most appropriate medium for reaching some groups of seniors, because of its emphasis on exchanging information orally and in a social setting. A meeting also offers the opportunity for seniors to compare notes later with others who were present to confirm or clarify the information they took in.

Checklist for Planning a Meeting

• The invitation to the meeting should give a contact name for notifying of any particular needs or aids.
• The meeting location should be accessible—close to public transportation, offering a place where seniors can be dropped off safely by car, and plenty of parking, preferably free.
• The meeting room should be accessible to people with varying degrees of mobility; the meeting room chairs should be comfortable.
• Arrange the room to ensure that everyone can see and/or hear and understand your message. The requirements will vary with the audience and could include public address systems that accommodate assistive listening devices and hearing aids, sign language interpretation, large posters or projected images to convey key points. But beware of projection methods that require a darkened room (difficult for low vision).
• Always start the meeting at the appointed time.
• Make sure the first speaker announces who is at the head table and asks speakers or persons asking questions to identify themselves. This is particularly useful to people who are blind or otherwise not able to read name tags/plates.
• It is also helpful to announce the location of washrooms and other amenities like coffee shops. If there are refreshments available, announce the location and the choices.
• Messages should be simple and concise: narrow them down to three or four points—no one can retain more than that, senior or not so senior. Handouts can reinforce and supplement the information.
• Allow time for questions and clarification.
• Schedule a few minutes of wrap-up at the end of the gathering to repeat and reinforce key messages.
• Offer plain-language handouts and a telephone number (answered by a real person) for questions that remain unanswered.
• Finally, plan to end the gathering on time, so that people using public transit or arranged rides can get home safely and conveniently.

Print

Print has the advantages of allowing skilled readers to absorb information at their own pace and to retain the item for future reference. Print can also be tailored for an audience with more limited literacy skills through plain language, design and message development. Keep in mind that any attempt at simplifying the task (large letters, simple words, etc.) will make your message available to a wider audience.

Your print material must invite readers to begin reading, and your writing must make it easy for them to get your message.^{Footnote 33} The checklist below offers basic advice in the use of plain language to reach the largest possible audience with printed materials; the next section contains detailed information on writing techniques.

As we have seen, however, written material, even plain-language material designed for maximum readability, is not always seniors' preferred information source. Moreover, written material may be of limited use to reach people with low literacy skills or limited vision, or to communicate with members of cultural communities who are literate in their mother tongue but not in English or French. Before printing leaflets, placing notices or advertising in newspapers and magazines, consider your audience and whether this method is likely to reach it.

Finally, if print documents are the chosen medium for your message, consider also conveying the information in large print or in braille, audio- or videotape or CD/DVD format. Providing information in print alone means you may miss large segments of your target audience.

Plain Language Checklist

• Use familiar words and a conversational, personal tone.
• Proceed logically, with the most important ideas first, with good links from one paragraph to the next.
• Use action verbs and active construction, not passive.
• Favour short words and short sentences.
• Use short paragraphs.
• Use concrete examples to illustrate ideas or concepts.
• Present ideas with illustrations or diagrams if it makes them easier to understand.
• Highlight main ideas and important information with headings, point form and bold face type.

Internet

The Internet can be a very effective and efficient way to reach seniors. Internet use by those aged 65 and over is on the rise (31% in 2004), with the next generations of seniors using the Internet at much higher rates (63% of those aged 55 to 64 and 76% of those aged 45 to 54 years).^{Footnote 34} Given the growing importance of seniors as a proportion of the population and their current and expected Internet use, seniors are an Internet audience well worth considering.

Design for use

Web site design and online documentation present many of the same challenges as print and other media, such as telephone answering systems. The design guidelines that apply to print—using large type sizes, ensuring contrast between type and background—also apply to Web sites and online documentation. Other design features make just as much sense for Internet products as for print, telephone and other communication vehicles—in particular, the notion of "keeping it simple." For Web sites, this means designing with easy-to-use navigation systems, providing site maps and using such techniques as "bread crumbs" (a list at the top of the page of what page(s) were followed to get to the current page). In fact, senior-friendly design makes using online information sources more enjoyable and informative for all users, not just seniors.

