To all:

I agree health literacy is about communication but I also believe  
interpretation (the processing of information) is  necessary.  One  
cannot understand the information if one cannot communicate it or  
process what is being said. The biggest issue regarding health and  
social systems is that individuals and organizations believe they are  
communicating when actually they are not. The problem is the  
assumption of information being presented will be interpreted a  
particular way to one group or individual while to another group or  
individual it may be interpreted differently. One has to remember the  
visual, verbal and kinetic learner in the way one communicates  
information.  Also, cultural beliefs and values often dictates how  
one interprets.  In more homogeneous societies it is easier to  
communicate information while in  heterogeneous societies it becomes  
more complicated.   This is why one has to look at the population  
groups one is serving and gear health literacy to that group or  
individual.

I do agree with Janet, that we have totally gone over the top with  
health care forms in order to protect ourselves.  Do you think a  
individual can process or understand information if we give them more  
forms, ask more of the same questions, show them more pictures?   At  
what point do individuals become saturated and are on  overload by  
this,  resulting in individuals stopping to listen and a negative  
outcome?  Sometimes less is more.

Navigating the health care system is extremely difficult.  Technology  
was suppose to make it easier but I disagree.  Look at yourself when  
you have a problem and have to make a telephone call.  First you have  
to listen to the long winded message, wait to see what number  to  
press, gosh  missed the correct number start all over again, finally  
push 2, then get another message, finally get someone on the  
telephone and get disconnected.   I think we all feel this.  In  
health care systems we have become overly sophisticated in the way we  
communicate ideas, thoughts etc., that sometimes the message is missed.

I remember when Powerpoint came out.  I did my lectures on  
Powerpoint.  Had a few pictures, lots of words etc.  I thought I was  
being so progressive while I was boring my students to tears.  How  
many individuals have taken continuing education, seminar courses and  
this has happened?

So when one thinks of making the health care system better it is  
important to remember simplicity is better and involve all in the  
process of change.


Christine Matis, RDH, MPA
Farmingdale State University of New York



On Dec 4, 2008, at 11:00 AM, Janet Sorensen wrote:


> I'd like to forward this, as well as Ms. Rudd's last comment, to  

> our clinical quality improvement staff here at AFMC.

>

> I've said this before, and may have irritated some folks, but I'm  

> saying it again.

>

> Our health care system has a lot going for it, and a lot of room  

> for improvement. It needs to be more user-friendly. Fewer forms to  

> fill out, more plain language on paper and in person, better  

> communication internally and between providers and health care  

> settings. Maybe some of these things don't fall under "health  

> literacy." I'm still trying to wrap my little brain around the full  

> definition. But it is all communication.

>

> We need to listen to the people who have to use our health care  

> system. They often know better than professionals what needs to be  

> changed. But for so long, the focus of health care communication  

> has been professionals teaching patients. Instead of just teaching  

> patients how to "navigate the system," we also need to learn from  

> patients and the public, and change the system. It isn't going to  

> change on its own. It will take pressure from many different  

> directions.

>

> Janet Sorensen, Writer

> Arkansas Foundation for Medical Care

>

> From: healthliteracy-bounces at nifl.gov [mailto:healthliteracy- 

> bounces at nifl.gov] On Behalf Of William Smith

> Sent: Thursday, December 04, 2008 6:06 AM

> To: healthliteracy at nifl.gov

> Subject: [HealthLiteracy 2551] Re: WednesdayQuestion: Lookingfor  

> CompellingHealth Literacy Facts

>

> Having been on the IOM committee with Rima I want to emphasis the  

> importance of this finding from the report.  Health literacy is not  

> a function of an individual in our minds - but of individuals,  

> organizations, and communities.  I wish many times now that we had  

> found a way to put that in the definition and not in an explanatory  

> note.

>

> The definition as it stands, as all of you know is:

>

> Health literacy is the degree to which individuals have the  

> capacity to obtain,process, and understand health information and  

> services needed to make appropriate health decisions.

>

> It is just as important to ask-  Do I work in a health literate  

> organization?    Is my community health literate?  Is my program  

> health literate?  Rima and I, at least the two of us perhaps  

> others, have been working on measurement tools to measure an  

> organization/community's health literacy. Despite the rhetoric we  

> continue to rely on measurements that focus only on the individual.

>

> In the definition we used the word "individuals"  and everyone  

> interprets that to be patients.  Again we failed to clarify that a  

> physician is an individual. Nurses, pharmacists, family members,  

> pharmaceutical executives are also "individuals" who require "the  

> capacity to obtain, process, and understand basic health  

> information....."  A physician who does not have the capacity to  

> illicit useful information from a patient, to understand what  

> impact information he gives a patient will have on that patient's  

> compliance, is not health literate.  This is equally true for those  

> us working in prevention - we too are individuals who require the  

> capacity to obtain, process and understand health information about  

> our audiences if we are ever to have a health literate America.

>

> There is a second aspect of the definition which is often  

> overlooked.  It is the word "services".  Too much of our energy is  

> going into making written materials clear and in  training  

> disadvantaged groups to understand the stupid things we tell them.   

> The services word places emphasis not on what we say, but on what  

> we do to help people make appropriate health decisions.  I would  

> love to see a marketing study of the service aspect of health  

> literacy as well as the information aspect.

>

> We should have done a better job of making this clear in the  

> definition itself.  For me today, after speaking to dozens of  

> groups, health literacy is the:

>

> "capacity of individuals, organizations and communities to obtain,  

> process, understand and share basic health information and services  

> needed to make appropriate health decisions. "

>

> Discussion of photonovels is interesting, but the real pay-off is  

> the re-structuring of our health care system so people can protect  

> themselves from disease and it consequences.

>

>

> Wm. Smith

> Executive Vice President

> Academy for Educational Development

> 1825 Connecticut Ave., NW

> Washington, D.C. 20009

>

> Organize policy until self-interest

> does what justice requires.

> Phone: 202-884-8750

> Fax: 202-884-8752

> e-mail: bsmith at aed.org

>

> >>> "Rima Rudd" <RRUDD at hsph.harvard.edu> 12/3/2008 3:59 PM >>>

> Hello...

> I will certainly think of my 'favorite' fact but I cannot resist  

> commenting on the one just posted.

>

> It is not correct to state that people cannot do any of the tasks  

> noted. A more appropriate way to say this is "people below level X  

> have difficulty completing this task with accuracy and consistency" .

>

> What is missing from this insight [and it is valuable measure and  

> an important insight] is the critical finding from over 800  

> published studies that health materials are generally poorly  

> written and designed.

>

> so... this does lead to my favorite assertion taken from the IOM  

> report:

>

> Health literacy is a shared function of social and individual  

> factors. page 4

> or

> Health literacy is a shared function of cultural, social, and  

> individual factors. Both the causes and the remedies for limited  

> health literacy rest with our cultural and social framework, the  

> health and education system that serve it, and the interactions  

> between these factors. page 32

>

>

> in addition:

> The cost research is not firmly established nor uniformly accepted.  

> It is not possible, for example, to differentiate between costs due  

> to medical errors [errors made by professionals] and costs due to  

> literacy related errors [errors made by patients]. I am very  

> disquieted by the assumption that costs are due to patient error or  

> to patient deficits.

>

> Rima

>

> Rima E. Rudd, ScD, MSPH

> Department of Society, Human Development & Health

> Harvard School of Public Health

> 677 Huntington Avenue

> Boston MA 02115

> Phone: 617 432 1135

> fax:     617 432 3123

> web:    www.hsph.harvard.edu/healthliteracy

> www.hsph.harvard.edu/sisterstogether

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