Despite an enormous investment in health education campaigns, studies find that many important messages concerning health promotion and disease prevention are not sinking in.
Although numerous government agencies, public health groups and company-sponsored programs have filled the airwaves with clear-cut messages about such important factors as regular
physical activity, healthy weight, good nutrition, smoking cessation and the need for regular health screenings, many people are simply not taking these steps even though they
might help them live longer.
From a health communications standpoint, what does this mean? According to a new body of research, the problem is not that Americans don't care about their health outcomes but
that many lack health literacy - meaning they are unable to process the health information available to them.
First identified in 1974, health literacy is a real problem. In the largest study of health literacy to date, one third of English-speaking patients at two public hospitals
were unable to read basic health materials. Forty-two percent of patients could not comprehend directions for taking medication on an empty stomach, 26 percent were unable to
understand information on an appointment slip, 43 percent did not understand the rights and responsibilities section of a Medicaid application, and 60 percent did not understand a
standard informed consent document. These findings were reinforced by a recent study of community-dwelling Medicare managed care patients in four cities which revealed that 34
percent of the English speaking and 54 percent of the Spanish speaking patients had inadequate or marginal health literacy.
Even when it comes to how Americans treat such common ailments as coughs and colds, fever, heartburn, and aches and pains, research finds that many Americans are not heeding
basic information when taking over-the-counter remedies. According to a major national survey commissioned by the National Council on Patient Information and Education (NCPIE) and
released in January, even though three-fifths of Americans take non-prescription medicines routinely, most consumers don't know the active ingredient in the OTC products they are
using.
Policy-makers are sounding a wake up call that the problem must be addressed. In fact, the federal government's Healthy People 2010, which lists the health objectives for the
nation, calls on all stakeholders - health professionals, educators, corporations and government agencies - to recognize the problem and to take a number of specific action steps.
Of key importance is creating effective, culturally and linguistically appropriate, plain language health communications.
Healthy People 2010 calls for the construction of health messages and campaigns that stress these communications attributes:
- Accuracy - where the content is presented accurately
- Availability - so that the intended audiences will have easy access to targeted messages and specific information
- Balance - presenting information about a specific health topic within the context of both benefits and potential risks
- Consistency - ensuring that the information is consistent with information from other sources
- Culturally competent - whereby the design, implementation and evaluation process addresses special issues for select population groups
- Evidence-based - so that the content and strategies are based on formative research with the intended audience
- Reach - ensuring that the content gets to or is available to the largest possible number of people in the target population
- Reliability - demonstrating that the source of the content is credible and the content itself is kept up-to-date
- Repetition - allowing for repeated delivery of/access to the content, both to reinforce the impact with a given audience and to reach new generations
- Timeliness - so that the content is provided/available when the audience is most receptive to the specific information
- Understandable - ensuring that the reading language level and format (including multimedia) are appropriate for the specific target group
Thus, as health communicators, we have an important role to play not only in raising awareness of health risks and solutions but in making sure that we reach patients/consumers
with marginal or low health literacy so they too will have the information they need to better manage their health.
Health Literacy: Facts At A Glance
According to Healthy People 2010, health literacy is a growing national concern. The report provides the following snapshot of the extent and impact of the problem:
- The National Adult Literacy Survey conducted by the National Center for Education Statistics finds that approximately 90 million adults in the United States have
inadequate or marginal literacy skills - The average annual healthcare costs of persons with very low literacy (reading at grade two or below) may be four times greater than for the general population
- An estimated 75 percent of persons in the United States with chronic physical or mental health problems are in the limited literacy category
- Changing demographics suggest that low literacy is an increasing problem among certain racial and ethnic groups and non-English-speaking populations.
- As the population ages, low health literacy among elderly people is becoming an increasing concern. A study of patients 60 and older at a public hospital found that 81 percent
could not understand basic materials such as prescription labels and appointments.