A broad number of trends and issues have been accelerated or exposed by COVID-19. One of them is the matter of health literacy.
Even in developed countries with high levels of general education, such as the US or the UK, there is marked variability in the understanding of information about health.
At the same time, it’s clear that the pandemic will have a significant impact on many people’s long-term health and wellbeing. Therefore the role of healthcare communicators in effectively reaching and engaging with audiences about their health has never been more important.
The WHO has, ironically, coined a quite wordy and complex definition for health literacy, so it’s perhaps most succinctly described as a person’s ability to access, understand and use information to be healthy. That ability is influenced by a range of personal characteristics and social resources.
Professor Don Nutbeam, the University of Sydney social scientist who has probably done more than anyone to academically advance and promote the concept of health literacy over the last 20 years, landed on three ‘types’ or levels of health literacy: functional, interactive and critical.
Functional health literacy is about the basic understanding of information in everyday situations – medicine labelling or social distancing signage, for example. Interactive health literacy relates to ‘participation’ and an ability to apply information from different places. This would include reading a web page about symptoms and asking your doctor questions.
The possession of critical health literacy skills – the ability to analyze information relevant to you and know which content to trust – is today more vital than ever. In an era of information overload, this can be a significant challenge for even the most literate – especially during a fast-moving pandemic. While practical access to basic health information has become easier in recent years, filtering and applying the right advice is now much, much harder.
To positively influence health outcomes, people need to quickly understand the ‘what’ and – vitally – the ‘why’ in a way that engages and means something, personally, to them. Only then can they be persuaded to act on a message and positively adapt their health behaviors.
Link Between Literacy and Outcomes
The relationship between health literacy and a range of health outcomes is well established. There is a clear correlation between low levels of health literacy, socioeconomic disadvantage and chronic illness. This means that those who could most benefit from the right health information can be the least likely to find and understand it. Worsened economic circumstances, deteriorated mental health and reduced access to secondary care services all disproportionately affect those who most need clearer, more meaningful information to help them manage and improve their health.
For example, many of those who suffer from a chronic condition are more likely to engage in unhealthy behaviors like excess alcohol consumption and less likely to engage with screening or vaccination programs. They need the most support, but find it difficult to understand and therefore act on the information intended to help them.
To ensure our campaigns genuinely engage those we aim to help, we must take the time to truly understand our audiences’ levels of health literacy. We may be surprised by what we find.
For example, work undertaken by the UK’s Stoke-on-Trent City Council, as a member of the WHO European Healthy Cities movement, revealed that 49% of the city’s adult population has inadequate health literacy. The finding is representative of Europe on average, with data suggesting around 47% of the European population has a level of health literacy that is inadequate or problematic.
This means that when we’re designing patient support materials, creating interactive resources or communicating with non-health professionals in any way, we must assume that around half the people seeing the content will struggle to understand it. Creating infographics or self-diagnostic digital tools must take into consideration the likely level of understanding of the people we want to use them. Otherwise there’s little chance that people will take the intended positive action to benefit their health.
One of the recommendations from the work undertaken in Stoke was to ensure a ‘multi-agency’ approach to health engagement, including working with patient groups and advocates – which reflects best practice in our industry. A collaborative approach has also been put forward by Professor Nutbeam, who advocates community-based educational outreach to help people make better health decisions.
A good example of this approach is the award-winning public campaign by NHS Sussex that helped reduce unwanted teenage pregnancies in East Sussex, UK, by 11% – more than twice the anticipated KPI – in a single year. The messaging and visual language was co-created with youth club members and pupils in school lessons. The resulting campaign featured a simple headline: “Which one is easier to carry?” followed by two images—a baby and a condom.
Sometimes, lack of understanding isn’t due to a low level of literacy or messages that don’t resonate, but the result of communicators trying to address too many audiences and reaching none. In a quest to quickly explain a complex concept and to bridge as many educational, social and language differences as possible, the actual meaning and purpose of a message can disappear almost entirely. The discussions around the COVID-19 ‘R’ rate is a good example of this.
With so much attention on health in 2020, now is the moment for us to verify how we’re communicating. Check that the information and resources created before the pandemic truly resonate and are helping people as intended. Check that we’re clearly explaining both the ‘what’ and the ‘why.’ Confirm that we’re not creating additional confusion with messages that try to do too many things and lose their meaning as a result. And don’t just check in an echo chamber. Refine and co-create programs and messages through genuine, robust collaboration and consultation with target audiences to ensure we can reach those who need the most help.
By keeping health literacy front of mind, we have a real opportunity to help tackle health inequality across populations. We can give individuals – regardless of geography, ethnicity, social background, age or profession – the tailored, trustworthy tools and support needed to help improve their understanding, health outcomes and wellbeing. If ever there was an opportunity for pharma and healthcare communicators to truly make a difference to people’s lives, it’s now.
To talk about creating health awareness and engagement programs with health literacy considerations built in, please contact us.