Healthcare providers and consumers have similar instructional needs

Research done in preparation for these hearings makes it clear that device users—healthcare providers and consumers—seek information and instructions that are clearly written and illustrated to support ease of use.^{1 2} Both groups want instructions to be available in multiple formats, such as quick reference guides and DVDs, and both groups want multichannel access, including print and digital. Check out our infographic (below) to learn more.

At HealthEd, we are excited to see this issue being explored in a more public forum. Having developed and tested numerous Patient Instructions for Use documents and device training kits, we have come to the same conclusion. Users are users, whether they are providers or patients. And our experience has shown that all users want to understand quickly how to operate a device and incorporate its use into their personal or work routine. Read more about our approach in our learning paper Solutions for Success: Clear Instructions Can Benefit All Users.

HealthEd will be listening to the hearing to add to our knowledge. By doing so, we continue to turn learning into doing to benefit clients, healthcare providers, and patients.

(View a larger version of the infographic or share it on Visual.ly.)

References

1. RTI International. Medical Device Labeling for Healthcare Practitioners Focus Group Study.  http://www.fda.gov/downloads/MedicalDevices/ProductsandMedicalProcedures/HomeHealthandConsumer/HomeUseDevices/UCM335197.pdf.  Accessed April 1, 2013.
2. National Family Caregivers Association. Consumer Survey: Feedback on Medical Equipment Labeling/Instruction Information. http://www.fda.gov/downloads/MedicalDevices/ProductsandMedicalProcedures/HomeHealthandConsumer/HomeUseDevices/UCM335198.pdf. Accessed April 1, 2013. 

Laura Wilson, MEd
SVP, Health Education
HealthEd

Mindfulness

Since I have a background in integrative medicine, my ears tend to perk up whenever I hear people use words like mindfulness and centeredness outside a yoga or meditation class. Not only were these words mentioned, but they kept reappearing throughout the day:

• Neema Morajevi, director of the Calming Lab at Stanford, spoke about strategies to embed mindfulness into devices that already pervade our lives
• Jacob Reider, MD, chief medical officer at the Department of Health and Human Services, focused on the need for providers to feel “centered” themselves before they can truly help others
• Jan Bruce of meQuilibrium boldly declared that “stress is the new fat” and shared how stress is correlated with obesity

Although I’m thrilled that these topics are being valued and promoted, what does it say about our healthcare system that I had to go to a “design” conference to hear about topics related to prevention and wellness? I think it says that designers are awesome, and it reinforces the importance of making design strategy a critical part of planning for patient-centered educational programs.

Designing for behavior change

Aside from wellness, the other main theme that emerged was the importance of engaging the patient in behavior-change strategies. From the research I do with patients, I know that they have individual needs and goals related to their health and their treatment. However, it was inspiring to hear others approach behavior change from different perspectives:

• Jane McGonigal, game designer and creator of SuperBetter, who shared her indirect approach to behavior change for users who are in the midst of health crises. Instead of tackling specific health issues directly, she designs games that boost users' problem-solving skills, strengthen users' resiliency, and help users expand their own social support. These new capabilities in turn enable users to take control over their own health situations and foster posttraumatic growth
• David Sobel, MD, MPH, medical director of health education and health promotion at Kaiser Permanente, talked about the indirect health benefits of behavior change—the confidence that results from succeeding at something. He believes that the key predictor of a health outcome is not the behavior change itself but the increased self-efficacy that results from that change. We can help patients by working with them to identify a potential behavior change that is personal, specific, easy, rapid, and pleasurable

Lacking the patient’s own voice and involvement, a behavior-change program is unlikely to change behavior. This validates my view that clients must conduct user research before planning such programs, and they ought to consider interactive approaches where possible—to better engage patients in their own behavior change. 

All in all, the HxD Conference reenergized my passion for helping patients and also reinforced the work that we are doing at HealthEd—we listen to our patients, we understand their barriers and motivators, and we design programs to help them achieve better health outcomes. I learned a lot, was inspired, and met great people—what more could you ask for? Also, they offered free 15-minute chair massages. To me, that alone was worth the cost of admission.

Tara Rice
Manager, Health Educator
HealthEd

According to the US Census, slightly more than half of all children born in the United States every year are minorities. Despite the growth in minority populations, however, the healthcare system has not been able to rise to the need. Some minority groups may have more health risk factors and a shorter life expectancy than the general population.

