Category: We Heart Health Literacy

We ♥ health literacy, of course! But where did that term come from, anyway?

The term “health literacy” dates back to a 1974 article by Scott Simonds, which advocated for health to be part of standard education requirements, like writing and math. Like so many other inventions from the 1970s — video games, Post-It notes, and Walkmen — health literacy has come a long way since then.

A newer definition in use today traces back to a National Library of Medicine Bibliography from the year 2000. It says that health literacy is:

• The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.

This mouthful of a definition was adopted in 2000 by Healthy People 2010, and by the Institute of Medicine in 2004. It was updated again in 2010 when health care reform was passed. The new law only added one word to the earlier definition, but it’s an important one.

• Title V of the Patient Protection and Affordable Care Act defines health literacy as “the degree to which an individual has the capacity to obtain, communicate, process, and understand health information and services in order to make appropriate health decisions.”

To make things easy, we often shorten it to:

• Health literacy is the ability to find, understand, communicate, and use health information.

Some researchers now describe health literacy as “dynamic,” meaning that people’s health literacy varies depending on their emotions and stress level as well as on which medical problem they have, how their doctor communicates, and other aspects of the health care system. We ♥ this view of health literacy because it takes into account the give and take between patients and the health care system as a whole (if you dig this, check out our post on the Calgary Charter).

The bottom line: The concept of health literacy has been around since the 70s, but it’s grown up since then — and it’s still evolving.

TV and movies can be powerful tools for conveying health messages to a wide audience. A 2008 report by the Kaiser Family Foundation and USC Annenberg found that 1 out of 4 people say that “entertainment television” is one of their top sources of health information. That’s a lot of people! And it means that TV is a potential platform for improving health literacy.

Successful collaborations between TV producers and public interest groups have bolstered public health campaigns about issues like smoking, seatbelt use, and designated drivers. Researchers found that an episode of the crime show Numb3rs that focused on organ donation directly inspired more people to become donors. And when Katie Couric had a colonoscopy live on national TV in 2000, colonoscopy rates increased by more than 20% in the months that followed.

We did our own (informal) research around the office and asked: What’s your favorite depiction of the importance of health literacy in popular culture? Do you remember a movie or TV show that changed your understanding of a health issue?

Some of us remembered the fails better than the successes — when shows pushed an issue in a clumsy, preachy, afterschool special way. One of our designers, Cozette, called out the 1990s high school sitcom Saved by the Bell’s legendarily over-the-top attempt to warn kids about the risks of caffeine pills. Jessie Spano’s highly-caffeinated freak-out would go on to launch a thousand .gifs.

Other staff noted that shows and movies about zombies — once C-grade horror staples — now tend to be mini lessons in epidemiology, complete with facts about vectors and exposure pathways. The zombie apocalypse survivors on The Walking Dead even visit CDC! (Better yet, CDC got in on the fun as a way to promote messages about preparedness.)

But our favorite — or at least our most sincere — story about health literacy intersecting with pop culture came from Amy, a senior editor. She said:

I saw an episode of ER in the 1990s in which a woman died because she accidentally overdosed on pills. She and her husband only spoke Spanish. The main characters were struggling to find out why the woman died, and then the big reveal happened — the medicine label said, “Take once a day.” But “once” is the word for “eleven” in Spanish. My middle school mind was blown.

The bottom line: Public health messages in pop culture can be effective teaching tools — and we’re sure to see a lot more of them in the future.

Wouldn’t it be great if science always gave us simple answers? You run some tests, look at some data, and BAM! — you arrive at a straight-forward, easy-to-understand conclusion (think “the world is round”).

As it turns out, science rarely works that way. Most studies reveal a whole bunch of complicated results. Like, “the substance has a 10% chance of harming you,” or “1 out of 4 study participants had fewer symptoms after taking the medicine.” In other words, they’re fuzzy.

As health communicators, we’re often charged with explaining these fuzzy findings. But how do you do that and still keep your message clear?

The key, as usual, is to think about your audience.

Do your readers want to know that 7 out of 10 studies show that 95% of people with a certain condition who took a drug had side effects, but were also 25% less likely to go to the emergency room? Probably not.

Rather, your readers want to know what the studies mean for them. It’s up to you to tease meaning out of these findings and translate them into plain language.

So, instead, you might say:

Some people who take this medicine don’t have as many flare-ups of their condition, so they’re less likely to need an emergency room visit. But most people who take the drug have side effects, like feeling dizzy or coughing. Talk to your doctor to see if the drug is the right choice for you.

Even if findings are complicated, they don’t need to be confusing.

The bottom line: You don’t have to relay the nitty-gritty of complicated scientific findings. Instead, write about what the findings mean for your reader.

Lately, we’ve been giving a lot of thought to something that comes up again and again in our plain language conversations: the medical consent form.

The consent form issue is a tricky one for a number of reasons — there are legal implications, and different doctors or hospitals might have specific requirements. There’s also the loftier ethical discussion about what informed consent actually is (and whether it’s truly possible to obtain it).

But without going too far down that road, we want to suggest that perhaps the conversation isn’t about the form itself, but rather when to get consent.

