Opportunities and Challenges

Communicating Health: Priorities and Strategies for Progress describes action plans for each of the six health communication objectives.² Health communication, however, involves all disease prevention and health promotion topics, every sector of the population, and rapidly changing technology and information. The challenges to making progress are numerous.

Internet access (11-1) is rapidly migrating from dial-up to broadband Internet service because of the greater range of functionality and download speeds.¹ Many online applications are not accessible or do not work well over dial-up connections.¹ Home-based access to computers and the Internet may be less important for some populations that choose other technologies such as cell phones to communicate and access content.¹² The objective will need to be considered in light of these technical changes to ensure that the data capture not only where but how people use technologies to access health information.

The release of two reports on health literacy has generated additional interest in health literacy improvement (11-2).^{13, 14} Several new initiatives address the issues raised in these reports. The Institute of Medicine (IOM) has secured sponsors for a roundtable to convene stakeholders in health literacy improvement.¹⁵ The roundtable will identify ways to move forward the agenda from the IOM report.¹³

The National Quality Forum and the Joint Commission on Accreditation of Healthcare Organizations have both initiated projects on patient safety and health literacy improvement.^{16, 17} Recognizing the need to strengthen the health literacy literature, the National Institutes of Health and the Agency for Healthcare Research and Quality (AHRQ) have sponsored a program announcement to foster more research.¹⁸

One of the main barriers to action is a lack of awareness about health literacy issues among policymakers and organizational leadership.² Even when awareness exists, more than the commitment of senior management is necessary to create changes in organizational and professional practices that would reduce health literacy barriers. These sectors include, but are not limited to, Federal and State government agencies, health care facilities, health care professional societies, insurers, and the mass media.² Opportunities exist to train health care providers, develop professional curricula, influence clinical policy development, and partner with health care professional societies to address health literacy.

Increasing research and evaluation of health communication activities (11-3) is a challenge.² The action plan for the objective identifies the following main factors affecting the amount of health communication research and evaluation.² In the Federal context, programs must secure clearance to conduct research and evaluation. In general, expectations of what communication research can accomplish can be unrealistic, and distinguishing the contribution of communication to the project outcomes can be difficult. Programs may not use appropriate research models or have personnel with training who can conduct communication research and evaluation. Finally, when resources are scarce, producing messages and materials may be prioritized over conducting research and evaluation.

The action plan for the disclosure of elements to assess health websites (11-4) is intended to provide a foundation for future efforts to assess quality more directly.² In the absence of consensus in the field about quality metrics and assessment tools, the measurement of the objective will proceed with the six criteria in the Healthy People 2010 publication. The criteria are the presence or absence of the following: the identity of website sponsors or developers, the purpose of the site, content development practices, privacy policies, evaluation and feedback mechanisms, and content updates. The quality of health information on the Internet will remain a high-priority issue as the Internet becomes an increasingly common information channel.¹⁹

Several strategies have been proposed to increase the number of Centers of Excellence in Health Communication (11-5), and these strategies are summarized in the action plan for the objective.² Through two of its agencies, HHS has supported three new centers since 2004: AHRQ—Clinical Decisions and Communications Science Center, Oregon Health & Science University,²⁰ and the Centers for Disease Control and Prevention—Southern Center on Communication, Health and Poverty, University of Georgia, and the Center of Excellence for Health Communication and Marketing, University of Connecticut.²¹ The Indian Health Service within HHS is considering how to support future centers. The opportunities lie in stakeholder collaboration to create and promote other centers by systematizing data collection and reporting on center operations, developing infrastructure—human and physical—to support center operations, publishing articles on center activities, training more health communication professionals, and recognizing publicly the contributions that centers make to the field.²

The objective on patients' satisfaction with health care providers' communication skills (11-6) would benefit from more precise metrics and a focus on the training and licensing of all types of health care providers.² Many current initiatives focus primarily or exclusively on physicians, who are only one type of provider. Some of the action steps in the objective's action plan include expanding assessments of other types of providers, including nurses, dentists, hygienists, pharmacists, and therapists; developing closer connections between cultural competence and clinical communication initiatives; and focusing assessment efforts on the quality of patient-provider interactions.²

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