To find out how healthcare professionals are trying to close this gap by engaging patients from minority groups, HealthEd Academy conducted a detailed survey of 192 healthcare extenders—non-MD healthcare professionals who work directly with and on behalf of patients. The full report, Engaging Patients From Multicultural Backgrounds, is available at www.HealthEdAcademy.com.

The findings reveal that healthcare extenders are treating an increasingly diverse patient population whose members speak a wide variety of languages. As might expect be expected, the most common languages spoken are English, Chinese, and Spanish. However, 40% respondents selected “other” as 1 of the 4 most common languages spoken by their patients—this after respondents were presented with a list of the 10 most common languages spoken in the United States. Respondents listed dozens of additional languages, including African, Arabic, sign language, Southeast Asian languages, and Indian/Pakistani languages.

Despite the diversity in languages spoken by patients, there is a homogeny in the patient education materials available. Often, creating materials in Spanish, for example, is an afterthought at best. Yet Spanish is just the very beginning of patient needs. About half of those surveyed don’t have access to patient education materials in the languages they need.

Respondents are also concerned about gaps in how well patients and providers can understand each other. Almost half of respondents say that they often or sometimes experience situations in which language differences prevent effective communication between them and their patients or caregivers. Also, 44% of respondents are often or sometimes uncertain how to best educate a patient or family member because of cultural differences.

These findings point to an acute need to give healthcare extenders the support and resources that will let them more effectively treat patients from diverse cultural backgrounds. The needs they have expressed will only continue to grow. Now is the time to turn our attention to healthcare extenders and the role they can play in ensuring safe and accurate preventive and medical treatment for all.

To download a free excerpt of the report or learn more about purchasing the full report, visit www.HealthEdAcademy.com.

Katie Margolis
Director, Health Behavior Strategy and Research
HealthEd

About the Health Design Challenge

The Office of the National Coordinator of Health Information Technology and the Department of Veterans Affairs issued a challenge to designers throughout the United States: imagine how personal health records could be improved for clarity, readability, and visual appeal. Given HealthEd’s mission to create better outcomes in personal wellness, the team embraced the Health Design Challenge with typical enthusiasm. 

The Health Design Challenge was more than an exercise in graphic design, however. Entrants were required to demonstrate expert knowledge of clinical systems and to render information of relevance for both millennials and senior citizens. The judges wanted more than pretty pictures—participants had to know their stuff.

Making Health Records Easier to Understand

A cross-functional team of experience designers, health educators, visual artists, information architects, and technologists arrived at 2 strong concepts deemed worthy of entry. One was a “health summary” scorecard that is transferable from doctor to doctor. It takes into account a patient’s holistic criteria at all steps of the health journey:

The other was a health records style guide created to help standardize how data could be parsed and interpreted across multiple off-line/online formats:

Obviously, the buzz around the office since Tuesday’s public announcement is a tremendous boost to the team of Susan Collins, Alyssa Costino, Michael Genkin, Michele Lomas, Dan McGorry, Ide Mills, Michael Parker, Venessa Perez, Marilin Polanco, and Tara Rice. More important, this recognition validates HealthEd’s commitment to the patient-centric ethos that drives our digital innovation. Our work continues to encourage productive dialogue between patients and their healthcare providers by removing barriers to comprehension.

Kel Smith
Chief Innovation Officer
HealthEd

Ever think about how pictures affect what you do in your daily life? Have you ever tipped a waiter a little more because he drew a smiley face on the bottom of your check? Or donated money to a local humane society when you saw pictures of puppies in its literature? Studies have shown that the frequency and size of a waiter’s tips were greater when a smiley face was present. And that showing pictures of puppies alongside a charity solicitation increased the amount of money donated, versus text-only materials.

Pictures can play an important part in all communications, and especially in health education.

The Fry formula, the Flesch-Kincaid test, the SMOG. These are all health literacy assessment tools. According to experts, some of these are better than others. But whether better or best, all of these tools do only 1 thing—calculate the grade reading level of materials in question.

HealthEd applies health literacy guidelines to all of its patient materials. We understand that written health education plays a major role in helping patients comprehend and apply positive behaviors to their treatment. And with 50 percent of all Americans reading below the eighth-grade level, using the appropriate grade reading level for the written word becomes even more important.

