Category: We Heart Health Literacy

Here at We ❤️ Health Literacy HQ, we’ve been hearing the term “endemic” a lot lately. (As in, “Is COVID endemic yet?”) We’ve also noticed that, like with so many things COVID, many people are confused about the term. And for good reason! People often misuse it, and it’s easy to mix it up with “epidemic.” Plus, “endemic” starts with the word “end” — which makes it sound like a pretty good thing right about now.

As health communicators, we can help by clearly explaining what “endemic” means — and doesn’t mean — to our audiences. Let’s start with the gist: A disease is endemic if people in a particular area continue to get it — that is, it never completely goes away — but it’s predictable. In other words, a relatively steady number of people in a specific place get the disease, and experts have a pretty good idea how it will play out.

Think of the flu. Most flu strains are endemic in most places, meaning they never go away entirely, but we can be pretty sure when cases will rise (you know, flu season) and then fall again. The flu example is also a good way to demonstrate what “endemic” doesn’t mean — specifically, that it does not mean harmless. The flu causes tens of thousands of deaths a year, making it a serious public health issue.

It can also be helpful to explain that it’s still possible to have an outbreak, epidemic, or pandemic of an endemic disease. Once COVID becomes endemic, this could happen if, say, a new variant emerges and current vaccines don’t offer enough immunity. (Remember the H1N1 flu pandemic of 2009?)

So when will COVID become endemic, you ask? Unfortunately, dear readers, no one knows. We’re not there yet because experts aren’t able to accurately predict what will happen next, mostly due to the possibility of new variants. It’s also good to keep in mind that the “when” will probably vary from place to place. And while some people might find this uncertainty frustrating, the good news is that we do know how to protect ourselves — like with vaccines, masks, and testing.

The bottom line: Experts believe COVID will become endemic. So let’s help people understand what that does — and doesn’t — mean.

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Tweet about it: Everyone’s throwing around the term “endemic” lately! Let’s make sure people understand what it does — and doesn’t — mean, says @CommunicateHlth: https://bit.ly/3uYkVYV #HealthLit

This week, we’re bringing you something a little different. CH President Stacy Robison wrote an article that was translated and published in a plain language bulletin from the Swedish Institute for Language and Folklore called Klarspråk. Since we assume many of you, our dearest readers, do not read Swedish, we wanted to give you an opportunity to check out Stacy’s thoughts here. What follows is a slightly edited English version of the article. Enjoy!

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One of the tenets of plain language is to write conversationally. When we write how we talk, we’re more likely to use familiar words and active voice. But there’s another reason to write as if we’re having a conversation, one that’s just as important to the success of our communications: connection.

To create meaningful communications — whether they’re campaigns, websites, or social media messages — we need to understand and care about our audience. In other words, we need to empathize with people.

This is especially important in health communication. In the United States, when we talk about health literacy, we often cite the statistic that 90 percent of adults struggle with complex health information. While this is correct, it frames the “problem” as an individual deficit. If we’re approaching this from a place of empathy, then we might reconsider — if the “problem” affects 90 percent of people, maybe it’s not them… Maybe it’s us!

In health care, studies show that empathy can improve patients’ emotional health, symptoms, and physiologic responses and increase medication adherence. This link between empathy and adherence is particularly fascinating. Another way to look at it is: feeling seen and heard makes people more likely to listen to and follow a recommended course of action. Why? Because empathy builds trust. And because negative emotions like fear and shame can make us feel invisible and get in the way of clear thinking and informed decision-making.

So what does this mean for our writing? One of the primary ways we express empathy is through language. Choosing familiar words, acknowledging emotion, and using inclusive language can go a long way toward building trust. After all, we’re not writing into a void. There are people on the other side of our words! Rather than talking down to them, let’s meet them where they are, use their language, and put ourselves in their shoes.

