Category: We Heart Health Literacy

If you’re anything like us, dear readers, you have many thoughts about generative AI’s role in health comm. Generative AI (short for artificial intelligence) uses source content, like a database or websites, to create new content. And while some folks think it has great potential to improve health comm, others have serious concerns.

At this point, we have lots of questions — which is why we’ve been eagerly watching for articles that might have some answers. Today, we’re sharing a few of them with you in the latest installment of our Health Comm Headlines series. We hope that they spark discussion with your fellow health communicators. And as always, we’d love to hear what you think — so reach out if you have comments!

• Distilling the Promises of AI in Global Health from the Hype (Johns Hopkins Center for Communication Programs)
  This piece gets real about generative AI’s potential in public health and health comm — and its limitations. The article features a fun example of AI-generated content: a song aiming to get men in the Democratic Republic of the Congo more involved in family planning. But it also discusses serious issues, particularly the fact that AI relies on data and some of that data is biased. As the author puts it: “Generative AI may provide the starting point; however, human input is still needed to quality check and provide expertise into context. It is naïve, though, to think these tools won’t factor into future content development.” We couldn’t agree more.

• How AI Is Helping Doctors Communicate with Patients (Association of American Medical Colleges)
  This article focuses on health care’s use of chatbots — computer programs that simulate conversations with people. It notes that chatbots interacting with patients have 2 main purposes: monitoring health conditions and answering questions. For example, it describes a chatbot service that reaches out to different types of patients, like people who just returned home after surgery and people with chronic conditions. The idea is that these types of services can help make sure people are getting the care they need — like by alerting a doctor to call them for a follow-up — if their answers indicate a health concern. (While that is definitely promising, it’s also important to keep in mind that chatbots’ track record is far from perfect.)

• A.I. May Someday Work Medical Miracles. For Now, It Helps Do Paperwork. (New York Times)
  This piece makes the case that currently, one of generative AI’s biggest benefits in health care is that it can… reduce paperwork. While that doesn’t sound overly exciting, it’s actually a pretty big deal and could potentially go a long way toward improving patient-provider communication and reducing provider burnout. As the article explains, doctors spend a lot of time — during patient visits and after hours — taking notes and logging info in electronic health records. But AI can do this for them, which can free up doctors’ time and improve the quality of doctor visits. The article describes an AI tool that not only takes notes during visits but also sends patients a plain language summary immediately afterward. You can bet that piqued our interest!

• AI Might Be Listening During Your Next Health Appointment (Axios)
  This article is also about AI tools that can take notes during doctor visits and provide summaries, but rather than highlighting these tools’ benefits, it focuses on a potential drawback: privacy concerns. For example, the article says advocates are concerned that these tools are being released with little oversight and without standards for notifying patients about their use. Also this: “AI systems are trained on large amounts of real data, raising the question about whether patients’ data may be used for such training in the future.” These are valid concerns that we should all take seriously.

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Post about it on X: In their latest #HealthComm Headlines post, the @CommunicateHlth team rounds up food for thought on generative #AI and the future of #HealthCommunication: https://bit.ly/3RWc6M4

If you’ve been following us for a while, dear readers, you know we’re always thinking about ways to improve health communication. Recently, that’s included a lot of noodling about how to effectively fight misinformation. That’s why we ❤️ The Debunking Handbook 2020 — a guide with actionable tips for disproving false claims and dispelling myths.

Written by a group of 22 international scholars (and available in many languages), the handbook describes misinformation as “sticky,” or hard to get rid of. Alternately, you might think of misinformation the way you think of weeds in the garden: Once it takes root, it’s notoriously hard to get rid of — even if it’s been corrected.

That’s why the best thing to do, according to The Debunking Handbook, is prevent misinformation from taking root in the first place — by prebunking false claims before they start circulating. With prebunking, you explain the techniques that people who spread false information use, which can help your audience spot misinformation in the future.

If misinformation has already taken root, though, don’t despair — that’s when the debunking part comes in. But first, the handbook suggests that you consider these questions:

• Is the myth circulating widely? Does it have the potential to cause serious harm? If not, your energy may be better spent battling other “weeds.”
• Can you provide accurate information without directly debunking (and thereby mentioning) the myth? For example, you might be able to highlight a vaccine’s success and safety rate without bringing up any misinformation related to it — and by doing so, drawing attention to a false claim.

