health literacy insights for public health practice: case studies …€¦ · · 2016-04-29health...

Health Literacy Insights for Public

Health Practice: Case Studies in

Preparedness & Disaster Management

Dr. Rima E. Rudd

Senior Lecturer on Health Literacy, Education, & Policy

Department of Social & Behavioral Sciences

Harvard T.H. Chan School of Public Health

Three Cases

The critical value of health literacy studies and

application of findings:

• Anthrax: An Act of Terrorism

• Hurricane Katrina: A Natural & Political Disaster

• Fukushima City Disaster: Earthquake, Tsunami, and

Nuclear Radiation

Dr. Rima Rudd - IHA - May 2016

Objectives

• Identify and describe, with examples, at least 4

insights from health literacy research that can be

integrated into public health practice for disaster

management

• Identify and describe three mechanisms for enhancing

the match between a public health message and the

public

• Outline and describe a health literacy training

program to improve public health communication

efforts


2013 PIAAC OECD

Country Score

Japan

296.2

Finland 287.5

Netherlands 284.0

Australia 280.4

Sweden 279.2

Norway 278.4

Estonia 275.9

Czech Republic 274.0

Slovak Republic 273.8

Canada 273.5

England (UK) 272.6

Country Score

Korea 272.6

Denmark

270.8

Germany 269.8

United States 269.8

Austria 269.5

Poland 266.9

Ireland 266.5

France

262.1

Spain

251.8

Italy 250.5

Reminder

Average Score: 272.8 Dr. Rima Rudd - IHA - May 2016

Health Literacy:

An Evolving Concept Don Nutbeam, Social Science and Medicine, 2008

the cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand and use information in ways which promote and maintain good health Nutbeam, WHO, 1998

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

2010

engagement in a wide range of health actions that extend from personal behaviors to social action to address the determinants of health Nutbeam, SSM, 2008


Conceptual Errors


Change

Limited

Focus &

Measures

Misplaced

Responsibility

Neglected

Context

Expanded Understanding

Expanded Definitions: Health Literacy as an

interaction HHS, 2003; IOM 2004; Rudd 2004

Consider a shift in focus:

The abilities of health professionals and the

capability of health systems to support and

actively encourage effective social, political, and

individual action for health. Rudd, McCray, Nutbeam, 2012


Change & Action

Shifting Focus

Literacy skills of individuals

Focus on the

Mismatch

Public’s Capabilities

Professionals’ Skills

Practitioners’ Actions

Institutional Culture

& Literacy Environment Dr. Rima Rudd - IHA - May 2016

Who/What Carried the Burden

of Responsibility & Change?

Paradigm Shift What next?


Game: Connect All the Dots

Use 4 straight connected lines

Once you begin: Do not lift pen from

paper Dr. Rima Rudd - IHA - May 2016

Problem: A Box


Focus on the Skills and Capabilities

of Individuals

Current Health Literacy Work

Health Literacy in Health Care

Contexts


Health

Systems

Health

Professionals

Patients

Working Outside the Box


Health

Systems

Health

Professionals

Patients

Public Health

Health Literacy & Public Health


Health

Systems

Health

Professionals

Patients

Public Health

Policies

Regulations



Health

Systems

Health

Professionals

Patients

Public Health

Work

Places Community

Policies

Regulations



Health

Systems

Health

Professionals

Patients

Public Health

Work

Places Community

Policies

Regulations Programs

Communications

•Accessible

Information

•Respectful

Exchanges

•Participation

•Engagement

New Horizons

Continue and Expand Health

Literacy Efforts in Health

Care

• Redress the mismatch

• Measure and improve

health professionals’

communication skills

• Measure norms and

institutional characteristics

to identify and remove

literacy related barriers

Bring Health Literacy

Inquiry & Practice to the

Outside World

Focus on public health

communication and

programs for Community

Health and Safety as well

as for Preparedness &

Disaster Management


Critical Needs: Preparedness

& Disaster Management

Consider Current Events • War

• Terrorism

• Migration

• Climate Change

• Air quality

• Water access and quality

• Viruses

• Infrastructure Neglect

. . . . . .


