Category: We Heart Health Literacy

Here at We ❤️ Health Literacy HQ, we write about HIV a lot. After all, preventing HIV is a public health priority.

Not long ago, we covered how to explain medicines that can prevent HIV in plain language. And when we did, we got a request from one of you, dear readers, to cover “viral load” next. (Here’s your reminder to always reach out with post ideas or requests!)

Why do we need to talk about viral load, you ask? For people with HIV, viral load is a key indicator of how healthy they are. That means they’re likely to hear the term from their doctors. And that means it’s important to make sure they understand it.

So here’s how to give a quick but clear explanation of “viral load”:

• The amount of HIV in your body is called your viral load. When your viral load is low, your immune system can fight infections so you can stay healthy.
• If your viral load is so low that a test can’t find any HIV in your body, it’s called an undetectable viral load. This means there’s almost no chance you can pass HIV to other people through sex.
• You can keep your viral load low by taking HIV medicines — called antiretroviral therapy, or ART.

Our eagle-eyed readers may notice that we recently shared thoughts on avoiding “detect” and other forms of the word. So it’s worth noting that we’d make an exception for “undetectable” since people who have HIV are so likely to hear the term that it’s important to teach it.

Also, you may have heard people refer to the info in that second bullet above as “U=U,” or “undetectable=untransmittable.” While it’s a super important concept (and also a social marketing campaign!), we’d generally recommend against using it in plain language consumer materials. We know that users with limited literacy may struggle to interpret symbols, and the terms themselves aren’t particularly plain language anyway. If you do want to go that route, be sure to contextualize it in plain language.

The bottom line: When you’re writing materials for people who have HIV, make sure to explain “viral load” in plain language. 

Tweet about it: People with #HIV need to understand the term “viral load,” but it’s not exactly #PlainLanguage! @CommunicateHlth has #HealthLit tips that can help: https://bit.ly/3kezraE

If there was ever a health issue that’s divided our country, it’s abortion. And it’s been top of mind here at We ❤️ Health Literacy HQ since we learned last week that Texas passed one of the most restrictive abortion laws in recent history. The new law makes abortion illegal before many people even know they’re pregnant. And as if that wasn’t bad enough, it doesn’t make exceptions for pregnancies resulting from rape or incest.

As health communicators, it’s more important than ever that we provide clear, non-judgmental information about abortion. Let’s start with some basics:

• Abortion is safe. Many studies have shown that all types of abortion are safe and effective.
• Abortion is very common. In fact, about 1 in 4 women in the United States will have an abortion by the time they’re age 45.
• Abortion is a personal decision. There are lots of reasons a person might decide to get an abortion — and they’re all valid.
• Abortion is essential health care. Abortion is a medical decision. And don’t just take our word for it — the American College of Obstetricians and Gynecologists, the National Health Law Program, Amnesty International, and other organizations say so, too.

But if abortion is safe, common, and essential, why is it so dang political? In recent years, states have passed all kinds of laws making it harder to get an abortion — regulating when you can have one, why you can have one, where you can have one, what kind of health care provider you see… the list goes on. And we know that abortion restrictions disproportionately affect people of color, people in rural communities, undocumented immigrants, and young adults.

So what’s a health communicator to do? While there’s no magic bullet for communicating about abortion, here are some general tips:

• When in doubt, go back to basics. We can’t say it enough: abortion is safe, common, and essential health care. We give you permission to shout it from the rooftops, even!
• Check your assumptions. Be careful not to draw your own conclusions about why someone might choose to have an abortion — or how they feel about it.
• Be intentional about the language you use. Watch out for value-laden terms — and consider the implications when choosing words like “baby” or “fetus.”
• Aim for inclusion. All kinds of people access abortion care — including people of different ages, people who are already parents, people from different cultural backgrounds, and transgender and nonbinary people. Make sure the language you use is inviting and inclusive to all.

The bottom line: Abortion is safe, common, and essential health care. Using fact-based inclusive, non-judgmental messaging can go a long way toward erasing abortion stigma.