That said, sometimes you won’t be able to avoid mentioning the falsehood you’re trying to debunk. If you find that it’s time to pull misinformation out by the root, The Debunking Handbook has a solution. To our long-time readers, that solution will sound familiar: You wrap the myth in facts — also known as a truth sandwich! That way, you’re guiding your audience’s attention toward the correct information, not the falsehood.

The bottom line: The Debunking Handbook offers hands-on strategies that can help health communicators weed out misinformation and plant the seeds of fact-based, accurate health info.

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Tweet about it: The Debunking Handbook offers actionable strategies to fight misinformation. @CommunicateHlth has the details: https://bit.ly/3PV19cd #HealthComm

Here at We ❤️ Health Literacy HQ, we’re excited to see many research institutions and pharmaceutical companies working to increase diversity, equity, and inclusion in clinical trials. These efforts often focus on enrolling participants from underrepresented groups — like people of color, women, and LGBTQ+ people.

But did you notice anyone missing from that list, dear readers? Although 1 in 4 people in this country have a disability, people with disabilities are often left out of clinical trials and the conversation about diversity in clinical trials. That means researchers miss out on data about how treatments affect people with disabilities, creating gaps in medical knowledge. Here’s a great example from the STAT piece linked above: Although many people with Down syndrome develop Alzheimer’s disease or dementia later in life, few clinical trials for Alzheimer’s treatments include people with Down syndrome.

So why don’t more people with disabilities participate in clinical trials? Eligibility criteria are a big factor. Some trials have criteria that specifically exclude people with certain disabilities. And some trials exclude wide swaths of people, like anyone who has cognitive challenges, can’t drive to study appointments, or seems unlikely to successfully complete the study. Subjective criteria leave room for implicit bias to sneak into the selection process — if a researcher has negative beliefs about disability (even subconsciously!), they may be more likely to exclude people with disabilities based on vague criteria.

Most clinical trials don’t seek out people with disabilities or offer the accommodations they need to participate. Accommodations like having an ASL interpreter on site, making consent forms easier to read, or allowing participants to bring a support person to appointments would enable more people with disabilities to join clinical trials. On top of these barriers, many trials don’t include disability in their participant stats. So even when people with disabilities do participate, researchers are missing opportunities to analyze the data through the lens of disability.

The work of making clinical research more inclusive is complex, and it’s important to acknowledge some nuances here. Of course, there are situations where disabilities can prevent people from completing clinical trial activities. Plus, researchers aim to eliminate confounding variables — outside factors that may affect study results. In practice, this often leads researchers to exclude people with “complex” medical histories.

So where do we go from here? Researchers can structure eligibility criteria to include as many people as possible, proactively seek out participants with disabilities, and provide necessary accommodations. Of course, these changes won’t happen overnight. In the meantime, health communicators can do what we do best: make clinical trial materials easier to read and understand. And we can amplify the work of people with disabilities who are advocating for a more equitable world.

The bottom line: People with disabilities are often left out of clinical trials and the conversation about diversity in clinical trials. Making clinical research more inclusive is a complex task, but it’s a critical step toward health equity.

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Tweet about it: This week, @CommunicateHlth explores why people with disabilities are often left out of #ClinicalTrials — and why inclusive research is an important step toward #HealthEquity: https://bit.ly/3rnO1TG #DEI #HealthComm #HealthLiteracy

Back in pre-COVID times, “wastewater surveillance” wasn’t a term we came across much (ever?). But that all changed due to the pandemic — and the launch of CDC’s National Wastewater Surveillance System (NWSS). Now it’s quite common to see casual mentions of wastewater surveillance, like in a news report about rising COVID cases.

As many of you know, wastewater surveillance is a way that public health professionals can track community levels of COVID. But unless you’re writing for, say, wastewater treatment plant employees (and we’re guessing most of you aren’t, dear readers), it’s a safe bet that’s lots of folks in your audience don’t know what the term “wastewater surveillance” means.

So if you find yourself mentioning wastewater surveillance in your COVID health comm materials, it’s important to clearly explain it. Here’s the gist:

Wastewater surveillance means tracking the level of COVID virus in samples of wastewater — the water that goes down the drain in our homes and businesses. It works because people with COVID (and other diseases caused by viruses) can shed very small amounts of the virus in their pee, poop, and other bodily waste. And that happens even if they don’t have symptoms. (Want to know how exactly wastewater surveillance works? Check out this nifty infographic.)