But the grade reading level of health education materials alone is only one guideline of many that help in the creation of effective patient education. According to the US Department of Health and Human Services, we must “use measures of reading grade level only in combination with other factors to judge ease of reading.” As a creative director, and one who speaks frequently on the role of design in creating materials that comply with health literacy guidelines, I am well aware that pictures and visuals are among those “other factors.”

Do pictures really affect comprehension of health education materials?

In a recent study involving 60 respondents with low literacy, researchers assessed how employing pictures affected patients' understanding of medication instructions. Of patients who received a leaflet with pictures, 93% correctly responded to the question “How must you take this medicine?” versus 47% for those who received text-only instructions. And when asked, “What are the actual times?” 73% who had been given the text plus pictures answered correctly, versus 3% of those who received the text-only version.

Many other health education studies have reached similar conclusions. Incorporating pictures into health education materials helps patients better understand the information. But as health educators, we know it’s not just about patients’ ability to comprehend the information. We want them to act on the information as well.

Do pictures influence people’s intentions and behavior in response to medical instructions?

A study of 234 emergency room patients compared 2 groups of patients given instructions for managing lacerations. Not surprisingly, 77% of those whose instructions were accompanied by pictures did what was recommended, versus 54% of those whose instructions were text only. A different study involved 78 nonliterate women. On average, women who received picture instructions took 90% of the pills prescribed for the affected time period, versus 78% for the women who received only spoken instructions.

So, it seems logical to assume that incorporating pictures into health education can not only enhance comprehension but also help patients accept the message as something they should act on. With that in mind, here are some recommendations for using pictures in health education:

Look for ways to include pictures

    Think visually and ask, “How can I use pictures to support key points?”

Use the simplest drawings or photographs possible

    This helps viewers with low literacy skills to understand the intended message without being distracted by irrelevant details.

Guide viewers' perception and interpretation of pictures

    Use captions that describe what is happening in the picture and that link to text through proximity.

Be sensitive to the culture of the intended audience

    Readers want to see themselves and their concerns related in the piece. If they don’t, chances are they will not fully understand the information.

Evaluate the effect of pictures

If possible, conduct follow-up interviews that assess attention, understanding, recall, and adherence as it pertains to the inclusion of pictures in the pieces. We understand that the grade reading level of health education materials can be a make-it-or-break-it point for patient comprehension. Writing copy at a lower grade reading level can certainly help readers understand the information. But words alone won’t do the trick. As referenced above, pictures along with copy allow for better  comprehension, better recall, and ongoing adherence to treatment regimens than does just plain text with no visuals.

And can also lead to higher tips. Just ask the waiter with the smiley face. 

Ken Thorlton
SVP, Creative Director
HealthEd

Instilling a love for reading reaps long-term rewards

According to numerous literacy studies and childhood development experts, children with strong reading and writing skills and a love of books are more likely to be successful in school and in their adult lives than are children with weak skills. The National Commission on Reading states that reading aloud to children is the single most important activity for building the knowledge required for eventual reading success. Yet children from low-income families do not have access to the multitude of resources and opportunities that their peers without financial hardship receive. And the National Center for Children in Poverty reports that the achievement gap for low-income young children starts early in life and is difficult to reverse.

The most successful way to improve the reading achievement of low-income children is to increase their access to print. Reach Out and Read is a national nonprofit organization that promotes literacy as part of pediatric primary care. The goal is for children to grow up with a love of reading and to develop literacy skills early so these children can enter school prepared for success.
 
Pediatric healthcare providers support reading to young children

Reach Out and Read trains doctors and nurses to advise parents about the importance of reading aloud and to give books to children at pediatric checkups from 6 months to 5 years of age. The organization has a special focus on children growing up in poverty. Children participating in this program have been shown to enter kindergarten better prepared to succeed and have:

• Larger vocabularies
• Stronger language skills
• A 6-month developmental edge over their peers

HealthEd supports Reach Out and Read

HealthEd recognizes that these families need our help and has pledged to support the local chapter of Read Out and Read at the Bristol-Myers Squibb Children's Hospital at Robert Wood Johnson University Hospital. Throughout the year HealthEd donates new and developmentally appropriate books for children 6 months to 5 years old. In honor of health literacy month, please help nurture a love for reading among children from low-income families. To learn more, go to http://reachoutandread.org.