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Tweet about it: It’s more important than ever to communicate clearly about abortion. @CommunicateHlth revisits why abortion is essential health care and shares #HealthComm tips for reducing stigma: https://bit.ly/3MWpyd5 #HealthLit

If you’re like us, dear readers, you were thrilled to hear about the first COVID-19 vaccine to receive FDA approval last week. With the Delta variant causing COVID surges across the country, it’s certainly good timing for this important step.

This news has also really gotten us thinking about all things FDA approval. What exactly is an Emergency Use Authorization (EUA) anyway? What’s the practical difference between EUAs and full FDA approval? Will approval of the Pfizer vaccine help us move the vaccination needle among hesitant folks? There’s a lot to discuss!

That’s why we felt like this was the perfect opportunity to introduce a new series we’re starting here at We ❤️ Health Literacy Headquarters. Every so often, we’ll bring you a roundup of articles or other resources that caught our attention and sparked discussion among our team. Hopefully they’ll be of interest to you, too — and they might even help you communicate to your audiences about the latest health comm conundrums!

So without further ado, here’s some reading material on FDA approval and FDA approval-adjacent things — feel free to let us know your thoughts by responding to this email or tweeting at us!

• Emergency Use Authorization for Vaccines Explained (U.S. Food & Drug Administration)
  This explainer from FDA itself has some helpful details and framing about the ins and outs of EUAs, including a section at the end that outlines how experts were able to develop COVID-19 vaccines so quickly.

• The FDA Really Did Have to Take This Long (The Atlantic)
  This piece lays out what it calls a “fundamental tension” between access to lifesaving vaccines and the assurance of quality control. As the author states: “For full FDA approval to bring all the benefits it could, people need to trust that such approval means something.”

• Why Pfizer’s FDA Approval Matters and What It Means for Vaccine Mandates (NPR)
  This article starts by explaining how a drug gets FDA approval — then moves into tricky territory like the legal distinctions between EUAs and full approval, how approval might impact school and employer mask mandates, and the impact of Pfizer’s new status on vaccine-hesitant folks.

• Pfizer-BioNTech Coronavirus Vaccine Gets Full FDA Approval, Potentially Persuading the Hesitant to Get a Shot (Washington Post)
  Let’s keep talking — err, reading — about whether the approval of Pfizer’s COVID vaccine will persuade people who aren’t yet vaccinated and what it might mean for vaccine requirements!

• How the Messaging Around FDA Approval Could Boost COVID Shots (Axios)
  This piece by Drew Altman, president and CEO of the Kaiser Family Foundation, gives some insight into how people who haven’t gotten their vaccine yet might feel about the approval of Pfizer’s COVID vaccine. It’s important to note that Altman wrote this piece before Pfizer’s FDA approval, but we really ❤️ the emphasis of leveraging the approval to message about vaccine safety and efficacy.

Tweet about it: Check out @CommunicateHlth’s #HealthComm Headlines for a roundup of reading material related to FDA’s approval of the Pfizer #COVID19 vaccine: https://bit.ly/3gVBCOy

Here at We ❤️ Health Literacy Headquarters, we’ve been thinking a lot lately about unintended consequences of common health comm terms like “target audience” and “vulnerable communities.” And this week, we’re tackling another health comm no-no: “hard-to-reach” populations.

What do we mean by “hard to reach”? Jay Bernhardt, dean of the Moody College of Communication at UT Austin, explained the problem with this term at this year’s Health Communication Leadership Institute — he argued that “hard to reach” is an excuse for not putting in the work and the resources to successfully reach people. And we think this is spot-on. It’s time we stop implying that the audience is at fault when health messaging fails to reach or connect — and start asking how we as communicators can do better.

Even if these problematic labels never appear in our consumer materials, using terms like “hard to reach” internally can set us up to expect failure when we’re communicating with these populations — or perhaps to not even try. And when you expect to fail, you might eventually give up too soon. That’s a sure way to make existing health disparities even worse.

So how do we avoid “hard to reach”? One option is to swap in an alternate term like “high priority” or “under-resourced” that keeps the responsibility centered on the systems and organizations that fail to prioritize these populations. In other words, you could describe the specific problems at hand more directly. For example, instead of “this campaign will target the hard-to-reach population of Black adults ages 65 and older,” you could say “this campaign will prioritize Black adults ages 65 and older — a population that previous campaigns have largely failed to reach due to a lack of culturally relevant messaging and trusted messengers.”