Wastewater surveillance gives public health professionals important information about how COVID and other diseases are spreading in our communities, even if people who are sick don’t go to a doctor’s office or clinic to get tested. This is very important because many people now use at-home test kits to test for COVID (if they test at all!) — meaning lots of cases aren’t reported to local health authorities. And that means official case counts may not paint an accurate picture of COVID case rates in a community.

Adding wastewater surveillance to the mix can help us get a much clearer idea of what’s going on in a community at any given time. And local public health officials can use that info to make recommendations about protective measures for their community, like mask wearing. CDC has a tool to look up wastewater reports by county and monitor trends in COVID levels over time. Put it in your health comm toolbox — and consider sharing it with your audiences as appropriate to help them stay informed and take steps to protect their health.

The bottom line: Wastewater surveillance is an important public health tool — make sure you’re clear on how to explain it in plain language if you need to.

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Tweet about it: Wastewater surveillance is an important #PublicHealth tool. Make sure you know how to explain it in #PlainLanguage, says @CommunicateHlth: bit.ly/3LsD3D9 #HealthComm

Today, we’re shining the spotlight on a book that illuminates what it’s like to live with a hard-to-diagnose disease: The Invisible Kingdom: Reimagining Chronic Illness by Meghan O’Rourke. Part memoir, part highly researched nonfiction, it’s an eye-opening read about the experiences of people on the margins of medicine: those with a so-called “invisible illness” not easily identified or treated.

For over a decade, O’Rourke dealt with intermittent but debilitating symptoms: brain fog, vertigo, fatigue, rashes, and what she calls “electric shocks” — stabbing sensations in her arms and legs. Her symptoms were wreaking havoc on her relationships, career, and sense of self. But despite the serious impact of her illness, O’Rourke struggled to find a doctor who would take her seriously. Again and again, her symptoms were dismissed or derided, and test results and appointments often left her with more questions than answers.

The Invisible Kingdom also explores how modern medicine is contending with chronic diseases and autoimmune disorders (spoiler alert: not all that well), both of which have a lot of overlap with hard-to-diagnose conditions. We ❤️ that the author draws attention to what’s working against those with invisible illness — among other barriers to proper care, she names social determinants of health, gender bias, harmful “problem patient” stereotypes, an inefficient health care system, lack of understanding of autoimmunity, and physician burnout.

While O’Rourke eventually received diagnoses and treatments that helped, she writes that she’s never fully free from her symptoms. Health and illness are often framed as mutually exclusive states — someone is either well or unwell. But O’Rourke explains that for her and many others, the options just aren’t so clear cut. Instead, they “live in a gray area between health and disease for years … between feeling well and being symptomatic.”

There are so many important health comm takeaways from this book that we couldn’t possibly include them all. So, dear readers, here are 3:

1. Empathy is key. Of the countless doctors that O’Rourke saw, only a handful treated her with respect or took her symptoms seriously — especially after the first rounds of tests failed to identify the problem. Unsurprisingly, it’s the doctors who were willing to connect with and listen to O’Rourke that were finally able to offer some relief. Empathy, empathy, empathy!
2. Illness is isolating. O’Rourke emphasized how lonely her illness made her feel: “One of the hardest things about being ill with a poorly understood disease is that most people find what you’re going through incomprehensible — if they even believe you are going through it.” As health communicators, we can acknowledge that isolation, as well as offer guidance on how to get social support and reminders that patients deserve doctors who take their concerns seriously.
3. It’s okay (and critical!) to acknowledge what we don’t know. The Invisible Kingdom reminds us that there’s still plenty of uncertainty in medicine — particularly related to concepts like autoimmunity. And if there’s one thing we learned from the last few years, when it comes to health comm, it’s that acknowledging what we don’t know is always best.

The bottom line: Check out The Invisible Kingdom for the story of one woman’s experience with invisible illness — plus powerful health comm lessons about empathy, isolation, and uncertainty.

