Hyphens or spaces - and dashes

[JackMatthams]

What

There are some words and phrases that cause uncertainty over whether a hyphen or space should be used between words, or if it should all be one word. For example:

• short term/short-term and long term/long-term
• straight away and straightaway (Note: we've resolved this one.)

Why

We need to make sure there is clear guidance in the service manual to keep consistency and accuracy with any phrases or words like those above.

[sarawilcox]

Have we resolved the issue of long-term vs long term? We were considering this for the Feb Style Council meeting: We propose to add the following entries to the A to Z of NHS health writing:​

long term and long-term​

Use "long-term" if you are using the phrase as an adjective, for example "long-term care". Use "long term" if you are referring to the term as a noun, for example "in the long term"​

short term and short-term​

Use "short-term" if you are using the phrase as an adjective, for example "short-term care". Use "short term" if you are referring to the term as a noun, for example "in the short term"

[mattbancroft23]

As the live service changes and we make a move away from sub-editing content we should decide on this issue as soon as possible so content designers are clear. The guidance for short term and long term should also apply to "follow up". Example being "follow-up appointment".

[mattbancroft23]

"life threatening" is a similar example that I just came across.

[OliviaThornton]

A few more cases were discussed at a recent exploration session with the NHS App and NHS.UK content designers:

• self-care
• self-test
• self-isolate
• self-help

Mind tends to hyphenate 'self-care', and we recently used 'self-care' in the 'every mind matters' campaign.

A quick search on Google trends showed that people tend not to hyphenate these words when searching, and Google tends to ignore the hyphens anyway.

A question was raised about what is best for assistive technologies, like screen readers and translation apps. Although it doesn't seem to make much difference when we checked on Google translate.

[sarawilcox]

We didn't get a chance to discuss this at the November Style Council meeting so I've put it on the agenda for December instead.

[sarawilcox]

Worth mentioning to test hyphens/dashes with assistive tech? They can be read as minus. For example: 'one to be taken every evening minus 18ml' on Android, during voiceover.

See also an example in our ticket for Time format in patient information.

[mattbancroft23]

I believe that one of the reasons we have used long dashes (apart from being grammatically correct) is to avoid a short dash being read as minus. I don’t think we can do any more than that. We can’t make everything accessible at the expense of grammar and reading for the majority of those who don’t require assistive technology. It is the job of those providing assistive technology to improve their product. Unfortunately those using it have to put up with the fact that it’s not always good enough for them yet. We are providing content for the vast majority of people for whom it is not an issue.

From: Sara Wilcox notifications@github.com Sent: 16 December 2020 12:47 To: nhsuk/nhsuk-service-manual-backlog nhsuk-service-manual-backlog@noreply.github.com Cc: BANCROFT, Matt (NHS DIGITAL) matt.bancroft@nhs.net; Comment comment@noreply.github.com Subject: Re: [nhsuk/nhsuk-service-manual-backlog] Hyphens or spaces (#206)

Worth mentioning to test hyphens/dashes with assistive tech? They can be read as minus. For example: 'one to be taken every evening minus 18ml' (see JIra NHSO-2404 Android - During voiceover, special character (hyphen) is referred to as 'minus')

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[sarawilcox]

Thanks @mattbancroft23 . I think en-dashes can be just as problematic as short dashes. @mcheung-nhs found that JAWS read "Symptoms – heart attack" as "symptoms en-dash heart attack", which for someone who doesn't know what an en-dash is would be very confusing.

I think it's worth content designers/editors being aware that a dash can be misread. Sometimes it's just a matter of rewriting something without a dash. For example, rather than writing "1 to be taken every evening - 18ml" (read out as "minus 18ml"), we could write "1 dose (18ml) to be taken every evening" or something like that.

[sarawilcox]

Why Don’t Screen Readers Always Read What’s on the Screen? Part 1: Punctuation and Typographic Symbols

[sarawilcox]

At Style Council, we agreed to add the following additional information about hyphens to the style guide.

"Sometimes it depends on the context.

Use "long term" in phrases like "in the long term". But use a hyphen for "long-term" as an adjective, for example in "long-term care". Do the same with "short term" and "short-term".

Use "follow up" as a verb, but "follow-up" with a hyphen in "follow-up appointment"."

We also agreed to add these 4 examples:

• self-care
• self-help
• self-isolate
• self-test

All of this subject to testing on screen readers. I've tested them on Voiceover and on Android voice assistant and they're fine.

@mcheung-nhs, would you have a mo to check the above text please, to make sure that it doesn't cause any problems on JAWS or NVDA? Thanks very much.