We know people’s ability to understand and use health information is affected by how sick, anxious, or scared they are. Why, then, do health professionals present these often unwieldy and confusing consent forms at the time of a health service or procedure?

Of course we acknowledge that emergency care is different and, depending on the circumstances, there may be no other choice. But there are many, many medical procedures that are not emergencies — and for those, health professionals often ask for patients’ consent minutes beforehand.

Our proposed solution? Move the consent form process (and discussion) to an appointment before the service takes place. Patients need to hear about the risks of the procedure before they’re sitting in front of the doctor in a gown.

Here’s an example: You’re going in for a colonoscopy. You’ve taken the day off from work, secured someone to drive you home, and fasted for a day. The nurse asks you to sign a consent form. Are you going to read it carefully? Is this the moment that you are going to ask your doctor about all your options?

We didn’t think so. And who can blame you? You’re hungry, anxious, and resigned. From the consumer perspective, the “consent” form was totally useless.

But what if you got all of the information and had the opportunity to discuss it with your doctor at your last appointment? Would you think a little bit more about what it means to sign on the dotted line? We bet you would.

The bottom line: To make consent forms truly effective, look at the whole process — not just the words on the paper.

A good homepage marries design, content, and usability. But what exactly does that look like? People often ask us for examples — so here are a few homepages that we ❤ and why we ❤ them.

• ourbodiesourselves.org
  Hooray for actionable buttons and plain language!
• hioscar.com
  We’re not usually a fan of splash pages, but this one really focuses on a single, clear message — which is important for a young company with a new idea.
• letsmove.gov
  There’s no question what this website is about — and the colors really make it pop!
• cancer.org
  This homepage makes it really easy to find what you’re looking for without scrolling endlessly.
• healthymagination.gehealthcare.com
  When you think of how complicated this homepage could be (diagnostic imaging options, anyone?), you understand what a feat it is that they’ve made it this simple.
• plannedparenthood.org
  Great colors and a user-friendly design make this one of our favorite homepages.
• healthcare.gov
  The latest facelift of this one makes it even easier to use.

Every one of these homepages lets you know what the website is about right away — who they are, what they do, and how they want you to feel.

What are your favorites? Share them in the comments below.

The bottom line: There’s no single way to make a perfect homepage, but some really stand out from the crowd — in a good way!

A lot of media outlets have made a good effort to clarify how a person can and cannot get Ebola. But confusion persists. Could it be a health literacy issue?

Think about it: When was the last time that terms like “bodily fluids,” “mucous membranes,” and “infectious” got so much traction in newspapers and news reports? Is it safe to assume that people know what these terms mean? (And that everyone has seen Outbreak at least a dozen times like us health geeks?) Of course not, dear readers.

Let’s take a look at some common terms used in the Ebola news coverage.

Bodily fluids
This one is everywhere. As in, “Ebola is passed from person to person by contact with infected bodily fluids.” But what exactly is a bodily fluid?

It helps to give examples:

You can get Ebola from contact with the bodily fluids of someone who has it — for example, blood, saliva (spit), vomit (throw up), feces (poop), urine (pee), or sweat.

(And if you need advice about how to handle those, umm, sticky terms, we’ve got you covered.)

Direct contact
This goes hand-in-hand with “bodily fluids,” and unfortunately presents equal potential for confusion. You need to have direct contact with the bodily fluids of someone with Ebola in order to get it. But what other kinds of contact are there?

Again, be sure to clarify the information with examples.

To get Ebola, you have to have direct contact with the bodily fluids of someone who has it. Examples of direct contact include infected fluids getting into your mouth or eyes — or touching a cut on your skin.

Mucous membrane
This is a jargon term if we’ve ever seen one. And what do we do with jargon, team plain language? Define, define, define.

Ebola spreads through direct contact with mucous membranes such as your eyes, your mouth, or the inside of your nose.

You get the idea. Remember: In the face of fear and uncertainty, plain language saves the day. Keep it up, fellow health literacy advocates!

The bottom line: The Ebola outbreak is an extremely tragic situation. It’s also a very good reminder of why plain language and clear communication are so important.

We really hate to do this, but we’re asking for your help.

We know, we know — your Facebook and Twitter feeds are already flooded with similar demands. “Like” this, retweet that, gimme money for my poorly-conceived Kickstarter, and so on. But we swear, this is different — a project that anyone committed to health literacy can get behind.

We’ve applied for a $150,000 grant through the Chase Mission Main Street fund to back a project we’re super excited about — Picture Public Health, a database of stock photos specifically designed for health communicators.

Sure, the web is chock-full of stock photos tagged “health” already, but we’ve written about our struggles with the available selection before. Basically, it can be hard to find health-related photos that aren’t terrible.

So we’ve been working to create a library of stock photos showing real people doing healthy things. That means no Photoshopped models staring blankly at forkfuls of salad, no silhouetted figures striking yoga poses on the beach, and no photos tagged “bike safety” showing kids riding without helmets.