These language changes may seem insignificant, but they can help us hold ourselves accountable for finding solutions. And then the real work and progress can begin!

The bottom line: Let’s stop calling populations “hard to reach” — and put in the work, time, and resources to successfully reach people instead!

Tweet about it: Why are some populations “hard to reach” in #PublicHealth? Because we’re not putting in the work to reach them! @CommunicateHlth takes inspo from #HealthComm hero @jaybernhardt and explains why: https://bit.ly/3sup3OC #HealthLit

With COVID-19 cases once again on the rise, dear readers, putting a stop to the spread of vaccine misinformation is crucial. But mythbusting in the midst of an ever-shifting pandemic can be a difficult task. So this week, we’re sharing our appreciation for some folks who are leading a coordinated charge against COVID-related false information: Stronger.

Stronger is a national advocacy campaign created by The Public Good Projects that aims to stop the spread of vaccine misinformation. They work with partners to share correct info — and also provide useful tools to help people find trustworthy answers to their vaccine questions, spot misinformation in the wild, and report accounts that spread dangerous myths. We especially ❤️ how they make it easy to stay on top of the misinformation landscape by sending super timely email alerts about misinfo surges (sign up for those here).

Another one of our favorite offerings from Stronger is this handy roundup of resources, including how to spot misinfo and how to report it on social media. And if you’re as jazzed about Stronger’s efforts as we are, check out more ways to get involved. 

The bottom line: Stronger works to stop the spread of vaccine misinformation — and that’s something we definitely ❤️!

Tweet about it: It’s not easy countering #COVID19 vaccine misinfo. Fortunately for us #HealthComm folks, @stronger_org is up for the challenge, says @CommunicateHlth: https://bit.ly/3jOvgB4 #HealthLit

As you know, dear readers, we’re always on the lookout for jargon words to ban from our vocabularies. On the chopping block this week: “detect” and “detection.”

In health comm, we often talk about the benefits of early detection to improve outcomes. But “detect” often brings to mind devices like smoke detectors, lie detectors, metal detectors… not exactly setting the scene for a cozy prevention visit with your human doctor!

So next time you detect this bit of jargon in your materials, see if you can swap it out for a friendlier plain language alternative — like “find,” “notice,” or “check for.”

Try this:

• Regular mammograms can help find breast cancer early, when it’s easier to treat
• If you notice any of these symptoms, go to the doctor right away
• Your doctor can do an eye exam to check for signs of glaucoma

Not this:

• Regular mammograms allow for early detection of breast cancer
• If you detect any of these symptoms, convey yourself at once to the nearest physician
• Your doctor can do an eye exam to detect glaucoma

The bottom line: Forget “detect” — “find,” “notice,” or “check for” symptoms and diseases instead!

Tweet about it: It’s time to ditch “detect” in your #HealthLit materials! @CommunicateHlth explains why and offers #PlainLanguage alternatives: https://bit.ly/37kK191

Here at We ❤️ Health Literacy HQ, we’re always on the lookout for cool new tools to help us make the web a more accessible place. Today, we’re geeking out about tools that can help you make your site more accessible for users who are blind or have vision problems.

Use browser extensions for quick accessibility tips

Browser extensions are tools that you can add on to your internet browser. There are 2 free browser extensions that you can use to identify accessibility issues: Accessibility Insights for Web and WAVE Web Accessibility Evaluation Tool.

These extensions flag common issues like confusing links and missing alt text and offer practical tips to help you avoid those pitfalls. They can also help you understand how users might navigate your site using a screen reader.

See what your users see

Seeing the web through your users’ eyes can help you better understand their needs. Google Chrome and Firefox offer built-in tools that can show you what it’s like to browse the web with different kinds of color blindness. Chrome also has a filter to simulate blurry vision.

Here’s how to access these tools.

