Bridging the Health Literacy Gap

In his book The Checklist Manifesto, Dr. Atul Gawande argues that people, even experts, often skip basic, critical steps that can determine success or failure in a project or task. He proposes that people use checklists to increase the accuracy and consistency of their performance.  Checklists draw our attention to all the elements in a process, not just a selective few that we remember or feel most comfortable doing.  

Last week’s health literacy workshop at the National Conference on Health Communication, Marketing and Media illustrated how often we overlook basic, critical steps in public health communication. Workshop participants used a health literacy checklist to evaluate 2 public health materials. Although the checklist had almost 3 dozen items, the first 2 items – audience and purpose – took up the majority of the discussion period in the exercise.

Participants identified multiple audiences and purposes for each piece. Without a clearly defined audience and purpose, it was difficult, and in some cases, meaningless to go through the rest of the checklist. For example, you can’t decide if a material is filled with jargon if you don’t have a clearly defined audience. Jargon for one audience might be everyday language for another.  Or, you can’t determine if you’ve included the correct health behaviors if you don’t know audience and purpose.

If you want to try a full checklist, see CDC’s plain language manual, Simply Put, Appendix A . Whether you use a checklist or not, try using these 2 questions when you plan, review or revise your next health material.

1)      Who is the primary audience?

2)      What is the primary purpose of this material?

Do you agree these are the 2 most important questions? Can you think of other, equally important questions that have made a difference in your materials?

This week marks the Sixth National Conference on Health Communication, Marketing and Media in Atlanta, Georgia. Each August, health communicators, educators, social marketers, media specialists, and other public health professionals discuss the state of the science in communicating about health.  

Once again, the conference includes a 3.5 hour workshop on health literacy as part of a social marketing strategy. Health literacy and social marketing approaches put the end user or “customer” at the center of exchange and focus on creating useable products and services.

Although social marketers will tell you information is not a product, information is a critical component of how people make decisions that can affect their use of products and services.  When we design information that reduces the demand to understand information about symptoms, for example, we can positively affect people’s use of medicines and visits to healthcare providers.

In addition to the workshop, a breakout session includes four presentations on health literacy. One previews a new tool for CDC staff to evaluate health messages and materials. Another reports findings of a content analysis and consumer interviews on public messages about H1N1 pandemic influenza. A third presentation describes changes to CDC’s immunization campaigns based on parents’ feedback. The fourth presentation describes how a manual for health professionals was revised using plain language. 

For the first time, parts of the conference will be streamed live. You can watch the plenary sessions and a limited number of special and breakout sessions. To register, visit  https://cdc.6connex.com/portal/2012NCHCMM/login

How do we know that focusing on health literacy makes a difference?  The passing of Len Doak, co-author of the classic text Teaching Patients with Low Literacy Skills, places this question in a personal context. The question is also relevant for health research, evaluation and policy. Policymakers, managers, project funders, and professional and administrative staff want to know if paying attention to health literacy makes a difference.

Len and Ceci Doak and Jane Root wrote the book on health literacy practice in clinical settings. They were tireless advocates and made a difference by explaining health literacy and engaging others in the work.  The large number of people drawn into health literacy because of their book and gracious mentorship is one type of difference.

But, decisionmakers typically want evidence of a different kind. They want measurable outcomes aligned with organizational or policy requirements to know if a change or intervention is worthwhile.  Quality, cost and access are typical healthcare outcomes of interest. The two systematic reviews of evidence along with many single studies suggest that limited health literacy decreases healthcare quality and access and increases costs.

Defining outcomes for health literacy practice in public health is equally important. If we aim to reduce illness and death on a large scale, how can attention to health literacy help us get better public health outcomes? 

For example, many different organizations provide health information to the public. Sometimes they use highly visible mass media campaigns directed at millions of people; other times they may use a web site and targeted promotion to a very specific audience.

The outcomes for mass media campaigns might include reach (did we reach the audiences we intended to reach?), recall (does the audience recall seeing our messages and do they recall specific messages?), and attitude change (did our messages change their attitudes?). Web site metrics might include most popular features, time spent on pages and number of downloads of site products.  How might these outcomes help us learn about health literacy?   

As we think about the many types of public health work that could benefit from health literacy insights, we should also think about the outcomes we want. Please share your ideas about outcomes you already address and outcomes you’d like to address from a health literacy perspective.