This project won’t only benefit us and the people who use our products. Our goal is to make Picture Public Health accessible to everyone — and affordable for public health organizations on a budget.

This project is dear to our hearts, but we need funding to pull it off. That’s why we’re asking for your help.

So follow the directions below and cast a vote for real, engaging stock photos for health communicators! If we get enough votes by October 17, we’ll make it into the next round.

Thank you. And we promise, we won’t make a habit of this.

Help Us Win a Chase Mission Main Street Grant in 3 Easy Steps

1. Go to our Business Profile
2. Click “vote now” to vote with your Facebook account (don’t worry — it won’t post to Facebook when you vote)
3. Kick back and bask in your awesomeness

The bottom line: Health communicators need better photo options. You can help.

As bulleted list enthusiasts, we often get asked about how to punctuate them. Style guides are all over the place on this issue, but we like to keep it simple (no surprise there). That’s why our answer is: Whenever possible, don’t punctuate bullets in consumer health materials.

If you have a list of things or incomplete sentences, never punctuate them.

We ❤ Health Literacy is:

• An excellent resource that I forward to all my friends
• The best
• Helpful

If you have a list of complete sentences, you really don’t need to punctuate those either.

Our favorite use of lists is for action items. Be sure to:

• Use lists to break down information into helpful pieces
• Add lists to your top 10 favorite things
• Make lists about lists every day

See? Clear information, no punctuation needed!

If you feel like your list isn’t clear without punctuation, rethink it. Does the information need to be broken down into smaller chunks? Is it more appropriate for short paragraphs than a list?

And please, whatever you do, don’t use semicolons.

The bottom line: Keep your bulleted lists simple and skip the punctuation.

Picture this: you’re drafting an oh-so-health literate health material, slicing through jargon with your razor-sharp plain language skills, when you hit a medical term that leaves you stumped: the dreaded “inflammation.”

At first, you may think it’s an easy fix. In plain language circles, it’s not uncommon to say inflammation = swelling, the end! But not so fast. “Swelling” might work for an inflamed knee or elbow, but what about chronic inflammation that causes sneakier problems?

The truth is, inflammation isn’t the same as its symptoms — it’s a complex process in the body. So unfortunately, you can’t change every “inflammation” to “swelling” and still be medically accurate.

So what’s the solution? As is so often the case, it depends on the context. First, decide if your audience needs to know the word “inflammation” at all.

When people have inflammation from a cut or injury, they may not need to know the underlying cause of their symptoms. So stick to what they can actually feel or see.

Instead of:

• Call your doctor if you see signs of inflammation near the cut.
• Apply ice to reduce inflammation in the knee.

Try:

• Call your doctor if the area near the cut gets red, swollen, or hot.
• Put ice on your knee to help reduce swelling.

But when people have inflammation as part of a chronic disease, they need to know the lingo — and “swelling” won’t cut it. In that case, follow these tips to explain inflammation:

• Start with the system. Inflammation begins with the immune system — so your story should, too. Explain how inflammation can mean that the body is fighting an infection — or, in the case of autoimmune diseases, that the body is fighting… itself.
• Skip cytokines and the like. As a health whiz, you may be comfy discussing all the teensy molecules at work in inflammation. But people with complex health conditions are likely already drowning in scary jargon. So don’t drag their attention down to the molecular level.
• Tailor the symptoms to the situation. In some health conditions, swelling might be the only sign of inflammation. But inflammation can also affect less visible body parts, like the heart — and cause more subtle symptoms, like fatigue. So list specific symptoms for each condition, and ditch the one-size-fits-all approach.

The bottom line: Don’t inflame your readers with unnecessary “inflammation” — and when you need to use the word, explain it in plain language.

Tweet about it: “Inflammation” got you down? @CommunicateHlth has #HealthLit tips to demystify this tricky term: https://bit.ly/39eJlAG

Let’s face it: The best-written web content is useless if your audience can’t access it. Many of us take our ability to find information online for granted, but did you know that about 1 in 5 people copes with some type of disability? Unless you make sure your content is accessible, many people may not be able to get your otherwise wonderful health information.

Don’t panic. We’re here with some tips to make your web content accessible to everyone.

Images
Many people with disabilities use assistive technologies, like screen readers, to access information on the web. Screen readers are software programs that “read” electronic text and graphics out loud. They allow people with visual impairments to hear what’s being displayed on a screen. That’s why you need to include clear text descriptions of the images you use in your content. This language is called alternative (alt) text.

Good alt text is descriptive and explains not only the image, but also how it relates to the content on the page. For example:

• Okay: “man washing hands”
• Way better: “a man washes his hands with warm, soapy water before cooking his meal”

Content
The most important step you can take is to follow health literacy best practices and make sure content is clearly written and easy to read. But you already knew that! Also be sure to provide:

• Headings for text and tables
• Alt text for images and graphics
• Link labels that make sense out of context — for example:

Okay: “Sign up”

Way better: “Sign up for the We ❤ Health Literacy weekly email”

Design
Design with this alphabet of users in mind. (We know — how cool is that blog post?!)

The bottom line: We all have a responsibility to make health information accessible to everyone.