[sarawilcox]

At the December Style Council meeting, it was noted that this sentence at the top of the hyphens section in the style guide is not clear: "We avoid using hyphens unless it confuses people to leave them out."

This needs some further research and discussion so that we can be more specific about what our position is.

I think this guidance was based on the GOV.UK A to Z style guide which says: "Do not use a hyphen unless it’s confusing without it, for example, a little used-car is different from a little-used car. You can also refer to The Guardian style guide for advice on hyphenation."

[mcheung-nhs]

Hi @sarawilcox

JAWS says the word "dash" for hyphenated words, NVDA does not

Using JAWS (2019.1912.1): long-term = "long dash term" follow-up = "follow dash up"

Using NVDA (2020.3) long-term - "long term" follow-up = "follow up"

[sarawilcox]

Oh dear. :-( Thanks a lot @mcheung-nhs.

[sarawilcox]

There's some helpful advice in the Readability guidelines on hyphens and dashes.

[sarawilcox]

A Home Office accessibility audit identified ‘-’ as an issue as the screen reader read it as ‘en-dash’. They have removed dashes from their content.

I asked about this on GOV.UK Slack. Two responses:

• I think unless the way screen readers read it is known to cause problems for screen reader users, we try not to write content differently for them. Leonie wrote about this a few years ago https://accessibility.blog.gov.uk/2017/02/08/advice-for-creating-content-that-works-well-with-screen-readers/. Screen readers read lots of things a bit weirdly - but it's not necessarily an issue. A regular screen reader users will likely be familiar with much of it. So what's weird to a non screen reader user may well not be for them.
• Doesn't sound like something we in the internal team accessibility team would say. What Ed said and test with assistive technologyfor reality.

[sarawilcox]

Proposal for January 2021 Style Council meeting (25 January): that we add in the extra hyphens examples we discussed at the last meeting, but with the following caution:

"​Bear in mind that screen readers read out hyphens and dashes in different ways. For example a screen reader may read:​

• "symptoms – heart attack" as "symptoms en-dash heart attack", which could confuse users who don't know what an en-dash is​
• "1 spoon to be taken every evening - 18ml" as "minus 18ml"​ ​ If in doubt, rewrite your content without the hyphen or test it on assistive technology."

I'm going to run the above by Alistair Duggin before the meeting.

[sarawilcox]

Alistair's advice: "If it’s grammatically correct English, then go with it. Don’t adjust it based on how it is announced.... An exception would be when having something like -£20 where it not being announced is a problem."

"Avoid hyphens where possible, but they are fine to use when necessary."

[sarawilcox]

Notes from January Style Council meeting

At the December meeting, we agreed to add the following text to the style guide, but this was subject to testing on screen readers.

"Sometimes it depends on the context.

Use "long term" in phrases like "in the long term". But use a hyphen for "long-term" as an adjective, for example in "long-term care". Do the same with "short term" and "short-term".

Use "follow up" as a verb, but "follow-up" with a hyphen in "follow-up appointment".

Plus some more examples:

• self-care
• self-help
• self-isolate
• self-test

Screen reader testing identified an issue with JAWS but advice from via GOV.UK Slack and from Alistair Duggin suggests we should:

• avoid hyphens where possible, but use them if grammar requires them
• not adjust punctuation for screen reader users, except where important information might not be announced, for example in -£20

(More detail in the presentation slides.)

We agreed to go ahead and make the changes noted above.

We also discussed the following sentence in our existing guidance: "We avoid hyphens unless it confuses people to leave them out". It isn’t clear enough what we’re recommending and why.

GOV.UK and the Readability Guidelines have similar guidance. We looked at the fuller guidance in the Readability Guidelines, and agreed to add the following to the style guide:

Only use a hyphen if a word or sentence is confusing without it.

Hyphens can clutter content and make it more difficult to read.

Ask yourself if there's a chance someone could misread what you've written and then add a hyphen if needed. Compare “recover” and “re-cover” (meaning putting on a new cover).

You can often write something simply and clearly without a hyphen. For example, "has no sugar" instead of "sugar-free".

[sarawilcox]

Two new issues identified at January Style Council meeting

With some details taken from comments at the meeting.

Should we specify that 'non-' requires a hyphen?

Note that GOV.UK says this in its A to Z: non-executive director. The Guardian style guide treats different words in different ways, e.g. non-binary, noncommissioned, nonfiction, non-white.

@mattbancroft23 Do you know what we've done in the past and why?

Do we use word login/log in/log-in with a hyphen? Or do we recommend sign in?