Ide Mills, LCSW
Senior Vice President, Health Education
HealthEd

The challenge was a collaborative effort between The Office of the National Coordinator for Health Information Technology (ONC) and the US Department of Veterans Affairs (VA). The intention was to re-imagine how personal health records (PHR) could be improved for clarity, readability, and visual appeal.

The HealthEd team separated into 2 groups and embarked on a journey of intense effort, amazing thinking, and the kind of satisfaction that results from doing something you really love. Our submissions can be found below; both entries demonstrate how PHR can be integrated into clinical systems, yet rendered accessible across multiple formats.

Health Resume
The Health Resume provides a holistic view of the patient’s current health.  A health score determined by body, emotional, and lifestyle factors helps the patient easily identify where s/he is most healthy and where there’s room for improvement.  Relevant and immediate medical data is presented in an easily consumable format for patients, caregivers, and doctors to quickly gain an understanding of the patient’s active conditions and treatments. 

 (click to enlarge images)

The intent of the Resume is to transfer the wealth of medical knowledge from doctor to patient in a way that the patient can understand and take informed action to improve his/her health. 

Patient-Centered Design Pattern
"Patient engagement" starts with patients not only accessing health information but also feeling comfortable and confident enough to act on the health information. With that in mind, the design pattern was built to support behavior change by providing strong visual flags for important information that must be acted on.

 (click to enlarge images)

Standardizing how to treat patient information will ensure patients not only have access to their data but can also work successfully toward their health goals. 

Venessa Perez
Director, Digital Product Strategy
HealthEd

As noted on the Movember Web site: “Mo Bros effectively become walking, talking billboards for the 30 days of November. Through their actions and words, they raise awareness by prompting private and public conversation around the often ignored issue of men’s health.”     

In addition to the men growing mustaches and some healthy competition we have set up, HealthEd has developed a series of newsletters to educate staff and their family and friends about 6 health issues of serious concern to men. The newsletters define the health topic and highlight who may be at risk and what steps one may take to mitigate the risk. Information about screenings and additional resources is provided in each newsletter. Short and to the point. Isn’t that what we are looking for today—sounds bites of information?

Taking action for better health

Knowing is one step, but taking the action is the next step. And HealthEd staff took action. Last year, we measured the impact of our educational interventions for Movember. We aimed to improve our staff’s awareness of the issues, the ability to have these health discussions, and knowledge of when to seek appropriate examinations. Among our staff members, 83% of women reported having discussed Movember with family, friends, and/or colleagues, and compared with the previous year, 20% more of our female staff reported having encouraged a male to get screened for prostate cancer. We measured a definite increase in awareness and self-efficacy for men’s health discussions and examinations in the offices.

As for HealthEd's men, the data show that there was a 15% increase in the number of them who had been screened for prostate cancer and that 60% of men felt confident in their ability to get a complete health checkup within the 3 months after Movember. These numbers show that both men and women in the office began taking more active roles in men’s health, which coincides with an increased awareness  and self-efficacy regarding men’s health discussions and examinations.

We anticipate another successful Movember—spreading the word about men’s health issues.

And Happy Thanksgiving!

Ide Mills, LCSW
Senior Vice President, Health Education
HealthEd

In our media-saturated culture, health literacy has taken on a new meaning in the world of online health information. Although there is an abundance of health information available online, if people don’t know where to find it, what good is it? And if health information is only as trustworthy as its source, what happens if people don’t understand the need to think critically about the information that they find on the Internet?  Simply having access to the Internet and having computer and Web skills do not guarantee that a person will be able to evaluate and understand online health information. Even though the Internet has offered us much more access to health information, without the media literacy skills needed to find information and interpret it correctly, many people are still at a disadvantage. 

People trust what they read online

From my own experience, I have realized that online information is not always useful or credible. And depending on the subject, sometimes I've had to sort through a lot of content to find what I’m looking for. But fortunately, I’ve had the opportunity to build the media literacy skills needed to access health information and, more important, convert that information into knowledge that I can apply to my own health circumstances. But research shows that many people do not have these skills. Many people consistently believe what they read online, regardless of the credibility of the content and source.¹ In fact, a Pew Internet report stated that 72% of health seekers said you can believe all or most online health information, and 69% said they had not seen any wrong or misleading health information on the Internet.¹

This type of trust in online information invites the need for media literacy skills. By definition, media literacy consists of someone being able to²:

• Recognize when information is needed
• Locate the right information
• Critically analyze the content
• Understand what actions to take

Ways to increase media literacy

So what can be done to increase media literacy skills? Well, one idea is to empower healthcare providers to help patients’ improve their media literacy skills. Currently, this type of education does not seem to be taking place. In fact, some research shows that providers do not routinely assess patients’ use and evaluation of online health information.³ And only 22% of patients reported that a healthcare provider had suggested an Internet Web site to them.³ Assessment of patients’ knowledge is a key aspect of clinical practice. If providers routinely asked patients about any information found online, it would help providers better understand patients’ knowledge level and provide an opportunity to clarify or correct any misinformation. But healthcare providers should not only be aware of the information their patients are currently reading online but also help patients find credible sources and interpret the information with them. 

