Week 6: communications, Marketing & Public Relations 

Week 6: Health Literacy and Marketing

1. To realize a person-centered health care system, the ACA and the HITECH Act, two federal laws, promote new health care service delivery models and health information technologies that emphasize teams and people’s engagement in information seeking, decision making, and self-management. These changes reflect the growing priority of health literacy.

—Koh, Baur, Brach, Harris, & Rowden (2013, p. 1).

As a health care administrator, you might be responsible for ensuring that communications from your agency and materials developed by your agency adhere to best practices on health literacy. Understanding the health literacy needs of your target audience or community will influence the approaches you might take to ensure that information is clearly articulated and effectively understood. While health literacy may present a definite challenge for health care administrators to address, understanding how to promote effective health literacy is essential to an agency’s visibility and commitment toward fulfilling the health service needs of their target population.

This week, you examine health care administrator consequences for health literacy in communications. You explore the importance of health literacy in influencing services for health care delivery and consider the health literacy of target audiences. You also examine strategies health care administrators might implement to tailor health communications based on differing levels of health literacy for target audiences.

Learning Objectives

Students will:

· Analyze consequences for health care administrators in relation to health literacy in communications

· Analyze health literacy in influencing services and programs for health care delivery

· Analyze implementation of health care administrator solutions

· Analyze health literacy of target audience

· Evaluate strategies to tailor messages for target audience 

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

· Parker, J. C., & Thorson, E. (Eds.). (2009). Health communication in the new media landscape. New York, NY: Springer.

Chapter 1, “The challenge of Health care and Disability” (pp.3-19)

Chapter 11, “Health Literacy in the Digital World” (pp. 303–320)

· Heinrich, C. (2012). Health literacy: The sixth vital sign. Journal of the American Academy of Nurse Practitioners, 24(4), 218–223. Note: Retrieved from Walden Library databases.

· Jibaja-Weiss, M. L., Volk, R. J., Granchi, T. S., Neff, N. E., Robinson, E. K., Spann, S. J., … Beck, J. R. (2011). Entertainment education for breast cancer surgery decisions: A randomized trail among patients with low health literacy. Patient Education and Counseling, 84(1), 41–48. Note: Retrieved from Walden Library databases.

· Zoellner, J., You, W., Connell, C., Smith-Ray, R. L., Allen, K., Tucker, K. L., … Estabrooks, P. (2011). Health literacy is associated with healthy eating index scores and sugar-sweetened beverage intake: Findings from the rural lower Mississippi delta. Journal of the American Dietetic Association, 111(7), 1012–1020. Note: Retrieved from Walden Library databases.

Required Media

Laureate Education (Producer). (2011). Health literacy [Video file]. Baltimore, MD: Author.

Note: The approximate length of this media piece is minutes.

This is the download transcript: 

Health Literacy

Program Transcript 

Chanel F. Agnes: Health literacy is the ability of a person to be able to obtain, process, as well as understand, health information to take care of their health. Health literacy are a little bit different terms. So in 2003, the National Center for Education Statistic did a survey of the literacy of all Americans, and one part of that survey was looking at just the literacy of Americans. And the definition of literacy is the ability to read, write and understand English, as to be able to do basic computational skills to carry out a job. 

Now the difference with the health literacy is that health literacy is a different set of skills, a different set of knowledge that most people aren’t born into learning or they’re not taught in school. So it’s a whole different set of skills, a whole set of information. So for example, someone who has just developed diabetes, and you’re trying to explain to them the mechanism of how this disease state occurs, and you talk to them about the pancreas and beta cells that secrete insulin, this is not common knowledge that someone who’s just functioning in society would already know. 

There are a number of different examples of revealing low literacy in patients. For example, if a patient goes into to see their primary care provider, and the primary care provider recommends getting a Colonoscopy, One barrier to the patient actually taking that recommendation and getting it done is their normal activities of going to work and interacting in society, so that’s new information.

So first of all, it’s important for the provider to clearly communicate what that test is, how that test is done, where that test is done, where that test is performed, as well as the risks and benefits of doing the procedure, for the patient to feel comfortable enough to make that decision to say yes, or even decide that they will not get the test done. Then there are a number of steps that the patient has to go through to successfully get the test done. So the next step would be that the provider would say “You need to pick up GoYTellY” – and that’s one of the names for the solution, and basically it’s used to kind of clean out the colon before the test is done. And then, eight hours before the procedure, you should have nothing to eat or drink by mouth. And then maybe they’ll give them some instruction about not taking certain medications before the procedure. So the provider has given them at least three or four steps, three or four things to do, in relation to getting this test done. 

So maybe the patient feels confident about going to the pharmacy to fill the prescription. So they pick up the prescription, and here’s another point where communication is very important. Is the pharmacist communicating clearly and completely how the solution should be taken? Can it be taken with regular food? Should it be taken without foods, with or without foods, with or without medications? It’s important to communicate that to avoid any negative adverse effects. 

So although promoting something as simple as a Colonoscopy, it seems simple on the surface, there a number of different steps that the patient has to follow, a number of different areas of knowledge and skills that it draws on, and it’s important that we don’t assume that everyone is easily able to do this. Also, repetition is very good, and asking the patient if they understand the information that was provided, because it can get pretty complicated. 