In Google Chrome:

1. Click the 3 dots in the top right corner of the Google Chrome window — then click More Tools > Developer Tools
2. Hold down Command + Shift + P to open the Command Menu
3. Click Show Rendering to open the Rendering Pane
4. Choose an option from the Emulate Vision Deficiencies section

In Firefox:

1. Click Tools > Web Developer Tools > Accessibility
2. Choose an option from the Simulate drop-down menu

The bottom line: Find tools to help make your website more accessible for people with vision problems.

Tweet about it: Want to make your site more accessible for people with vision problems? Try these helpful tools, says @CommunicateHlth: https://bit.ly/3lagneD #a11y #HealthLit

During COVID-19, we here at We ❤️ Health Literacy Headquarters have found ourselves drawn to stories about past pandemics. So this week, we’re introducing you to a must-read novel set during a very different (and perhaps even more gruesome) pandemic. Doesn’t it sound like the perfect beach read?!

In Year of Wonders, Geraldine Brooks tells a fictionalized tale of the real-life English village of Eyam during the 1600s. When the bubonic plague arrived at their doorstep, Eyam’s villagers made the difficult decision to quarantine their entire community to avoid spreading the “plague seeds” elsewhere. Over the 14 months of the self-imposed quarantine, 260 villagers got sick and died.

Our health communication brains saw a lot of COVID-19 parallels in the pages of this book. For example, Brooks’s narrative explains that the villagers of Eyam didn’t make the selfless decision to quarantine on their own. It was the town minister who came up with the idea and convinced everyone to get on board. In other words, the community needed a trusted messenger who could explain in plain language what steps they needed to take and why!

And much like health communicators today, the minister and others in favor of the quarantine had to combat dangerous health misinformation. When a myth about local healers being witches who caused the plague went, ahem, viral, some villagers turned on the very people in a position to help them. Sound familiar, dear readers?

In spite of the community’s inner turmoil, the villagers stuck with the quarantine — and that decision likely slowed the spread of the plague to nearby towns and villages. Brooks also dramatizes how, despite all their personal losses, many villagers went above and beyond to help each other through an incredibly dark time. And that’s what we call a public health success story.

The bottom line: Read Geraldine Brooks’s novel Year of Wonders for a historical take on the trials and triumphs of quarantining during a pandemic.

Tweet about it: Looking for your next plague-related beach read ??? @CommunicateHlth recommends Year of Wonders by @GeraldineBrooks: https://bit.ly/3rdXybB

As health communicators, we deal with survey data on the regular. Surveys can be a powerful tool to help us better understand our priority audiences and their information needs. But without thoughtful interpretation, survey data can be confusing at best — and misleading at worst.

So this week, we’re bringing you some food for thought about a key ingredient in every survey: the respondents. Answering the questions below will help you interpret, apply, and explain survey results with more nuance — and with a better sense of the people behind the data.

• Who took the survey? The first step in understanding survey results is getting a grip on exactly who answered the questions. For example, if 97 percent of your respondents regularly talk to cats, it’s pretty important to know that you only surveyed cat owners. Ideally, your survey’s eligibility requirements will overlap with key characteristics of your priority audience. But if they don’t perfectly align — say, your audience is cat owners but you were only able to survey people with spooky hairless sphynx cats — make sure you take those differences into account as you interpret the results.

• Who didn’t take the survey? If you sent the survey to 1,000 cat owners and only 100 responded, it’s important to think about what that response rate might mean. Start by taking a look at the demographics — were people of a certain race, age, or income level more likely to respond? Then you can think about what these differences mean for your results.

• How many people took the survey? In survey research, size really matters! After all, 90 percent of 1,000 people is very different from 90 percent of 10 people. And a result that seems noteworthy in a sample of 10 people — like 3 people who say that when they talk to their cats, their cats talk back — may not be so impressive if it’s 3 in a sample of 1,000. Larger sample sizes typically mean better-quality survey data — so keep sample size in mind to keep your results in perspective.

• How many respondents answered each question? Some survey questions may only apply to certain respondents. Let’s say you ask, “How often does your beloved cat bring you offerings of dead birds?” People with indoor cats are likely to skip that question (barring any unfortunate overlap with pet parakeets). So it’s important to always take careful note of the base — the number and description of respondents who answered each specific question. In this case, that would be the number of outdoor cat owners in your total sample size.