A number of organizations have studied how seniors use the Internet and how sites and online forms and other resources can be designed to make them more useable. One such study, conducted in the U.S. and Japan compared how tasks on a Web site were completed by seniors and by younger adults.^{Footnote 35} Results show that poor design was a major contributor to seniors' difficulties with the tested sites. Small font size, the use of drop-down menus and other design features that call for heavy reliance on fine motor skills, memory and superior vision were some of the unfriendly features noted. Similarly, forms that were unforgiving (for example, one that would not accept a hyphen in a telephone number) and error messages that were difficult to notice rendered sites difficult to use.

Tips and advice on design of Web sites to include as many users as possible are now numerous.

Common Look and Feel Standards for the Internet have been developed by Treasury Board and were updated in 2006. While mandatory for most federal government departments and agencies, the guidelines have much to offer non-government organizations (see Advice from the Experts).

Web Site Checklist^{Footnote *}

Typeface

• Use a sans serif typeface for body text, such as Helvetica, that is not condensed. Double space body text.
• Use 12- or 14-point type for body text, medium or bold weight.
• Present body text in upper and lower case—save all capitals and italics for headings. Reserve underlining for links only.
• Left-justify body text to make it easier to read.
• Use dark type or graphics against a light background to ensure contrast between text and background. Avoid patterned backgrounds.
• Ensure that text and graphics are understandable when viewed on a black-and- white monitor. Avoid using yellow and green in close proximity—some older adults have difficulty telling these colours apart.

Writing Style

• Present information in a clear, simple and familiar way. Use positive statements wherever possible. Provide an online glossary of technical terms.
• Use the active voice.
• Organize text in a standard and familiar format. Break long documents into shorter sections/pages.

Other Media

• Use illustrations and photographs that relate to or support the text.
• Audio, animation and video clips should be short to reduce download time on older computers.
• Provide text alternatives to all animation, audio or video segments.

Navigation

• Keep the organization of the site simple and straightforward. Use explicit step-by-step navigation procedures whenever possible to ensure that people understand what follows next. Carefully label links.
• Use single mouse clicks (instead of double) to access information.
• Be consistent—use a standard page design and the same symbols and icons throughout the site. Use the same set of navigation buttons in the same place on each page. Label each page in the same location with the name of the Web site.
• If you use icons, support them with descriptive text if possible. Make navigation buttons large enough that they do not require precise mouse movements for activation.
• Use pull-down menus sparingly—opt for static menus whenever possible.

Forms

Forms are another type of written communication widely used in our society. Many large organizations—governments, health care facilities, financial institutions, insurance companies—use forms to communicate and exchange information with clients and customers. Forms filled out incorrectly or incompletely can significantly affect a senior's health care, entitlement to social benefits or financial security. Correction of these errors is also a source of huge human resource costs for business and government—extra time spent answering phone calls from confused customers, postage and effort returning incomplete forms for more information, wasted forms discarded because of mistakes, and additional time and cost to process long, complex forms. Forms therefore require careful design to ensure that they capture the necessary data and convey vital information to intended users.

Signage

"Public" print—direction, street and warning signs, video displays giving schedules and other information, transit ads and similar signage—also requires careful attention to design. The size and location of signs, the colour and size of type used, the colour of the background and the contrast between print and background, and the potential for glare from nearby light sources can affect their ability to communicate clearly with seniors and others with low or declining vision.^{Footnote 36} Also, some colour combinations (for example, the commonly used red on black) do not provide enough contrast to be legible by people with low vision.

Radio

Surveys on seniors' preferred methods of receiving information show that radio is not high on the list for most. Radio is a fast-paced medium, where listeners generally have to acquire information at the pace set by the broadcast. But radio could be effective in reaching parts of the older population, some of whom are devoted radio listeners. This is especially true if declining visual acuity has reduced the appeal of print and television as means of staying abreast of current and community affairs.

A radio message must be designed carefully, bearing in mind that the older person's ability to hear and understand the message is affected by the pitch of an announcer's voice, the speed at which the message is delivered, and the presence of background sound, which can interfere with receipt of the main message.

Seniors' radio listening (and television watching) habits are charted by the Bureau of Broadcast Measurement, among other organizations. Their published surveys can help you determine whether the audience you're trying to reach is likely to be listening or watching at any given time.

