Health Literacy – Your A, B, Cs to Staying Healthy

 

Patient Health Literacy & Education:

Is this ad believable? It is a satiric ad from a 1950’s British magazine. Almost everyone would laugh-out-loud (or ‘LOL’ if you are text messaging) at such an absurd message today but unsubstantiated health claims and promises are made every day in newspaper, journals, and in particular, on the Web.

Are we in a position to be able to agree or disagree with medical or health claims that are made? Usually not.

I recently had a conversation with a well-educated, young business professional. She stated that it was probably time for her to use those popular whitening strips on her teeth – again. When I advised that frequent usage of such whitening strips could damage the enamel on her teeth, I received a rather surprising answer that may be a sign of the times – “If I have to choose between health and beauty, I choose beauty.” I was speechless and people who know me only wish it could happen more often (LOL).

If this occurred with a highly educated person what actually happens with Canadians who do not have the literacy skills needed to respond to their daily health information demands? The situation has been described in Living Literacy, as  being “critical.” Senior citizens are even more disadvantaged as 88% cannot cope on their own with modern health care information demands, as  reported  by Canadian Public Health Agency (2008).

This prompts the need to address the shortfall in health literacy education and make provision for effective, health information delivery, which is available in a  simplified, patient-friendly, visual manner. Health literacy education must be  universally accessible. Access can also be made convenient via online hosting.  Delivery of content should also favour the biases of learners. as 2 out of 3 Canadians   are visual learners, irrespective of their level of education, language,  background or comprehension skills; the majority will benefit from an approach  that is visual, animated and simplified – to address their understanding of  important health, medical and illness-related issues.

 Need for Health Information Made Simple:

A plethora of textual resources predominate the internet but few resources focus on the appropriate levels of understanding of the vast majority of patients or the general public. Research has shown that providing information below a “Grade 8 level” is  essential to reach the majority of patients and individuals. Few web sites focus on the preferred learning styles, or formats of preferred learning, of most learners. Most sites disregard the predilection for visual learning.

Educational research strongly supports provision of health information that is presented in a simplified manner and based on the individual’s visual learning preference to address the challenges of patients in need of education or information critical to their health or disease.

Understanding Low Literacy in Canada

In 2003, 23,000 adult Canadians participated in an international literacy survey led by Statistics Canada. Almost half of Canadians are either poor readers, or narrow readers.  The results showed:

Adults in Levels 1 and 2—42 percent of those surveyed—have low literacy skills. This means their ability to respond to various types of written information they may encounter in life is compromised. The combination of low literacy and a lack of health literacy can be dangerous—even deadly. By providing clear, reliable information to the public, health professionals and governments are helping citizens and patients to manage their health, understand treatment protocols, decide on surgical or severe therapeutic interventions, as well as safeguard their children’s health and avoid catastrophe (by taking the wrong prescription dose, for example).

Canadian Public Health Agency research indicates that 42% of Canadian patients fail to understand their medical prescription information. More so, many patients are not able to comprehend the textual complexity of the science of their disease and fail to or erroneously interpret clinical or health information related to disease complications. Many misinterpret how to implement important lifestyle interventions or choose from different management, treatment, chemotherapeutic, or surgical options.

It is often patients that drive the types of care they seek, since they are frequently required to make informed choices about the options presented to them by medical professionals. This highlights the need for easy access to reliable, simple-to-understand formats of learning and information.

Visual Learning Support, Animations and Health Literacy:

Animations and visual learning have been proven to transcend and overcome many challenges in health literacy. They have an additional auditory learning component. This further enhances the learner’s understanding, retention of knowledge and facilitates patients’ taking charge of their disease issues and decisions.

Visual learning, made up of diagrams, illustrations, videos, and animations that deliver important information in formats most patients can comprehend is advocated in this proposal. Visuals have proven to be a valuable asset in building patient-physician communications, enhancing patient education, and improving the informed consent process because patients are better able to grasp the implications of their condition, its prognosis, and treatment options. Visuals can increase patient satisfaction and treatment compliance, while helping to reduce the amount of time a physician needs to spend explaining complex areas of disease and treatment.

