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Article Excerpt
With the recognized need to increase health literacy, some practices have not worked and, therefore, "should be dumped." Herein we present alternative approaches that may increase health literacy.
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Is this the beginning ... or is this the end?
According to the U.S. Department of Health and Human Services, low health literacy is associated with poor health, higher hospitalization rates, less use of preventive medicine, and higher health care costs (U.S. Department of Health and Human Services 2009b). Unfortunately, the National Assessment of Adult Literacy suggests that only 12% of U.S. adults have "proficient" health literacy. This low level of literacy indicates that health care professionals need to break away from traditional communication methods that are based on the assumption that consumers are actively and rationally processing information and will fully integrate that information in their future decisions.
The pragmatic directive is to move beyond documenting consumer frailties, and turn to theory-based research designed to create health care systems which maximize consumer health literacy. This agenda must incorporate the communicators (the health care professionals, the insurance providers, the lawyers' requirements, the government regulators, the Courts, the bench scientists), the receivers of information, and the context in which the information is generated.
To this end, we present observations that use common life experiences as the framework for progress. Perhaps, we erroneously assume that most readers have experience with the romantic break-up, but we will forgo some of our own advice, reasoning that most of us have at least second-hand experience with these cliches. Undoubtedly, cliches become cliches because of the underlying element of truth. These common tales of break-up in life and popular culture provide a basis to explain the value of a new approach.
"IT'S NOT YOU; IT'S ME"
Plain language is proposed as one important tool for increasing health literacy. Plain language documents are designed so that "people can find what they need, understand what they find and act appropriately on that understanding" (U.S. Department of Health and Human Services 2009b). Yet, this basic tenant of health care communication is often ignored. Indeed, we suggest that much of the low health literacy rate can be attributed more to the communicator than to the consumer.
The U.S. government website on "Preparing for Pandemic Influenza" (U.S. Department of Health and Human Services 2009a) presents an overwhelming amount of information. If the consumer is persistent and links to "Health and Safety," (the seventh item on the left side of the homepage screen), s/he will see a series of links--one being "families." This consumer will learn that s/he should do the following:
1) Develop preparedness plans as you would for other public health emergencies.
2) Participate and promote public health efforts in your state and community.
3) Talk with your local public health officials and health care providers; they can supply information about the signs and symptoms of a specific disease outbreak ...
7) Practice good health habits, including eating a balanced diet, exercising daily, and getting sufficient rest and take these commonsense steps to stop the spread of germs.
a. Wash hands frequently with soap and water.
b. Cover coughs and sneezes with tissues.
McCormack and her colleagues (2009) propose that understanding one's insurance plan is an important component of health literacy. They find that overall understanding of the insurance terminology and Medicaid proficiency is low to moderate among older adults. Given the methods used to communicate insurance information, it is difficult to expect otherwise. Let's look at an example from West Virginia Public Employees Insurance Agency (PEIA). The first page of PEIA's 37-page Shopper's Guide includes a five-paragraph disclaimer that ends with "We have tried to ensure that the information in this booklet is accurate. If, however, a conflict arises between this Guide and any formal plan documents, laws, or rules governing the plans, the latter will necessarily control" (West Virginia Public Employees Insurance Agency, 2). This is followed by a 7 by 62 cell matrix entitled "Benefits at a Glance" comparing the different available plans.
In a good-faith effort to be comprehensive, both of these "communications" are likely to fail to communicate because of simple information overload effects. Consumers have difficulty encoding and using information when too much information is densely presented. This is a widely known problem, well documented over several decades, but which health care communicators tend to ignore. Fortunately, some not-for-profits and governmental units are improving. In 1999, the Food and Drug Administration changed the labeling format for over-the-counter drugs from block paragraphs to a standardized format incorporating section headings and easy to understand language (21 CFR 201.66 et al). Industry has also begun to respond. Consider, for instance the relatively recent changes in the "brief summary" used in direct-to-consumer pharmaceutical advertising. These summaries, intended to provide consumers with important risk information, were originally indistinguishable from the physician labeling sporting technical language in small print and unbroken columns. Now, many sponsors offer a more consumer-friendly format using layman's terms and white space.
What can be done when consumers must deal with considerable information in making a choice, such as when selecting an employer-based insurance plan from one of multiple options? Basic research is needed...
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