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Pee and poo and the language of health

How do we decide which words to use on the NHS website? Sara Wilcox, content designer with NHS.UK’s standards team, explains. 

By Sara Wilcox, 5 February 2019

someone holding phone looking at 'P' on the A to Z

People come to the NHS website to get answers to their questions about health, so they need web pages that are easy to understand. The content designers who write our pages know that the words we use affect how well, and how quickly, people understand. And that affects their health.

We research and choose the words that work best – and now we’ve published some of them in an A to Z list for people who write about health and the NHS. The list includes around 100 words and phrases and we’ll be adding more.

Many of our web pages are about medical conditions and treatments. We talk about body parts and how bodies work and sometimes that means talking about uncomfortable topics. That’s why our list includes the words ‘pee’ and ‘poo’.

How we decide what to include

We try to use the words people use when they talk about their health and when they search the internet. We avoid jargon, such as medicine ‘interactions’. Instead we start with user needs.

We:

  • listen to what people say when we test our web pages
  • look at our website data, survey feedback, and what people type into Google
  • talk to colleagues in other teams ­– because people respond differently to language in different contexts

We take all of this into account when we decide which words to use.  

Some people don’t like words like ‘pee’

We get some complaints when we use words like ‘pee’ and ‘poo’. People tell us they see it as:

  • ‘dumbing down’
  • ‘simplistic’
  • ‘patronising language’

We wanted to understand how widespread these views are, so we looked at over 10,000 replies to our website survey. Most people are positive about the language we use. They like the way we write and say our language is:

  • ‘clear’
  • ‘direct’
  • ‘language that anyone can understand’
  • ‘pitched at the right level’

Overall, we get more than 10 positive comments for every negative one. This reflects what we see when we test our content face-to-face. Most people appreciate simple, everyday English. 

The people who fill in our survey tend to have good levels of literacy. But we also wanted to understand the needs of people who don’t find reading easy.

We tested ‘pee’ and ‘poo’

We tested the words we get most complaints about with people with different levels of literacy. We found that everyone understood ‘pee’ and ‘urine’. People with higher literacy skills were slightly more likely to use ‘urine’ and people with low literacy were more likely to prefer ‘pee’.

We tested ‘poo’ against ‘stools’ and ‘bowels’. No one used ‘stools’ and everyone (low and high literacy) preferred ‘poo’ to ‘bowels’.

Feedback also showed that people with a learning disability or dyslexia are slightly more likely to use simple words like ‘poo’.

We decided against ‘wee’ and ‘stool’

We thought about whether to use ‘wee’, but people who use voice technologies sometimes confuse it with ‘we’ – or ‘wee’, meaning tiny. And some people only know a ‘stool’ as something to sit on.

We agreed ‘pee’ and ‘poo’ work best

Our team of content designers agreed that it’s OK to use ‘pee’ because everyone understands it, especially people who find reading difficult. We also use ‘urine’ because most people understand it and search for it.

In the same way, we use ‘poo’ because everyone understands it. Sometimes we use ‘stool’ or ‘bowel’ when people will hear their GP use them but when we do, we explain. For example:​ ‘a sample of poo (stool sample)’. That helps people learn the language of health.

A few people don’t like the words but they help lots of people understand

We think it’s important to use the language that’s most widely understood – by people of different ages and literacy levels. 

We know some people think we shouldn’t use words like ‘pee’ and ‘poo’, but we haven’t seen anyone have problems knowing what we mean. Most importantly, if someone with poor literacy understands ‘blood in your poo’, it might just save their life.

Have a look at our A to Z

‘Pee’ and ‘poo’ are just a couple of the words in our A to Z. They’re the most hotly debated ones… so far.

Whether this blog made you smile or wince, we’d be interested to know what you think, especially if you have any research to share about the words people use to talk about health. Contact us at service-manual@nhs.net or join us on the NHS digital service manual Slack workspace. You’ll need to sign up.

screenshot of A to Z page

Last edited: 5 February 2019 1:48 pm