CDC’s Virus Messaging Is Too Complicated to Trust

(Bloomberg Opinion) -- Lots of people are not wearing masks, avoiding crowds or otherwise doing whatever is needed to stop the spread of Covid-19. Some of that is obstinacy or denial of the threat, but much more of the poor virus-fighting behavior likely derives from misunderstanding of the health risks and what precautions to take.

Guidance on the pandemic, especially in the U.S., has been explained inconsistently and changed frequently, which naturally leads to confusion. But a recent JAMA Network Open paper by scholars Vishala Mishra and Joseph P. Dexter suggests there's more going on: The language in government messages may be especially hard to read and process in the first place.

The American Medical Association, the National Institutes of Health and the Centers for Disease Control and Prevention all suggest that pandemic information should be clear and simple to interpret. The benchmark target is no higher than an eighth-grade reading level, and the CDC specifically recommends short, eight- to 10-word sentences with “everyday” language.

But when Mishra and Dexter tested notices on Covid-19 from 15 countries around the world, they found text far more complicated than that — often at an 11th-grade reading level or above.  Even the CDC's messaging didn't follow its own guidelines: The median grade level was 11; median words per sentence were 15.6; and 99% of pages used at least one term the CDC had explicitly noted as “difficult.” Many individual states' announcements were even more complicated.

Being at a high grade level doesn't exactly mean that people can't read it (although in places with low literacy, that may indeed be an issue). Rather, Mishra and Dexter's findings indicate that the sentence structure, phrasing and terminology used in Covid-19 guidance is hard to parse and interpret — and that means people need more time and focus to process it.

Of course, time and focus are at a premium for many of us during the pandemic. Even someone who goes out of his or her way to find the official Covid-19 safety guidance might not have the mental bandwidth to really comprehend it.

And most people aren't getting their information directly from the CDC or other official sources; they're getting advice filtered through the news media, friends and family, or the workplace. The more complicated the primary sources are, the more fuzzy the secondary sources will be. It's like a game of Telephone: If someone has trouble understanding the original message, whatever they convey to others will be garbled.

This compounds the challenges of shifting instructions and new information. The CDC only started recommending mask wearing on April 3, for example — and many people still don't understand the reason for the change. Clear, simple messaging would help.

Complicated central guidance also places a much larger burden on private institutions in managing their own Covid-19 responses. The harder the official instructions are to interpret, the more likely it is that businesses' policies around mask wearing, social distancing and so forth diverge.

As Mishra and Dexter point out, all of this stands to exacerbate the impact of the Covid-19 pandemic on places and communities with lower health literacy.

So although a lot of damage has already been done, there's still value in trying to put out more readable materials to improve virus controls.

Clearer messaging can encourage healthier behaviors and improve public trust. And indeed, a few places with better communication regimes do seem to have had some success. Plus when the status quo changes — such as with the arrival of a vaccine — it will be essential to communicate it well.

Mishra and Dexter make for a particularly interesting team of collaborators: Mishra is a physician with an interest in public health policy, and Dexter is a computational biologist who studies applications of text analysis (check out his Quantitative Criticism Lab!).

This was true under a variety of different complexity metrics, so it isn't likely to just be driven by the way they evaluated the text.

By contrast, the relevant language on the faq.coronavirus.gov website took this commentator three readings to parse – and indeed appears to be 11th-grade reading level under the Flesch-Kincaid metric.

This column does not necessarily reflect the opinion of the editorial board or Bloomberg LP and its owners.

Scott Duke Kominers is the MBA Class of 1960 Associate Professor of Business Administration at Harvard Business School, and a faculty affiliate of the Harvard Department of Economics. Previously, he was a junior fellow at the Harvard Society of Fellows and the inaugural research scholar at the Becker Friedman Institute for Research in Economics at the University of Chicago.

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