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Tweet about it: Check out @CommunicateHlth’s latest pick for the We ❤️ Health Literacy Book Club, The Invisible Kingdom by @meghanor. Part memoir, part nonfiction, this powerful read has powerful lessons for #HealthComm professionals: https://bit.ly/3YYlj8g

Here at We ❤️ Health Literacy HQ, we’re fond of rethinking terms that have been hanging around for a while — but, for one reason or another, aren’t getting the job done anymore. Today, we’re pondering a term that often comes up in health care: “noncompliant.”

Health care providers and other professionals may label a patient “noncompliant” if the patient isn’t following instructions or taking steps to care for their health at home (like taking medicine consistently or making changes to their eating habits). Well, we think it’s time to ditch “noncompliant,” whether you’re talking to consumers or professionals.

First, “noncompliant” paints people as rulebreakers. The word reminds us of a student getting sent to the principal’s office — or someone who has “failed to comply” with a judge’s order. It sets up an us-vs.-them dynamic, painting doctors as the authority figure and “noncompliant” patients as people who choose not to follow their simple instructions. This dynamic brings shame into the conversation — and we know, dear readers, that shame isn’t an effective tool for behavior change.

“Noncompliant” also fails to acknowledge the many reasons why people may struggle to follow health advice. Sure, it’s possible that some people just don’t like being told what to do. But we’d argue that many more people “fail to comply” for reasons outside their control. For example, if a doctor tells their patient to eat more fruits and veggies, but the patient lives in a food desert, they’re going to have a hard time finding those healthy options.

Or let’s say a doctor tells a patient who’s struggling with depression to get more physical activity. A 15-minute walk might boost the patient’s mood, but when you’re depressed, it can feel impossible to leave the couch. Similarly, many people with ADHD and other neurological conditions struggle with executive function— basically, the skills you need to plan ahead and stick to your plan. AND lest we forget that the instructions may have been so convoluted and jargon-y that the patient wasn’t clear on what they were supposed to do in the first place!

The way we talk about people influences how we treat them. Taking “noncompliant” out of our vocabulary reminds us to look at the whole picture, consider how social determinants of health play a role in individual well-being, and build respectful relationships with our audiences. Now that’s something we can get behind.

The bottom line: We think it’s time to ditch “noncompliant,” whether you’re talking to consumers or professionals.

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Tweet about it: This week, @CommunicateHlth explores why it’s time to ditch “noncompliant,” whether you’re talking to consumers or professionals: https://bit.ly/45CJL1H #HealthComm #HealthLiteracy

Here at We ❤️ Health Literacy HQ, finding effective ways to fight misinformation is one of our top priorities. It’s why we’re big fans of the trusty truth sandwich. And today we’d like to tell you about another important mythbusting method: prebunking.

Prebunking is based on inoculation theory, a psychological framework that aims to prepare people in advance to resist unwanted persuasion attempts. The idea? Just like giving people a weakened dose of a virus protects them from a disease, giving them a “weakened dose” of misinformation can help them spot misinformation in the future. And when it comes to health info, that can go a long way toward helping people make super important decisions.

Like its cousin debunking, prebunking disproves false claims — but prebunking is likely to have a more widespread impact. That’s because prebunking equips people to think critically about (mis)information rather than automatically accepting it as fact. Effectively debunking false claims, on the other hand, is notoriously hard. Once people accept something as true, explaining that it’s false may just not work.

Okay, back to prebunking. There are 2 main types of prebunks:

• Fact-based: warning people about a specific false claim they might see or hear — and correcting that claim
• Logic-based: explaining the techniques that people who spread false information use to manipulate folks

While both can help us combat misinformation, logic-based prebunks in particular can have far-reaching effects. Let’s play out an example. Say you’re creating materials to warn newly pregnant people about the dangers of crisis pregnancy centers — which masquerade as legitimate health centers but often lie and use shame and fear to keep people from getting abortions.

You might say: “Abortion does not raise your risk for cancer. Clinics that say it does are usually fake health centers that spread false information to prevent abortion. But the truth is that abortion is very safe. So be on the lookout for fake clinics that say otherwise!” (Look familiar? Yep, that’s a prebunk that basically takes the form of a truth sandwich!) This is a fact-based prebunk, and it may make sense to use fact-based prebunks strategically to address particularly widespread or harmful false claims. That said, crisis pregnancy centers spread so much false information that trying to refute each claim would be inefficient — and likely ineffective.

