Category: We Heart Health Literacy

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

It’s that time of year again: the post-holiday period when we’re inundated with information about how to stick with our New Year’s resolutions and follow “healthy” routines.

While this guidance is usually well-intentioned, it’s not always helpful — and sometimes it’s downright harmful. You don’t have to look far to find health advice that’s unrealistic or perpetuates stigma and stereotypes (not to mention all the information that’s just plain untrue!).

As health communicators, it’s up to us to counteract this January jumble of unhelpful health tips by providing our audiences with clear, empathetic, and actionable information — just like we do all year long! With that in mind, below are a few steps to take when you’re writing about health behaviors in the new year.

Help people set realistic expectations. New Year’s resolutions tend to be big and bold — but our health advice shouldn’t be. We’ve said it before and we’ll say it again: Provide manageable action steps and clearly state that even small changes make a difference. So if you’re writing an article for people who aren’t physically active but want to be, offer a manageable suggestion, like: “Try taking a 10-minute walk a few times this week.” That’s a much more realistic goal than, say, a daily hourlong gym session. And that means people are more likely to stick with it! (You know, self-efficacy and whatnot.)

Avoid phrases with built-in value judgment. We’re talking terms like “clean eating” and “guilt-free.” These words are inherently judgy, and using them can induce shame and stress. If you’re not following a “clean eating” routine, are the foods you’re eating dirty? Absolutely not. That’s why it’s best to stick with solid, shame-free advice, like: “Try to eat a variety of fruits and vegetables.”

Even “fun” framing that tends to pop up in January can be problematic — just think how many times you’ve seen some version of the headline “New Year, New You!” While it’s snappy and could motivate some people (most likely in the short term), doesn’t it kind of imply that there was something wrong with the old you? Food for thought, dear readers.

Watch your framing of “failure” to meet goals. We all have off days — and busy days and sick days and lots of other days when we can’t check off our health goals. And guess what? That’s fine! Healthy habits and routines are just what their names imply — they’re patterns of behavior, not prescriptive requirements. So think twice before you call a missed workout or an unhealthy meal a “setback” or a “slipup” (are they really?) — and tell your audiences to go easy on themselves: “If you didn’t get all your walks in this week, it’s no big deal! Just try to get back on track — remember, even a few minutes of physical activity can have real health benefits.”

The bottom line: Health messages are everywhere right about now. Cut through the noise with clear, manageable action steps — and steer clear of terms and framing that could perpetuate shame or stigma.

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Tweet about it: #NewYear-style health messages are often unhelpful and problematic — but they don’t have to be! @CommunicateHlth has tips for providing clear, actionable, and empathetic health guidance in the new year: https://bit.ly/33eCyJS #HealthComm #HealthLiteracy

It’s that time again, dear readers, when we say to you: happy, happy holidays! We’re grateful to have such thoughtful, passionate peeps to share our health lit-related musings with — your questions, comments, and suggestions really do make our work better. So thank you.

It’s been a strange (almost) 2 years, but if we ever needed a reminder of why people need access to clear health information… well, you know.

Wishing you all the best as we head into 2022.

Public health friends, rejoice! The Centers for Disease Control and Prevention (CDC) has strongly recommended COVID-19 boosters for all adults. And a late-breaking update — as of TODAY, teens ages 16 and 17 can get boosters, too! The news comes not a moment too soon, as many of us are getting back into the groove of festive holiday celebrations with family and friends. Now is the time to encourage your audiences to get that booster!

Easy, right? Well, mostly. You’ve heard about boosters — but what about an extra dose for immunocompromised people? Yep, some people with immune system issues may not get full protection from COVID-19 vaccines. That’s why CDC recommends an “additional primary shot” of mRNA vaccines for this group. Here’s how it works:

• Immunocompromised people get the extra dose at least 28 days after their second dose of Pfizer or Moderna
• Then, at least 6 months after their additional dose, they get the same booster as everyone else

(At this point, there’s no additional dose for people who got the Johnson & Johnson vaccine.)

It makes sense that people with immune system problems need extra protection. But with all the focus on boosters, the additional dose can get lost in the shuffle — or confused with a standard booster. We’ve even heard from friends of the blog that some doctors aren’t making a distinction between boosters and additional doses. If that’s true, immunocompromised folks who aren’t inclined to carefully track COVID vaccine guidance may not know they need an additional shot. Yikes.

To further complicate matters, many immunocompromised people got vaccinated back when COVID-19 vaccines first became available. Because this guidance didn’t exist yet, they missed the opportunity to get the additional dose 28 days after their second shot. So in practice, this guidance may only benefit people who have just become immunocompromised (say they just started cancer treatment) and haven’t gotten their original COVID-19 vaccine yet.

So how can health communicators explain all this nuanced info to immunocompromised audiences? Don’t ask us! Kidding, dear readers. We’ve got some ideas, but — with pandemic-related guidance ever in flux — we certainly don’t have all the answers.

But for now, consider using a blurb like this to encourage immunocompromised people to talk to their doctor:

If you have serious health issues that affect your immune system (the system that fights off infections), you may be able to get an extra dose of the COVID-19 vaccine. Make an appointment to talk with your doctor about the vaccines you need to stay safe from COVID-19.

If you find yourself concerned about this approach given the mention of doctors above, gold star for paying attention! That’s why we’re also encouraging immunocompromised audiences to print out (or pull up on a smartphone) this page from CDC to discuss during the appointment. Doctors may not have all the answers either, but we certainly can’t expect patients to figure this out on their own. And while we haven’t untangled all the pieces here, helping people start a conversation with a medical professional is a solid first step.

Has the additional dose come up in your COVID-19 communication efforts? We’d love to hear your thoughts!

The bottom line: People with health conditions that affect their immune system may need an additional dose of mRNA vaccines AND a booster to protect against COVID-19 — but they may not know it. Encourage your audiences to talk to their doctors about getting the best protection.

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Tweet about it: People with health conditions that affect their immune system may need an additional dose of mRNA vaccines AND a booster to protect against #COVID19. The problem? They may not know that. @CommunicateHlth has thoughts for health communicators: https://bit.ly/3Gyy4Mv #HealthLit