This is now captured in a separate ticket as it's not just about the hyphen: https://github.com/nhsuk/nhsuk-service-manual-backlog/issues/306

[mattbancroft23]

Hi Sara,

I can’t remember how to find the service manual in GitHub… Anyway the old style guide said this:

As English evolves, compound adjectives often become single words – bloodstained, overblown, underdone, redheaded, halfhearted. This is also true of compound nouns – steam ship became steam-ship became steamship; machine gun became machine-gun, and now is machinegun. In general, favour the hyphenless form. It is neater and punchier.

There was nothing specific about “non” but this rule could apply with nonfiction and non-binary being good examples of when to hyphenate or not.

Does that help?

Matt

[sarawilcox]

Two more queries about dashes:

• In our 2i checklist we say that if we can’t avoid a dash, we should use an en-dash. Should we add that to the style guide/

• When is it OK to use a dash? Examples of when it’s acceptable?

[sarawilcox]

After a conversation with Alistair Duggin and a follow up meeting today, we've decided to test hyphens and dashes with screen reader users to find out whether/where it might cause problems.

@sarawilcox to prepare some examples. @mcheung-nhs and @davidhunter08 to prepare prototypes for testing. @KarinMochan for info.

[sarawilcox]

Sent notes from last Style Council meeting to clinicians for sign-off.

[sarawilcox]

Changes published. Maybe we can mop up outstanding issues at next Style Council meeting.

[sarawilcox]

Examples to test

Are there any problems with using dashes like these, from the aciclovir page?

What difference does it make if it's a short dash or an en-dash? Do users understand "en-dash"?

How do screenreader users understand: "1 spoon to be taken every evening - 18ml"? Is there any chance it reads out as minus 18ml?

[sarawilcox]

Other examples from the aciclovir page:

Use of bold for headings, use of en-dash:

Using bold with colon:

Using en-dash:

[sarawilcox]

On aspirin page:

Using dash (rather than en-dash):

Ditto: There are a lot of examples on this page.

[mattbancroft23]

Hi Sara,

The reason why a lot of medicines pages have hyphens instead of dashes is because the Medicines team wouldn’t go along with the style – although I kept changing them I don’t think Sinead did for instance.

Matt

[sarawilcox]

Thanks Matt. We're collecting different examples to test with screen readers users. The content style guide doesn't say to use en-dashes and, before we add that information to it (so that it's aligned with our practice), we just want to make sure that it doesn't cause any accessibility issues.

[sarawilcox]

Putting this back into In Progress for now.

[sarawilcox]

A suggestion via NHS.UK Slack that we add the following to make our info about dashes clearer.

Avoid using dashes to indicate a pause or to break up sentences. Consider other ways of formatting your content without using dashes, such as:

• using a comma, a colon or brackets
• writing shorter sentences
• using subheadings
• using a table

To go to June 2023 meeting.

[sarawilcox]

Australian Government style manual on dashes

It recommends using a spaced en dash (as well as commas, colons and brackets) to show additional, amplifying and parenthetical material.

[sarawilcox]

Style Council June 2023 - another question about whether we should specify en-dashes where we mention dashes in the content style guide.

Interestingly the GOV.UK design system uses em-dashes in the design system.

The ONS style guide says this about en-dashes: https://style.ons.gov.uk/house-style/dashes-and-hyphens/

[sarawilcox]

Notes from June 2023 Style Council meeting

Our current guidance on dashes doesn't say to avoid using them completely but says to avoid using them to indicate a pause. It implies there are times when you can use a dash. Albert proposed some additional guidance to make it clearer when we can use dashes and to steer people towards alternatives to avoid them.

We ran through some examples of good and bad use of dashes.

Agreed the following text for the style guide, with a few minor changes to the text Albert proposed.

People suggested that we should not use a colon instead of a dash. There was some discussion about brackets but we do use them for a plain English term followed by a medical term in brackets and for acronyms.

People suggested adding the Do example from the PowerPoint slides that talks about insect repellent and mosquitoes but changing the first dash to “and”.

Proposed addition:

Dashes can make content hard to read so we do not often use them.

You can use a dash, or a comma, in a bulleted list if you need to expand on an item. But follow our guidance on lists [link] and keep bullet points as short as possible.

Example:

Do

• use insect repellent on your skin and make sure it's 50% DEET-based

• sleep under mosquito nets treated with insecticide

• wear loose clothing that covers your arms and legs – the mosquitoes that carry Zika virus are most active during the day

Consider other ways of formatting your content without dashes, for example:

• using a comma or brackets

• writing shorter sentences

• using subheadings

• using a table

The text under “We use ‘to’ instead of a dash for ranges of numbers, dates or time” won’t change and the research insight will remain the same.

Action: highlighted text approved. Add to style guide, subject to clinical approval.