Developing Travel Health Alert Notices in plain language for international travelers arriving into the United States: Focus group results

The Division of Global Migration and Quarantine, Centers for Disease Control and Prevention used focus group data to develop Travel Health Alert Notices (T-HANs) for arriving international travelers who may have been exposed to certain communicable diseases during their travel. T-HANs are distributed during illness response. Each T-HAN addresses an illness or syndrome and contains transmission, symptom, and guidance information for travelers and their health care providers. It is important that travelers who get sick follow the health instructions on the T-HANs; this will also help slow the spread of communicable diseases. Using health literacy techniques and considering the international audience, we rewrote a sample T-HAN and developed three formats. A focus group of six international travelers representing diverse age groups, cultures, travel and work experience reviewed the original and new T-HANs. The purpose of the focus group was to gather feedback on the formats and the clarity of health messages. The focus group strongly favored the clarity of health literacy techniques: simplified text, action phrases, short sentences, boldfacing and bullets, and organization by importance. Using the results of the focus group, we created new plain language versions of T-HANs so people of diverse cultures could understand health messages in a format that will be kept and used. The focus group revealed the importance of using health literacy techniques for delivering key health messages to a general audience of diverse cultures. Focus group testing also provided valuable feedback about delivery preferences, key information desired, and ideas for new formats.