Television and Video

Some seniors watch a lot of television, but messages may not always be effective because this medium doesn't allow viewers to set the pace at which they acquire information. This is important in terms of the capacity to absorb information and retain it for future reference, which a fast-moving 30- or 60-second television announcement cannot promote very effectively. Special care must be taken in designing television messages for seniors.

Television in the form of community-run cable stations or community access programs may be useful in reaching specific audience segments, such as members of ethnocultural communities or Aboriginal people. Some specialty channels (those with travel and nature themes, for example) have also been shown to be of particular interest to seniors. Wise use of community programming could help overcome some of the language and literacy barriers to communication.

Videotape or DVD can also be used as an alternative form of communication. Of course, it must be as carefully designed as a radio or television broadcast or a public address announcement, with deliberate attention to the types of voices used, the speed of message delivery, repetition of key points, avoidance of background noise, and use of graphics and action sequences to "show" viewers instead of "telling" them what you want them to know.

If you choose television or DVD/videotape to convey your message, use captioning (open or closed) to reach an additional audience that might otherwise be excluded.

Public Address Systems

Airports, bus and train stations, hospitals and shopping malls all use public address (PA) systems to inform visitors, and some have audio-visual displays or information kiosks as well. They do not always communicate effectively with seniors if background noise interferes with the ability to hear or understand the message, or if announcers speak too fast or don't speak clearly. The softer consonants, "s" and "f," can be particularly confusing for someone with reduced hearing if words are not pronounced distinctly. Even the use of a hearing aid may not help people to hear PA announcements.

Public audio-visual displays should also be designed carefully to ensure that messages are clear, are repeated often enough, do not scroll by too quickly, and follow the other standards that enhance comprehension.

• Example: The Vancouver International Airport has a specially tailored PA system and flight information displays equipped with telephone access for those who can't read the displays. PA speakers are installed at 15-foot intervals, so that announcements can be broadcast at lower volume—more speakers at lower volume makes the message more intelligible. In some areas, announcements are presented visually on a board or video display. Check-in counters are also equipped with telephone handsets to amplify conversations between passengers and counter staff.

Designing universally friendly PA systems also means supplementing them with clear signs and other visual cues to help visitors navigate through the facility and find an information kiosk quickly and easily. The issue is not only conveying information, but also assuring safety and security.^{Footnote 37}

Publicity and Packaging

Applying effective communication principles to the way products and services are advertised and packaged is a vast field of its own.

The advertiser's knowledge of the audience and care in meeting the needs of older customers can make the difference between a marketing triumph and a flop.

Consideration should be given to offering products in non-child-proof packaging (clearly labelled as such and with a warning to keep out of the reach of children). A 1993 survey demonstrated that a good number of seniors (26% of those over 75) ceased to purchase a product whose packaging was difficult to open. As the senior population grows and businesses become increasingly aware of its needs and its tremendous consumer purchasing power, custom-crafted packaging and advertising strategies will be essential for commercial survival.^{Footnote 38}

Packaging and Labelling Checklist

• Does your company have a clear policy of designing and using packaging that takes into account the needs and characteristics of older consumers?
• Are there clear instructions to explain the product's use, including large print and illustrations?
• Do the instructions include safety and hazard warnings?
• Are labels, instructions and warnings written in non-technical language?
• Have you focus-tested the labelling and instructions with senior consumers?
• Is packaging easy to open, not demanding extra strength or dexterity?
• Are packaging, labelling and instructions printed in at least 12-point type with sharp contrast between background and foreground (i.e., at least a 70% difference)?

Automated Communication

In 2004, Canadians were the highest per capita users of automated banking machines (ABMs) and debit card services in the world, according to the Bank for International Settlements.^{Footnote 39} The design of ABMs and other automated services (such as museum displays and government kiosks dispensing information and licence renewals) should take into account the sensory, mobility and agility changes associated with aging.

Design considerations include not only physical specifications (height, glare reduction on screens, size of buttons and screen messages), but also the communication or interaction between the customer/client and the machine, such as the vocabulary used in visual or oral messages and the length of time needed to grasp the message and to react by pushing the appropriate button.

• Example: One bank has introduced audio banking at some locations—banking machines equipped with headphones for use by clients with low vision, and standards are being developed for more accessible machines to accommodate all types of disabilities (lower height, adjustable screens, larger buttons, etc.).