Effective visual tools can range from options as simple as a diagram of the musculoskeletal system such as trauma sustained in the lower leg describing various types of bone fractures to a video of the vascular system that demonstrates how balloon angioplasty will treat arteriosclerosis and improve blood flow.

Physicians are cognizant of the health education utility of visual aids. Physicians have long relied on visual aids — such as posters, charts, and plastic models — in their counseling sessions with patients.

Tools and Technology:

Therefore, creating an online initiative may be considered a strategically essential approach to capitalize on the very latest visual learning tools and technology to address health literacy concerns. This latest generation of health support information is designed for the low-level reader (“poor to narrow reader”). The illustrations, animations, video, and sound narrations are simple, yet complete, and can visually explain a disease or treatment for a patient’s specific situation and also avoiding complexity.

When patient education is delivered through a computer-based system, there is an additional opportunity for delivering interactive and engaging patient education tools. Programmable technologies allow for the monitoring of patient knowledge translation and online learner assessment. Tracking via computerized metrics, and learner utilization skills are evaluated, respecting privacy laws and governance in Canada.

Example – Animation Cae 1:

A video incorporating animations may be used by a physician treating an elderly patient recovering from surgery who is at risk for a pulmonary embolism. Because the physician is concerned that small blood clots may develop and cause a stroke or myocardial occlusion, a decision is made to place a small filter in the vena cava to capture fragmented tissue or activator plaque debris. Hearing the information from the physician, the patient, becomes confused about this intravascular procedure. Using a computer screen, the physician brings up a video and animation of the circulatory system. With a few simple video and animation segments, the physician demonstrates what might happen if a small blood clot enters the circulatory system. He then shows the patient x-ray images of the affected blood vessels and using a catheter, how a tiny filter to block any blood clots from entering important organ systems will have preventative benefits.

Example – Animation Case 2:

A mother has brought her 18-month-old son into the physician’s office multiple times because of ear infections. The physician has determined that the boy should have tubes placed in his ears to ensure that his language skills develop appropriately. The mother has a poor understanding about otitis media and is concerned about the upcoming surgical procedure.

Using a simple otitis media animation on a computer, the physician shows the mother a picture of the anatomy of an ear infection. Two illustrations point out the effects that the infections will have on the child.  This is not only related to pain and fever, but also interference with hearing, which is vital to the development of speech. The animation describes a third picture to demonstrate where the tubes will be inserted, how they will alleviate the problem, and a fourth picture to explain what the mother must do to care for the tubes. Not only do these four illustrations provide the mother with understandable information and assuage her concerns, she is able to access the animation at home, and the physician can print out pages for the mother to take home (with the physician’s notes) to show the child’s father and other worried relatives.

Visual tools like these overcome virtually any literacy problems a patient may display. Not only do they make complex topics easy to understand when first explained, they also help patients retain the information. A Range of Resources Web sites and patient portals can provide an effective short-term solution to providing visually delivered, easily understood health information to the public and patient population.

Regardless of literacy levels, many patients are highly motivated to learn as much as they can about their condition and the services offered by their healthcare providers. Even though seeking information on healthcare web sites and visiting a physician are relatively distinct and separate experiences for a patient, recent technology advances are capable of helping to integrate the clinical encounter with the health information available online. For example, physicians might refer a patient to a web site that will help prepare the patient for a scheduled surgery or test.

Healthcare professionals can “prescribe” visual health information and education for online learning. This would not only provide a documented record that information was recommended to the patient, but would also capture data regarding which information was actually viewed by the patient.

Your thoughts or comments would be appreciated on how to improve health literacy in both patients and the general public. If your organization requires additional support to any of your services for improving health literacy in Canada, the U.S. or elsewhere, please contact Marenon Consulting (info@marenon.com).

Adapted with permission from Mechanisms in Medicine and Marenon Consulting (2011)