Health literacy — It ain’t just about education

By Silver Lumsdaine

Literacy Drug_Package_Insert
The U.S. Food and Drug Administration – Drug Package Insert (FDA 115)

“The great enemy of communication…is the illusion of it.” –William H. Whyte

What if 9 out of every 10 Americans had trouble understanding and responding to ordinary traffic signs? It would be a national emergency, of course. Imagine the chaos, the crashes, and the loss of life that would occur if people didn’t know how to interpret stop signs, one way signs, do not enter signs, speed limits, and sharp curve ahead warnings. The public’s health and safety would be in grave danger and immediate action would be required.

Yet, almost 9 out of every 10 American adults have trouble comprehending and taking action on health information, thereby putting their well-being at risk. What kinds of health information, you ask? The kind we encounter every day in homes, health care institutions, public spaces, and through the media. Think about warning labels on cleaning products or medication, a flyer advertising flu shots, or a placard in a restaurant window noting an inspection rating of “B” by the county health department. How about the recent viral news story about cheese being as addictive as drugs or even the World Health Organization report that processed meat (mmmm, bacon!) causes cancer. How should we act on this information? Should we act on this information? The truth is most Americans lack health literacy, or the ability to make informed and appropriate choices about health. It’s a problem that touches everyone.

Before you lay the blame for low health literacy squarely on the shoulders of John Q. Public, take a moment and walk into your kitchen. Grab any food package with a Nutrition Facts label. Okay, now what the heck is a “% Daily Value”? Is 60g of cholesterol per serving good or bad? How many ounces are in a 28g serving? Not so easy, is it?

Whether it’s dense blocks of text, impenetrable medical jargon, or statistical sophistication (the prescription drug package inserts are a triple offender here), health information is often difficult to interpret, regardless of one’s level of education. And that’s under the best conditions.

Now picture a recently diagnosed cancer patient about to begin radiation and chemotherapy. Over the past several weeks, he or she has been overwhelmed by a battery of diagnostic tests, cancer specialists, and medical information. The emotional strain is enormous. The chemo drugs will be affecting appetite and digestion. It’s crucial that the patient follow a strict diet during therapy to minimize side effects, which may include diarrhea severe enough to end treatment. The patient receives a 6 page black-and-white, text-heavy, bullet-pointed, detailed diet guide to follow. After flipping through the first two pages, the mentally and emotionally exhausted patient tosses the diet guide into the pile of other handouts. Patient engagement fail.

Providing health information to someone doesn’t guarantee that person will use, or even look at, that information. In fact, social scientists generally posit that information is necessary but not sufficient for behavior change. In other words, information doesn’t equal action. If it did, we’d all eat healthier, never smoke, exercise daily, and wash our hands every time we used the toilet.

Perhaps just as important as the actual information is how that information is presented. The U.S. Department of Health and Human Services (HHS) believes the communication aspect is so important that it has developed a National Action Plan to improve health literacy. This plan borrows from multiple disciplines including education, communication, and design. These evidence-based approaches include the following:

User-Centered Design — Develop and test the communication with the intended audience. Design for the end users, not for the scientists.

Universal Precautions Approach — Assume health illiteracy is a universal problem. Use clear, jargon-free language to communicate. Think heart attack, not myocardial infarction.

Message Targeting/Tailoring — Adapt the health communication for the specific characteristics of the intended audience. For example, the formerly yawn-inducing and greatly ignored airplane safety briefing has become this. Over 11 million YouTube views. For a safety briefing!

We have a long way to go before we become a health literate society. True health literacy will require fundamental changes in the way organizations create, design, and disseminate health information to the public. Change will be difficult, but not changing how health information is delivered will continue to cost Americans their very health and well-being. To borrow from a popular bumper sticker, “If you think education is expensive, try ignorance.”

About the author

silver

Silver Lumsdaine will graduate from the University of Michigan School of Public Health with an MPH in Health Behavior & Health Education and an MS in Nutritional Sciences in 2015. She is a proponent of using plain language and narrative in health communications. Silver believes in the power of a great story. When she’s not diving into the latest nutrition research, Silver can be found blissfully meandering along some dirt trail listening to her favorite PRX podcasts, This American Life and 99% Invisible, doting on her two nephews, and creating t-shirts with nerdy captions involving bimodal distribution. She is a Peet’s coffee devotee and smoothie fanatic who cheerfully adds kale in places it probably doesn’t belong. Kale cookie anyone?

Connect with Silver on LinkedIn, even if you don’t like kale. She swears she won’t hold it against you.

Read all posts by Silver here.

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