When we reject the stereotype of the noncompliant patient, when we refuse to stigmatize, or when we simply change a pronoun in our writing — we send a powerful message to our readers. A message more powerful than the most compelling statistics or the flashiest marketing campaigns. The message is: I see you.

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Tweet about it: This week, @CommunicateHlth is bringing you thoughts on the importance of #empathy in #HealthComm from President Stacy Robison: https://bit.ly/3wTgNMc #HealthLit

Here at We ❤️ Health Literacy HQ, we’re big fans of Sesame Street — which has been serving up clear, actionable educational messaging for longer than many of us have been, well, doing anything at all! Today we’re digging a little deeper into the world of one Muppet in particular. One who loves to talk about himself in the third person. He’s also been known to sing with famous people and to pop up on the occasional late-night talk show. (He’s very popular.) That’s right, we’re talking about the fan-favorite, furry friend-to-all Elmo.

Elmo has done all sorts of things to bring about learning and laughing since he first showed up on Sesame Street in 1984. And with Elmo’s World, his Sesame Street segment for toddlers, he helps prepare our littlest learners for the real world by exploring topics like how to brush your teeth or ride a bike. But we think the best part of Elmo’s World isn’t what he’s teaching kids but rather how he’s teaching them. You see, Elmo is a pro at teaching kids to navigate new and unfamiliar topics — in other words, how to learn in the first place.

And this brings us to the fact that Elmo’s approach to teaching his audience about a topic that’s unfamiliar to them holds some valuable lessons for health communicators. So the next time you’re writing about a tricky or in-the-weeds health topic, take a little trip to Elmo’s World to leverage his tips for helping your audience learn something new.

• Answer common questions. Elmo likes to encourage his viewers to pause and talk it out when they’re confused or not sure about something. We couldn’t agree more, which is why we often use a Q&A format to structure our health content. Putting ourselves in people’s shoes by thinking through their potential questions is a powerful health comm strategy. Just be sure to use questions someone would actually ask (as opposed to forcing it for the sake of the format) and answer the questions you’ve raised right away.

• Offer credible sources to learn more. Elmo knows that kids might want to learn more than what he can teach in a few minutes, so he encourages them to find trusted sources that can provide more information. Chances are, you also won’t be able to cover every single fact about a complicated health topic in a single material. This is exactly why we’re so into the “bite, snack, meal” approach to writing — it helps us package our content into different “serving sizes” based on what we know about our audience.

• Encourage conversations and knowledge sharing. Elmo reminds kids that sharing what they learn can lead to meaningful conversations with people in their lives. Again, we agree! That’s some of the thinking behind tried-and-true communication strategies like the teach-back method, which can be super helpful for health communicators teaching information in real time.

• Celebrate the wins! As health communicators, we won’t always be around to help our audiences enjoy the triumph of learning something new. But we don’t think that should stop anyone (communicator and communicatee alike!) from celebrating health literacy wins. How? Well, Elmo is fond of a happy dance — and we’re not going to argue with Elmo.

The bottom line: Take a trip to Elmo’s World to find valuable lessons for helping your audiences learn something new.

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Tweet about it: .@CommunicateHlth invites you to visit Elmo’s World to discover valuable #HealthLit lessons for helping your audiences learn something new: https://bit.ly/3N1Pzso

Here at We ❤️ Health Literacy HQ, we love surprises — like a $20 bill surviving laundry day intact or the indoor trampoline you bought during the pandemic lockdown finally selling on eBay. But there’s one surprise that no one needs: surprise medical bills.

Picture this: You go to the emergency room (say, for the ankle you sprained while taking a tumble off that trampoline). You pay your copay and trust your insurance will take care of the rest — after all, the hospital is in your insurance plan’s network. But weeks later you get a jaw-dropping bill because your insurance didn’t fully cover the visit. The reason? While the hospital is in-network, the radiologist on shift who x-rayed your ankle is not. Unfair? We think so.

