With the need for clear, engaging and accessible patient communication greater than ever, Sally Snow puts the spotlight on our role as healthcare communicators in helping organisations achieve higher standards of health literacy – and ultimately to inspire healthy lifestyle choices and support safe use of medicines.
To protect and improve our health, we need to understand and act on everyday health information.1 But nearly half of working-age adults in England struggle.2,3 As a result, they are more likely to need emergency services and to live with long-term health conditions.2
Engaging and accessible health information has the power to inspire healthy lifestyle choices and support safe use of medicines. As healthcare communicators, our role is to help organisations, including pharmaceutical companies, achieve higher standards of health literacy.
What is health literacy?
Health literacy is a person’s ability to find, understand and use information to make health-related decisions.4,5 It’s not just about reading and using numbers. It can be influenced by mental health, previous healthcare experiences, and cultural factors. People in lower socioeconomic groups and those in minority ethnic populations are more likely to have limited health literacy.2 Familiarity with, and access to, technology plays an increasingly important role.6
Health literacy is also about a healthcare organisation’s ability to support well-informed decisions about health.4 This may be through talking to healthcare professionals, or by reading, seeing or hearing health information.
A personal perspective
Like most people in the UK, I recently received a COVID-19 vaccine.7 Having just finished a significant health literacy project with The Difference Collective, I reflected on the patient information leaflet while waiting in the observation area.
It wasn’t a bad example. The vaccine leaflet had a summary of important information. Content was split into short sections with clear headings, which helped me to find the relevant bits. Complex terms were explained using plain language. Crucially, I was able to use it to make decisions about my healthcare.
As a science graduate with more than a decade in the healthcare industry, I don’t fit the typical profile of someone with low health literacy. But, like most people, I struggle to process information when I am anxious, sick or tired. I need clear and simple information to help me make decisions under pressure.
If I had been reading the vaccine leaflet under pressure, I may have been confused when the patient information abruptly changes into instructions for healthcare professionals. Perhaps audio or video content would help me better understand the complex safety issues. There is certainly room for improvement.
An organisational perspective
Anyone working in the highly-regulated healthcare industry is familiar with restrictions around what we can say and where we can say it – especially to patients. We often hear that we need to use certain words or present information in a certain format. But if, as a result, we produce information that is not accessible, understandable, or easy for people to act on, we have failed in our collective responsibility.
Where regulatory restrictions which are there to protect people are a genuine barrier to creating understandable health information, we need skilled writers and communicators to work with the regulators at the highest level to find a solution. Public health and safe use of medicines is at stake.
Three steps towards better health information
A wealth of research has shaped best practice in health literacy, and there is an art to translating these rules into good health communication.8 But there is still work to be done. These are basic steps towards better health information:
Involve the intended audience: Involve patients or the general public from the start of content development. Listen to a range of voices, including those with low health literacy. They will tell you what they need to know to act on the health information they are given. They may also help identify barriers to understanding or access. Test word choices as well as icons and diagrams. Make sure they are culturally neutral and don’t have unintended meanings.
Check readability: Readability tests look at sentence and word length as an indicator of complexity.9 The UK COVID-19 vaccine leaflet scores 7.7, which is just within the recommended range for the general public (grade 8 or below).10 Readability scores are easy to calculate and writers should use them routinely, but they don’t give a complete picture. Content that is easy to read may not be easy for people to understand or act on.
Make sure content is actionable: Information is actionable if it specifies a clear, achievable action the reader can take. Useful tools for assessing actionability include the Patient Educational Materials Assessment Tool (PEMAT)11 and the Clear Communication Index.12
The pressing need to prioritise health literacy
Health literacy is an important determinant of health and a driver of health inequalities.2 If our goal is to prioritise patient safety and optimise health outcomes, we must first address health literacy. Working with patients and regulators, healthcare communication experts have a key role in ensuring information is easy to find, use and act on.
The Difference Collective is a group of health literacy experts, communicators and healthcare strategists. We would love to help your organisation refresh or refine its approach to health literacy and produce better health information.
References
- Wolf MS, Davis TC, Shrank W, et al. Patient Educ Couns 2007;67(3):293-300.
- Public Health England. Improving health literacy to reduce health inequalities. Practice resource summary: September 2015. Available at : https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/460710/4b_Health_Literacy-Briefing.pdf [Accessed 12 August 2021]
- Rowlands G, Protheroe J, Winkley J et al. Br J Gen Pract 2015;65(635):e379-86.
- Centers for Disease Control and Prevention (CDC). Health literacy. Website available at: https://www.cdc.gov/healthliteracy/learn/index.html [Accessed 12 August 2021]
- Santana S, Brach C, Harris L, et al. J Public Health Management Pract. Epub ahead of print March 12, 2021. doi: 10.1097/PHH.0000000000001324
- Sieck CJ, Sheon A, Ancker JS et al. npj Digit Med 2021;4:52.
- Package leaflet: Information for the user Comirnaty concentrate for dispersion for injection COVID-19 mRNA Vaccine (nucleoside modified). Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1000704/Comirnaty_PIL.pdf [Accessed 12 August 2021]
- United States Government, Office for Disease Prevention and Health Promotion. Health literacy online. Available at: https://health.gov/healthliteracyonline/ [Accessed 12 August 2021]
- com. Website available at: https://readable.com/readability/ [Accessed 12 August 2021]
- Oliffe M, Thompson E, Johnston J, et al. BMJ Open 2019;9:e024582.
- Shoemaker SJ, Wolf MS, Brach C. Patient Educ Couns 2014;96(3):395-403.
- CDC Clear Communication Index. Available at: https://www.cdc.gov/ccindex/index.html [Accessed 12 August 2021]
Sally Snow, is a medical writer and communicator with over 10 years of experience in the healthcare and pharmaceutical industries. She specialises in translating technical information for lay audiences and has a particular interest in promoting health literacy.