• Was the sample random or non-random? In a perfect world, we’d always use a random sample. Random samples are the next best thing to interviewing every single person in a population. But random sampling can be expensive and time consuming, especially if you’re researching a very specific population — people who have 12 or more cats, perhaps. So if your survey uses a research panel or another non-random sampling method, just remember that the results may not be generalizable to your whole priority audience.

• What’s the quality of the results? It’s important to take all survey results with a grain of salt. After all, we’re relying on people to self-report answers — and who wants to admit exactly how many times they have tried to dress up their cat as Mufasa from The Lion King? But the size of the grain will vary! A random sample of 10,000 people may yield high-quality results — so maybe just a dash of fine table salt. A non-random sample of 100 is a bit more iffy — think a generous dusting of coarse kosher flakes. Consider the quality of the results before you apply survey findings to your materials — and if you’re communicating survey results to others, make sure your framing mentions how much salt you recommend.

The bottom line: Take a closer look at respondents to better understand and explain survey results. 

Tweet about it: Surveys are a great tool for understanding our priority audiences. But first, we need to understand who’s taking the survey! That’s why it’s a good idea to take a closer look at respondents, says @CommunicateHlth: https://bit.ly/3wsqf5l

In public health, dear readers, talking about “vulnerable” communities, populations, or individuals is standard fare. We’ve all said it many times when referring to communities we’re prioritizing with our communications or programs. But this week, we wanted to make a case for retiring it from our vernacular. Why? Well, the term can put the blame on the very people we’re trying to help. And beyond that, it’s a card-carrying member of the “just plain vague” club — in a pretty problematic way.

We recently went to a conference where Dr. Tabia Henry Akintobi, a professor at the Morehouse School of Medicine, astutely pointed out that calling people “vulnerable” implies that the problem lies with them. This term carries a negative connotation of weakness and seems to suggest that certain people have some intrinsic characteristic that makes them more likely to get diseases or have worse outcomes from those diseases. It puts the onus on the people who are affected, rather than on the public policies and societal institutions that are truly to blame.

In addition, terms like “vulnerable groups” can obscure the actual people you’re talking about. It’s important to acknowledge not only the source or cause of a population’s oppression — but also the identities of the people who are oppressed! Calling a group “vulnerable” and leaving it at that erases specific populations with a vague, useless catchall.

We should note that calling out problems with “vulnerable” isn’t new, but it seems especially important to talk about now. As more and more people are confronting how deeply racism is woven into the fabric of our country and our society, we need to think about how our words could reinforce harmful patterns. When we list race as a risk factor, we conceal racism as the true cause of most racial health disparities — and when we call people “vulnerable,” we risk perpetuating the discrimination and unfair treatment that damaged their health in the first place.

So what’s an alternative?

When you’re talking to your health-communicating colleagues, consider “disproportionately affected by” (or “impacted” or what have you). It’s not the most elegant phrasing, but it’s accurate and everyone will know what you’re talking about (think: “populations disproportionately affected by COVID-19”). And if you need something more appropriate for consumers, consider the plain language “hit hard by” (as in: “communities hit hard by the pandemic”).

And instead of using “vulnerable” as a catchall, name the groups you mean. Sticking with a COVID-19 example, let’s say you’re talking about racial and ethnic groups that are at increased risk of getting COVID and having worse outcomes. Instead of “vulnerable populations,” list out the races and ethnicities you’re talking about: people who are Black, Hispanic or Latino, and American Indian or Alaska Native.

And if you can, describe the root causes that increase health risks in certain groups. For example, you could say: “We’ve identified Black people as a priority audience because structural racism and centuries of disinvestment in Black communities have damaged Black people’s health and increased their risk of getting and dying from COVID-19.”

The bottom line: Calling communities “vulnerable” puts the blame on those communities — and leaves too much room for interpretation. Let’s stop using it!

Tweet about it: We use the phrase “vulnerable communities” a lot in #PublicHealth and #HealthComm — but it’s pretty problematic. @CommunicateHlth explains why: https://bit.ly/3q5BKy5