Fortunately, the Biden-Harris Administration seems to agree — because the No Surprises Act went into effect on January 1, 2022. The act bans surprise billing for emergency services and offers other consumer protections related to payment. In a nutshell, if you seek emergency care at an in-network facility — or if you call 911 and can’t choose who sends the rescue helicopter — you won’t be responsible for any out-of-network costs.

Now that’s fair, which is why we ❤️ the No Surprises Act so much. And as health literacy-focused health communicators, we’re not just fans — we’re also advocates. We know many people in our audiences have probably never heard of the act and wouldn’t know what to do if they got a surprise bill. And we want to help change that.

So, dear readers, we hope you’ll join us in shouting this fantastic update from the rooftops! Or if you’re not up for rooftop shouting (understandable), at least make sure to mention the new rules in content about insurance billing issues. You can let your audiences know where they can learn more about the No Surprises Act and how to get help disputing a surprise bill.

The bottom line: Surprise billing is the surprise no one needs. Thankfully, the No Surprises Act protects us from unexpected medical bills for emergency services — let’s make sure our audiences know that!

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Tweet about it: Surprise billing is the surprise no one needs. As #HealthLit advocates, it’s our job to help people learn about new rights under the No Surprises Act, says @CommunicateHlth: https://bit.ly/3J7VTMH #HealthComm

Here at We Heart Health Literacy HQ, we know nurses are the best. Throughout the pandemic, millions of dedicated nurses across the country have put their lives on the line, worked double shifts, and sacrificed time with their families to care for their patients. In turn, they’ve often been hailed as “superheroes” — they even got their very own Marvel comic! 

While we ❤️ that nurses are getting some of the recognition they always deserve, the superhero narrative can come at a cost. As health communicators, it’s our job to be super mindful of the implications of language. And while we certainly agree that nurses are superheroes, we think it’s worth pressing pause the next time you’re about to call them superheroes. Here’s why: 

• Calling nurses superheroes puts pressure on them to put on a brave face while facing the stress, anxiety, and burnout that comes with constantly risking your own health and safety at work. As one ER nurse writes, “the superhero cape feels more like a lead balloon for many.” Glossing over the fact that nurses, like the rest of us, are mere mortals can make it harder for them to ask for help and get the care they need for their own mental or physical health.   
• The superhero narrative can distract from the real systemic changes needed to address understaffing, unsafe working conditions, and stagnant wages. Nurses are quitting their jobs in record numbers, leaving some hospitals unable to function and putting even more strain on the nurses who stay. Almost 7 in 10 nurses say their experiences during the pandemic have caused them to consider leaving their profession. Sit with that one for a second, dear readers.  
• Focusing on nurses’ superpowers puts an undue burden on them — and not enough on the rest of us. After all, why go to the trouble of getting vaccinated, masking up, and practicing social distancing when a superhero in scrubs will swoop in and save us if we get sick?  We’re not saying that people are thinking of it quite that literally — but at a time when it’s so critical to acknowledge the “public” in public health guidance, we think this point is worth mentioning.  

Of course, it’s true that some nurses may love being called superheroes — everyone’s different. Either way, we encourage health communicators everywhere to consider the implications of the superhero narrative.    

The bottom line: Calling nurses “superheroes” has become par for the course during COVID. But it’s worth thinking about the less savory side of the superhero narrative.

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Tweet about it: Calling nurses “superheroes” has become par for the course during #COVID19. But it’s worth thinking about the less savory side of the superhero narrative, says @CommunicateHlth: https://bit.ly/3hCWLwQ #HealthLit 

Here at We ❤️ Health Literacy HQ, we like to say that communicating about sexual and reproductive health care takes extra, well… care. After all, many people don’t feel very comfortable discussing things like HIV and other STDs (STIs? STDs). And when we’re dealing with a sensitive topic, we know we need to be extra thoughtful about the words we use.  