Questions

How can current health literacy finding

contribute to preparedness and disaster

management ?

What new studies are needed?

What new tools can be development?

What new efforts can we launch?


Learning from the Past Case Studies

Communication in the wake of Disaster

Considerations: Development Processes, Quality,

Lessons


Case 1: Anthrax, 2001

• Event: Anthrax laced letters

• Communication needs: nature of substance, risk, health implications, treatment, preventive action

• Problems: clearance system, rumors, misspeaks, leaks…

Case Focus: A Message to Americans, a postcard, sent to all households in the US by the Postmaster General

Purpose: immediate precautionary action

Analysis: RGL: 10-11 Design: clear and spacious

but with san serif font and reverse text style

Vocabulary: sophisticated use of uncommon words

Action: unnecessarily abstract

Journal of Health Communication, 8;1-2, 2003. Dr. Rima Rudd - IHA - May 2016

Lessons Learned & Insights

When rigor is abandoned in the name of expediency,

effectiveness suffers

• Match the reading demand of materials with the reading

skills of the average person

• Apply formative research and rigorous piloting

• Use ‘plain language’

• Develop a communication plan


Case 2: Hurricane Katrina

• Event: Natural disaster

compounded by political

neglect

• Communication need:

basic information related

to status, medicine, food &

water, return home

• Problem: Available

materials not suitable for

general public

• Case Focus: Application of

1st Responders;

Coordinators Ceci and Len

Doak

• Purpose: Prepare accessible

information; Assess, rewrite,

restructure materials for

immediate distribution

• Analysis: 1st Responders

improved clarity of

information

Publication in process Dr. Rima Rudd - IHA - May 2016


• Production of critical information for the public did not/does not follow recommended protocols

• The demands of many health materials far exceed the reading skills of the public

• Assessment tools [SAM, SMOG] yielded insight into needed change

• Assessment tools [SAM, SMOG] provided guidance for restructuring materials


Case 3: Fukushima City

Disaster

• Event: Multi-level disaster

• Communication Need:

Public health nurses

response to community

mothers re: radiation

danger

• Problem: Scientific

information not ‘translated’

for pubic health nurses;

nurses’ communication not

understood by community;

lack of trust

• Case Focus: Health literacy training program for public health nurses, glossary of terms

• Purpose: Improve health professionals’ communication skills

• Analysis: Improved skills, systemic barriers uncovered

Goto, Lai, Rudd. Japan Medical

Association Journal 58(3):1-9. 2015.



• Communication clarity influences trust

• Scientific information must be ‘translated’ for health

professionals and practitioners

• Positive response to health literacy skill development

• Training professionals without changing systemic

inhibitors places undue stress on professionals

• Needed attention to a social ecological model for

change strategies


Insights for Health Literate

Preparedness/Disaster Management A mismatch between the

demands of health information and the literacy skills of the public makes information inaccessible

Information/materials must be designed with respect and rigor

Assessment tools provide cues for design instructions, e.g.

• CDC Index: knowledge of audience, focus on Action

• PMOSE/IKIRSCH: Format & structure

Literacy is based on interactions

Health literacy involves multi-lingual skills on multiple levels

Health literacy requires a supportive political/normative environment


Mechanisms for Change

• Dissemination of information re: range of literacy

skills and assessment results

• Regulations for text production

• Clear protocols involving formative research

• Articulated strategies for times of chaos

• Required training for scientists for dissemination of

information

• Required training for all health communicators - that

includes health literacy findings


Training Programs

How to assess health

information

• Need for match: Demands

of materials / Skills of the

public

• Tools for prose materials

• Tools for documents

• Tools for videos

• Adaptations for speech

• Insights for math displays

See: CDC on line training

How to prepare health

information

• Formative research

• Piloting – in times of calm

& chaos

• Use of assessment tools

• Cues from assessment tools


Opportunities

• Voluntary National & International Organizations

• 1st responders

• Local, State, Regional Public Health

• CDC

• Environmental Protection Agency

• FEMA

• Homeland Security


health literacy insights for public health practice: case studies …€¦ · · 2016-04-29health...

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