Part of the message that was shown to 767 Americans by a US research team who aimed to determine the natural indicators of uncertain language and understand how these indicators predict decisional conflict, was:

“Whether you choose a conventional or nano-sunscreen, exposing unprotected skin to the sun’s ultraviolet light is one option that is definitely not safe.”

The research, published in the Journal of Cancer Education , provides valuable insight into words that consumers use when they are feeling uncertain about a health message.

The team of researchers also found a strong link between uncertain language and decisional conflict – that is, those who felt most uncertain about the skin cancer message demonstrated the most direct form of decisional conflict.

Uncertain language about sunscreen and nano-particles

After providing their demographic information, participants were presented with a short text about the differences in conventional sunscreens and sunscreens with nano-particles.

Benefits and risks for each type of sunscreen were presented, and the text concluded with the above-mentioned copy: “Whether you choose a conventional or nano-sunscreen, exposing unprotected skin to the sun’s ultraviolet light is one option that is definitely not safe.”

The text was formatted to look like a Facebook post.

After they read the information, participants were invited to submit a free-text comment about the information.

In total, 767 participants wrote a response to the uncertain language in the cancer message.

Of those, 285 (37.40 %) responses were identified as containing uncertain language, or language that signals uncertainty.

Of those 285 responses, 34.74 % (n =99) expressed uncertainty using more than one indicator.

How did the participants express uncertain language?

In the study, uncertain language was divided into the following types of indicators:

• Possibility-indicating verbs
  • would (45, 15.79 %)
  • may (25, 8.77 %)
  • could (11, 3.86 %)
  • ought (6, 2.11 %)
  • might (3, 1.05 %)
• Hedging verbs in undecertain language
  • sound (20, 7.02 %)
  • wonder (14, 4.91 %)
  • appear (7, 2.46 %)
  • believe (6, 2.11 %)
  • suggest (3, 1.05 %)
  • guess (3, 1.05 %)
  • assume (1, 0.35 %)
  • hope (1, 0.35 %)
  • doubt (1, 0.35 %)
  • debate (1, 0.35 %)
• Qualifiers
  • kind of (15, 5.26 %)
  • probable and probably (2.81 %)
  • hard to (5, 1.75 %)
  • likelihood and likely (4, 1.40 %)
  • often (3, 1.05 %)
  • possible and possibly (3, 1.05 %)
  • perhaps (3, 1.05 %)
  • rather (2, 0.70 %)
  • almost (2, 0.70 %)
  • fair (1, 0.35 %)
  • quite (1, 0.35 %)
• Direct expression of uncertain language
  • confused and confusing (36, 12.63 %)
  • don’t understand (20, 7.02 %)
  • worry/ied 14 (14, 4.91 %)
  • not sure (11, 3.86 %)
  • don’t know (9, 3.16 %)
  • complicated (6, 2.11 %)
  • not convinced (2, 0.70 %)
  • chance (2, 0.70 %)
  • complex (1, 0.35 %)

“To identify uncertain language, we reviewed literature published on language and health communication,” the authors wrote.

“This review lead to the creation of an initial set of words indicating uncertainty, including modal verbs (could, would, should, might), hedging (seems, probably), and direct expressions of uncertainty (I am not certain, I do not know).”

How did participants use the language indicators in their responses?

Here’s how participants responded to the uncertain language in the cancer message. The responses provide an insight into how uncertain language manifested:

• Possibly-indicating verbs
  • “The use of nanoparticles in sunscreen may be a better approach in that it’s using an approach where additional chemicals would not necessarily harm the person and/or environment. This might be a better approach.”
  • “It is important to protect your skin by using a sunscreen with an SPF of 15. Nano-sunscreens may be more harmful.”
• Hedging verbs
  • “It sounds like Nano sunscreen is the best choice. I wonder how the other sunscreen affects me.”
  • “I find the information confusing and left me wondering which sunscreen would be the best to use. In other words, which sunscreen is safest.”
• Qualifiers
  • “The difference between nanoparticles and non nano particles. One is bad for you and should probably avoid it.”
  • “The information is quite understanding to me.”
• Direct expressions of uncertainty
  • “Sounds a bit confusing as to which one you should use. I don’t recall that I’ve ever heard of the nano-particle thing. I would think that part of the decision as to which one to use, may have something to do with the length of time you plan to be in the sun.”
    “I don’t understand why one should use sunscreen if they have not seen or had adverse affects without it. It appears that it is another ploy to line someone’s pockets.”

Words that were used to express uncertainty included uncertain, unsure and not certain.

The take-home message

The researchers acknowledged that consumers can’t avoid conflicting information about health recommendations.

However, they argued, future research could evaluate strategies for assisting health consumers with decisional self-efficacy and resilience in the face of ambiguous and uncertain information.

Of course, as health writers, we need to ensure out writing and language remain coherent – even when the science is not straightforward.

We can also:

• Avoid using uncertain language altogether – refer to the above list as a guide
• Pre-empt possible decisional conflict – and address it in our writing
• Study the participants’ individual comments in response to the message – understand why the message was unclear, and use this understanding to enhance our writing moving forward

References

Strekalova Y.A. &James V.S. Language of uncertainty: the expression of decisional conflict related to skin cancer prevention recommendations J Canc Educ 2016;

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