Which brings us to this week’s post, in which we address a seemingly innocent but potentially very harmful word: “clean.” Maybe you’re thinking, wait a sec, clean is good! But here’s the thing: Context matters. And if your context is STDs, do everyone a favor and strip “clean” from your vocabulary.

Consider a couple examples:

• Get tested for HIV regularly so you know if you’re clean.
• If your chlamydia test comes back clean…

You can see how a health educator or communicator might get there. We often aim for a friendly, conversational tone — and “clean” is something people say in this context. But when you consider that it’s standing in for “STD-free,” the friendly part goes out the window. Because what’s the opposite of clean? That’s right, “dirty.” And we certainly don’t want to imply that someone with an STD — which, by the way, is 1 in 5 of us! — is dirty.

People who have STDs may already be dealing with feelings of shame and isolation. As health communicators, it’s our job to make sure the words we choose don’t perpetuate those feelings or contribute to damaging stigma. We think dropping “clean” once and for all is something we can all agree on.

So going back to the examples above, skip “clean” and aim for a stigma-free approach:

• Get tested regularly so you know your HIV status — and you can get the care you need if you’re HIV-positive.
• If your test result shows that you don’t have chlamydia…

The bottom line: Using “clean” to mean “STD-free” helps perpetuate damaging stigma. So skip the judgment and use objective words to say what you mean.  

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Tweet about it: Using “clean” to mean “STD-free” helps perpetuate damaging stigma. So leave it out of your STD-related #HealthComm vocabulary, says @CommunicateHlth: https://bit.ly/3550mk6 #HealthLit

Picture this, dear readers: Your team has just started a new project — let’s say you’re developing content for an app to help people with HIV manage their care. As your team is doing some initial content strategizing, you keep talking about the sheer number of jargon terms that are relevant to this particular topic (think “viral load” and “pre-exposure prophylaxis”). How will readers possibly keep track of all these terms?!

That’s when it hits you: the million-dollar idea. You’ll create a custom glossary with all the potentially unfamiliar or confusing terms, and your audience can refer to it whenever they get tripped up. It’s a win for everyone! Users have all the jargon terms clearly laid out in 1 place, and you don’t have to use all your content real estate explaining — and potentially reexplaining — tricky terms.

Problem solved, right? Well, maybe not. While the concept of a glossary to help with jargon terms in plain language content makes a lot of sense at face value, there’s a catch: Glossaries can be a real problem for users with limited literacy skills. That’s because glossaries require cross-referencing. So in a typical glossary experience, the user would:

1. Come across a word they don’t know
2. Stop reading and navigate to the glossary in question, whether it’s on the page they’re reading or it’s a hover situation
3. Locate the definition in the glossary (sometimes easier said than done!)
4. Take their new word knowledge back to the content they were reading
5. Resume reading

Now this might work okay for some people, but that kind of cross-referencing is quite taxing from a cognitive load perspective — it asks a lot of folks’ working memory. And that’s a big part of why people with limited literacy skills are more likely to get distracted, reread words or phrases, and lose their place when they read. Now with that context in mind, consider the “workflow” of using a glossary. Yeah.

Instead, we say stick to the tools that are already in your plain language and health literacy best practice toolbox — using plain language alternatives when appropriate, defining jargon terms in context, and teaching the terms that folks are likely to run into again. In our hypothetical app situation, you might also consider defining terms — for example, “the amount of HIV in your body (called viral load)” — in multiple places across your content. That way, users are seeing key terms with their definitions throughout the app, which can really help reinforce learning.

To be clear, we’re not saying glossaries are all bad. They can be a great tool to help writers find plain language substitutes. And you might run into a situation where a brief list of key terms could make sense for consumers. Just don’t rely on a glossary alone to get the job done — make sure you still use all those plain language best practices we know and ❤️ !

The bottom line: Using glossaries means cross-referencing, which can be tricky for people with limited literacy skills. So skip the glossary in your health materials — and stick with tried-and-true plain language best practices instead. 