From this type of exchange, patients will build valuable skills to manage their own health conditions and be able to apply these media literacy skills to aspects of their lives outside of healthcare.

References: 

1. Glinert L. Prescription drug brand Web sites: guidance where none exists. Inov Pharm. 2010;1(1):1-15.

2. Levin-Zamir D, Lemish D, Gofin R. Media health literacy (MHL): development and measurement of the concept among adolescents. Health Educ Res. 2011;26(2):323-335.

3. Gilmour JA, Scott SD, Huntington N. Nurses and Internet health information: a questionnaire survey. J Adv Nurs. 2008;61(1):19-28.

This blog is brought to you by HealthEd as part of our commitment to Health Literacy Month ... and to creating a healthier world. We are excited to share with you a series of tools, resources, and thought-provoking ideas. We hope you will join the conversation. Visit our health literacy page on HealthEd.com, watch for our blog updates, and follow us on Twitter.

Tara Rice, MPH
Manager, Health Education
HealthEd

Mutual respect and words of wisdom

I was fortunate to meet John Balan, the founder of the CLL (chronic lymphocytic leukemia) Information Group. I noticed him before a breakout session started. He was engaged in a conversation with the speaker, Richard Furman, MD. The doctor was listening intently, smiling in response to Mr. Balan’s comments. I was awed by their relationship, which appeared to be one of mutual respect.

Dr. Furman began his talk by saying he very much wanted the session to be open and inviting us to ask questions. The information he shared and the slides he showed were highly technical, and yet he did an excellent job breaking down the science for all of us. He used analogies to explain and reinforce the chronic nature of CLL. When Dr. Furman referred to a slide showing the complex CLL intracellular microenvironment, he focused on the advances being made to develop targeted therapies for a specific "road" on the "superhighway" of cellular communication. The rest of the image was a backdrop for Dr. Furman to express his genuine excitement and hope for the future to develop even more drugs directed at a specific intracellular target. The audience did not need to focus on the details of the PI3K or Btk gene; rather, we focused on Dr. Furman’s sincerity and honesty. When asked how scientists know what to attack in the microenvironment, Dr. Furman showed both his bewilderment with the science and his enthusiasm for the advances of 2 drugs he is currently studying in clinical trials.

Lymphoma experts share their knowledge and compassion

The first half of the day included talks by 3 leading oncologists: Owen O’Connor, MD, PhD; Steven Horwitz, MD; and Jeremy Abramson, MD. Each of their presentations was enlightening as I listened intently and wavered back and forth between the thoughts - Do I listen and try to take in the information and Do I scurry to write notes. Thankfully I already knew some of the information being shared, so I could sit back and listen. This allowed me to apply what I was hearing to ponder questions such as “How have treatment options improved?" and “What do newer therapy options mean for those making a treatment decision?” Yet there was so much more to learn about lymphoma that I also quickly wrote notes, trying to take in the doctors' thorough and clear presentations. Their commitment to quality of life and quality of care was apparent in their presentations. As with Dr. Furman, these 3 physicians answered thoughtful audience questions that demonstrated the extensive patient experience.

Each doctor took additional time to talk with the long line of people whose questions were more specific to their personal situation or who did not want to speak in public. When a person is faced with a life-threatening chronic illness, the myriad of questions seem never ending. How reassuring to have time with a renowned expert.

Saturday I learned a great deal about follicular lymphoma and chronic lymphocytic leukemia and the changing treatment landscape. As Dr. Abramson said, “Clinical trials are the engine of medical progress,” and thanks to trial work in lymphoma, people have reason to be hopeful. Thank you to the Lymphoma Research Foundation for holding such an informative meeting.

 

Ide Mills, LCSW
Senior Vice President, Health Education
HealthEd