That’s where logic-based prebunks come in. Sticking with our example, this means clearly explaining the tactics these places use to prevent folks from getting abortions. For example, you could say: “Crisis pregnancy centers use fear and shame to try to keep people from getting abortions. So if a clinic gives you information that’s overly scary or makes you feel ashamed for considering an abortion, it’s probably a crisis pregnancy center and not a real health clinic. Clinic staff should give you the facts in a non-judgmental way that doesn’t make you feel bad about yourself or your decision.”

The bottom line: Prebunking is an effective method for fighting misinformation — especially when it helps audiences understand and spot misinformation tactics.

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Tweet about it: Prebunking is a super useful #HealthComm tool for fighting #misinformation, especially when you expose misinformation tactics. More from @CommunicateHlth: https://bit.ly/3sdLknU

Here at We ❤️ Health Literacy HQ, we don’t really need another reason to love libraries — but they just keep popping up on a printing press-sized platter. Yep, we’re talking about how libraries across the country are pushing back against attempts from conservative lawmakers and advocacy groups to ban books and restrict what people can access through their local library. (Don’t even get us started on recent book bans in schools!) For example, check out this TikTok video by a group of Illinois librarians, featuring a special guest appearance by a former President.

To no one’s great surprise, many of the books being targeted showcase representations of communities of color, LGBTQ+ people, and other groups already marginalized by right-wing conservative politics. As health communicators, we know how much representation matters. We also know that health education doesn’t just happen at the doctors’ office or in a classroom. It happens when kids look at a picture book that helps them understand how their bodies work. Or when tweens pick up a novel that gets them thinking about their gender identity. And yes, sometimes it happens when teens read about tough topics — like abuse or depression — and start asking equally tough questions.

The ability to make informed decisions about health — that is, the desired outcome when we create health education materials using health literacy best practices — depends on having access to accurate information, without censorship or political agenda. Full stop. And that’s exactly what our libraries are fighting for. So go ahead and show them some love in the name of (health) literacy!

The bottom line: Libraries provide free, equitable access to (health) information. Let’s help it stay that way.

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Tweet about it: Libraries across the country are fighting back against book bans. @CommunicateHlth is here for it: https://bit.ly/3KrTxe6 #UniteAgainstBookBans

Today, we’re going to finish our conversation about implicit (or unconscious) bias. As you may recall, we started talking about this topic last month, and it was clear right away that it was going to be a 2-parter. So, if you missed it or need a refresher, check out the first installment of this set before you read on. In that post, we discussed what implicit bias is, why it happens, and why it’s important.

We also explained how actively challenging stereotypes can help us work against implicit bias. Indeed, research suggests that when we intentionally challenge stereotypes, we can retrain our brains so that our automatic responses aren’t shaped by our implicit biases. For example, the piece we shared in part 1 from the American Academy of Family Physicians discusses the specific strategy of “counter-stereotypic imaging” — essentially, once you’ve identified a bias, you actively work against it by bringing positive, non-stereotypical images to the surface of your brain in order to replace your implicit responses. According to the piece, “as positive exemplars become more salient in your mind, they become cognitively accessible and challenge your stereotypic biases.” That’s the retraining part.

Here are a few more tips to help you check implicit bias at the door:

• Get comfortable thinking critically about your own perspectives and sitting with tough stuff. Challenging implicit bias isn’t easy — but it’s one of the most important things we can do as health communicators and, frankly, as people. Over the last few years, there’s been a long-overdue reckoning with the damaging health effects of institutional racism and the fact that traditional public health approaches have reinforced harmful inequities. That’s why our equity-centered health comm framework includes nuggets like this: “Humility in health communication is the practice of self-reflection on how our own background and biases impact every aspect of the communication process. And this includes an examination of power dynamics and imbalances in our work.” Try to make friends with the discomfort so that challenging implicit bias becomes second nature.
• Let your audience share their experiences and preferences. That means getting real feedback from real audience members to ensure you understand their needs and leverage the right strategies to meet them. It does not mean creating a narrative for them based on our understanding of their experiences.
• Build in time for reflection — on your own and with your colleagues. Put simply, uncovering and challenging our own implicit biases takes, well, time! That said, the public health field isn’t known for its abundance of available resources, so we recognize that this might not always be realistic. But when you can, take time as you develop your health comm materials or design your intervention to reflect on your own and with others on your project team. Talk to each other about what’s coming up for each of you — good chance you’ll learn something (and more likely, lots of things).
• Think carefully about intersectionality within audience segments. Effectively reaching our priority audiences often means tailoring our materials to very specific subgroups, or audience segments. But what we often overlook is the intersectionality that exists within these segments — we need to think both across and within audience segments. So if you’re working on materials tailored to Black women, are you also thinking about Black lesbians? Biracial women who identify as Black? Essentially, make sure the conversation you’re having with yourself and your colleagues is the whole conversation.
• Read materials multiple times with different lenses. Disclaimer: There’s nothing evidence-based about this, but we find that it can make a difference. If you’re working on an original material, “assign” yourself different lenses for multiple reviews. For example, if you’re writing about diabetes among Hispanic people, read the whole material through once while thinking only about how the content might land with your audience — not about whether your plain language explanation of diabetes is getting the job done. Isolating specific things you want to focus on helps your brain do just that: focus on them. (This is also a good strategy for proofreading. But we digress.)

Before we close this one out, we want to acknowledge that this is hard. Trying to be conscious of something that literally (sometimes) has unconscious in its name is hard! But if we’re going to approach this work with empathy — and help make sure our audiences feel seen, respected, and valued — it’s a must.

The bottom line: Challenging our own implicit biases is tricky. It’s also a must for health communicators.

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Tweet about it: In part 2 of a mini-series on #ImplicitBias for health communicators, the @CommunicateHlth crew shares tips to help challenge those biases in #HealthComm. Take a look: https://bit.ly/43F7MTX

This week, we’re discussing something we often encounter in health comm: BMI, or body mass index. As you probably know, BMI is a number calculated using a person’s height and weight. In the most basic terms, doctors (and insurance companies!) use it to put people into 1 of 4 categories: underweight, healthy weight, overweight, and obesity. This is supposed to help assess how much body fat a person has and their relative health.

But, as you also probably know, BMI has long faced criticism from experts in just about every relevant discipline — not-so-favorable characterizations have ranged from just not that useful for individuals to a racist, sexist, misused tool that’s done serious harm. Regardless, for the most part, BMI has stuck around. But a recent announcement from the American Medical Association (AMA) may be about to change that, and we’re here for it.

Last month, the AMA issued a press release detailing its new policy that clarifies how BMI should be used (with “other valid risk measures”) and aims to build that knowledge among health care providers. The release references a report that concluded BMI is “an imperfect way to measure body fat in multiple groups given that it does not account for differences across race/ethnic groups, sexes, genders, and age-span.” The press release doesn’t mince words:

Under the newly adopted policy, the AMA recognizes issues with using BMI as a measurement due to its historical harm, its use for racist exclusion, and because BMI is based primarily on data collected from previous generations of non-Hispanic white populations. … The policy noted that BMI is significantly correlated with the amount of fat mass in the general population but loses predictability when applied on the individual level. The AMA also recognizes that relative body shape and composition differences across race/ethnic groups, sexes, genders, and age-span is essential to consider when applying BMI as a measure of adiposity and that BMI should not be used as a sole criterion to deny appropriate insurance reimbursement.

Well! It certainly sounds like this could have some serious (and overdue) implications for the health care field and health communicators like us. There’s a lot to say about how this might affect the conversation about weight in health care more broadly (be on the lookout for more on that!). But for now, we’d love to hear from you: Does BMI have a place in health care? Are you celebrating its apparent demotion? What broader implications could this update have? How should we contextualize BMI in plain language health materials?

Respond to this email or find us on social (LinkedIn or Twitter) and let us know what you think! And to learn more about this topic, check out the July issue of AMA’s Journal of Ethics — it includes multiple articles that explore BMI’s history, its current use, and related ethical issues.

The bottom line: Hats off to the American Medical Association, which recently released a new policy scrutinizing BMI and clarifying its appropriate use. This could have big implications for health care (and health comm).

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Tweet about it: This week, the @CommunicateHlth crew is chatting about @AmerMedicalAssn’s new #BMI policy, which could have big implications for health care (and #HealthComm): https://bit.ly/46U0Yo5 #HealthLiteracy