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Tweet about it: Using glossaries means cross-referencing, which can be tricky for people with limited literacy skills. Instead, @CommunicateHlth recommends sticking with tried-and-true #PlainLanguage best practices in your #HealthLit materials: https://bit.ly/3oH2TI9

Here at We ❤️  Health Literacy HQ, we’re feeling pretty enthusiastic about telehealth. It’s a great option for getting routine health care without anxiety about getting sick from sitting in a waiting room. So we’re not surprised that telehealth use increased sharply early in the pandemic — and we’re confident it’s not going anywhere.

This means that, as health communicators, we’ll be talking about telehealth plenty in the foreseeable future — which is why we want to learn as much as we can about it. And we have questions, like: What do people love about telehealth? What do they like less? How will telehealth change post-pandemic?

So, dear readers, we’ve rounded up some articles that help answer our questions — and we’re sharing them with you today in this second installment of our Health Comm Headlines series. (Check out our inaugural post, where we shared some resources about FDA approval of Pfizer’s COVID-19 vaccine.) We’re hoping you find these articles interesting — and maybe even helpful for talking telehealth with your audiences!

And remember that we want to hear from you! Share your thoughts on all things telehealth by responding to this email or tweeting at us.

• Patients Say Telehealth Is OK, but Most Prefer to See Their Doctor in Person (NPR)
  Through personal anecdotes and data-driven findings, this article demonstrates why people typically prefer in-person visits despite a common desire for convenience —which telehealth can provide.

• What Happens to Telemedicine After COVID-19? (Association of American Medical Colleges)
  This piece explains how state and federal agencies acted to rapidly expand telehealth early in the pandemic — and have since ended some of the regulations that increased access to telehealth services for people nationwide. The article also details what it will take to bolster telehealth access for the long haul.

• As Internet Access Limits Telehealth’s Reach, Insurers Are Starting to Cover the Bill (STAT)
  This article highlights efforts to bring telehealth to people with limited to no internet access. Thankfully, as the author explains, health plans are working on solutions to tackle the 3 legs of digital access: “One is having equipment, two is having broadband access, and the third is literacy,” says Sara Ratner, senior vice president of government markets and strategic initiatives at Icario Health.

• Telehealth a Lifeline for Patients with Substance-Use Disorders (American Medical Association)
  This article delves into the reasons why telehealth is an especially important option for people who need treatment for substance use disorders. As the author puts it: “Phone or video calls can help reduce the stigma wrongly linked with obtaining effective [substance use disorder] treatment, and the convenience of online formats can make care more accessible.”

• The Surge of Telehealth During the Pandemic Is Exacerbating Urban-Rural Disparities in Access to Mental Health Care (Health Affairs)
  It’s no surprise that the highest use of telehealth during the pandemic has been for mental health treatment. But unfortunately, as this article explains, telehealth use during the pandemic has been much lower in rural communities than urban ones. The authors end by laying out a few strategies — like investing in “telehealth centers” — for improving telehealth access in rural communities.

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Tweet about it: The #COVID19 pandemic has taken #telehealth to a whole new level. Check out @CommunicateHlth’s latest #HealthComm Headlines for a roundup of reading materials on the current telehealth landscape — and where we go from here: https://bit.ly/348348B #HealthLit

Here at We ❤️ Health Literacy HQ, we’re hearing lots of conversations about “learning to live with COVID-19.” While vaccines are working well to prevent serious illness and death, all signs point to COVID becoming endemic — meaning the virus is here to stay. So what does that mean for the way we live our lives and the guidance we share with our audiences? This is a critical question, but there’s a key audience that’s often left out of the conversation: people with disabilities and chronic health conditions.

We know that people with certain health conditions are more likely to get very sick from COVID-19. For many, COVID will be a serious health risk for the foreseeable future. Almost 2 years into the pandemic, many doctors are still telling their immunocompromised patients to stay at home, with no return to “normal life” on the horizon. Yet public health messaging often overlooks that reality — or worse, implies that the well-being of people with disabilities is less important. (See also: confusion about additional doses and/or boosters!)

Throughout the pandemic, people with disabilities and chronic health conditions have gotten the message that risking their health is the price to pay for everyone else to “get back to normal.” Sometimes that message is obvious, and sometimes it’s implied — like through policies that prioritize getting back to work and guidance that doesn’t address the needs of people with disabilities. With this context, it’s easy to understand how messaging that focuses on “learning to live with the virus” can miss the mark.

So how do we move forward? The truth is that we need to figure out how to live with COVID-19 and protect the well-being of people with disabilities and chronic health conditions. We don’t have all the answers, but a good first step is to listen to your audience. When you’re developing messages about COVID-19, invite people with disabilities to share feedback and ask about the issues that matter to them.

And speaking of feedback… we’d love to hear from you, dear readers! As we prepare for the transition from pandemic to endemic, how can health communicators better meet the needs of people with disabilities and chronic health conditions?

The bottom line: As we think about “learning to live with COVID-19,” we have to consider the needs of people with disabilities and chronic health conditions.

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Tweet about it: We need long-term strategies to manage #COVID19. How can we “learn to live with #COVID” AND protect the well-being of people with disabilities and chronic health conditions? @CommunicateHlth has some ideas: https://bit.ly/3Iq2rp0

Here at We ❤️ Health Literacy Headquarters, we’ve been keeping a close eye on all things Omicron over the last few weeks. But it’s been tricky to get our audiences the information they need — especially at first, when there were so many questions we couldn’t answer.

And unfortunately, Omicron won’t be the last COVID variant to hit the pandemic scene. As health communicators, we’ll need to do our best to give our audiences clear information and actionable guidance for every variant — so they can make informed decisions about their health.

With that in mind, here are some key tips for communicating with your audiences about variants:

Be honest about what we don’t know. This tip may well turn out to be the MVP of health comm during the pandemic, and it’s super relevant when we’re communicating about variants. When a new variant emerges, we simply won’t have all the answers. Be up front about that with your audiences — and explain that scientists are learning as much as they can, as fast as they can. If we can avoid getting ahead of ourselves in regard to what we know, we can avoid making U-turns in health advice — and losing our audience’s trust in the process.

Reinforce proven prevention strategies. It’s frustrating when we can’t answer our audience’s timely questions about new variants (or anything else). But one thing you can do in these moments is focus on what we do know. So take the opportunity to encourage your audiences to wear masks in public places, keep their distance, and — of course — get vaccinated and boosted. Speaking of which…

Leverage the science of variants to support vaccine messaging. Explain that when COVID spreads from person to person over time, it can mutate into different versions of the virus. And since the available vaccines were designed specifically to protect against the original virus, they may be less effective at preventing infections from new variants.

We know this one’s a little fraught since we don’t want to undermine our messaging about vaccine efficacy. But the fact is that while vaccines are working less well at preventing Omicron entirely, they are keeping many (most?) people from getting very sick. So tell your audiences that the more people who get vaccinated and boosted, the better chance we’ll have at keeping new variants from showing up in the first place. And that’s a win for everyone.

Give people the tools they need to make informed decisions about socializing. Lots of people are wondering if it’s still okay to see others in person with Omicron in the mix. And the answer is… it depends on too many things for us to, well, answer! So help your audiences choose ways to socialize that they’re comfortable with — and offer talking points for discussing those choices with friends and family.

The bottom line: Omicron isn’t the last COVID variant we’ll have to reckon with. When new variants crop up, be honest about what we don’t know yet — and reinforce tried-and-true messages.

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Tweet about it: With the rapid spread of #Omicron in recent weeks, @CommunicateHlth has been reflecting on how to communicate about new #COVID19 variants. Check out these #HealthLit tips: https://bit.ly/3I61L86