So there’s a method that’s called the teach-back-method, what it does is it just helps to assess the level of comprehension. So maybe the provider might ask “Now, I have given you a lot of information about what you need to do to get this colonoscopy done. Now, tell me, in your own words, if I was your wife at home, how you would communicate this to your wife about the procedure that needs to be done, and then listen to how the patient is communicating that information, and then twerking it where they may have gotten the information a little wrong. So that’s an excellent way to assess level of comprehension. 

Culture is a very important part of health literacy. And actually, it’s something that helps to- I guess it helps to shape our level of literacy. So for example, if we look at a person who recently emigrated from another country. They’ve grown up in a culture where the health practices maybe very different than the way that we practice here in the United States. For example, they may have very strong spiritual beliefs, and they may believe that actually poor health comes from a poor spiritual state, or that poor health may come from something negative that they did in their lives. So if a health care provider or health system does not appreciate those difference in cultures, there is where you really begin to see some disparities in how health care is received. 

So the public health leaders have an awesome opportunities to close that divide where patients who have low health literacy will be able to more easily navigate the health care systems through different initiatives that they may develop. It’s important to note that health literacy is not just a patient problem, but it’s actually a health system problem. So while a patient’s level of health literacy may be impacted by their cultural beliefs, these have been associated with low health literacy, but also on the health care side, how easy is it to navigate the health care system? How well are the providers communicating with the patients? And also, are we providing in education in terms of self –management when patients have chronic disease state? 

So if a public leader would like to develop an initiative or campaign, it’s important to consider the diversity of Americans. As time goes on, and we get older, the population will become more diverse. And actually, one of the minorities, the Hispanic population, will actually become the majority in this country. So it’s very important that public health leaders appreciate that change in diversity in the country, as the years go on. Everyone does not receive information in the same way. So some people may be acculturated to receive information verbally. Some may be able to understand information a little easier looking at diagrams, et cetera. But it’s important to be able to understand what is the easiest way for patients to receive information, also understanding culturally, what are their health beliefs, because really what you want to do is you want to work within that health belief to bring in that scientific base, that evidence-based medicine, to work together to have a plan that works well for the patient, not only using the best evidence-based medicine, but also acknowledging their different cultural beliefs. So for example, if someone comes from a culture that use alternative medicine, such as for example acupuncture, asking the patient, “what are the usual ways that you receive help, or what are the usual ways that you go about the healing process,” and using that, again, as a part of your plan, your strategy, your recommendation, and negotiating with the patient to see what would be the best strategy that they’re most comfortable with, and also you’re providing the best care. 

There are a number of ways to assess for health literacy. For the informal assessment of health literacy, one of the ways is that, and you can do this whether you’re in a very busy setting, for example, a community pharmacy versus in a primary care provider office, where you may have a little bit more time to interact with the patient, but just asking some simple questions, “Are you having trouble with understanding the medication labels? Or you may ask the patient, “Do you know the list of medications that you’re taking?” And this is usually very telling someone who has health literacy because many times the response are, “I take exactly what the doctor told me to take. Don’t you have it in your computer?” So this is a common response that we get. And sometimes they maybe a little frustrated, because we ask it very often, because we want to make sure that we’re giving the medication accurately. But many times it is, indicative that they have low health literacy, and they’re really not sure of what medications they’re taking. 

Another telling question is if you ask the patient, “What are you taking the medication for? And the patient says, “I don’t know”. Again, they may give you a similar answer, “I will take whatever the doctor gives me, “again, that’s another sign of low health literacy. In a primary care doctor’s office, an example of an informal assessment technique might be the need to just give them a form to fill out. And they may have a lot of blank spaces, and that may clearly demonstrate that they don’t understand some of the questions that have been listed there. Other ways to assess is just looking for red flags. So this may not even require you to ask information. So you may notice that a patient is very often missing appointments, and this could be that they don’t understand how to reschedule appointments. So maybe after a visit, you may say, “talk to the receptionist and reschedule your appointment for three months with a primary care doctor, and then four months later, I like to you to meet with a nutritionist, and then two months after that, you should make an appointment with your cardiologist”. So although to us, if we are often working in the health care system, it’s very simple, to a patient it gets a little bit complicated. 

One example of the formal assessment tools that I mentioned is the REALM. And what this tool does, it assesses word recognition, but they’re health-related words. And the nice thing about this tool is that it can be done very quickly, it only takes about two to three minutes to complete. With this tool, what it does is that it assesses word recognition, so the patients ability to say the words. And again if you’re not been in the health care system for a while, you’re not familiar with a lot of these terms, it can get pretty difficulty to say the words, because it starts out with some pretty simple terms, and then it gets a little complicated towards the end. Now, the tools is assessed based on grade level. So it’s assessed from third grade level up to adult up to about eight or ninth grade. And know the patient’s grade level with doing this tool helps us to understand what the best tools to use for patient education are. So this is actually something that would be good if you’re going to be working with the patient for a long period of time. 

The problem with the REALM is that it does not assess comprehension of the words. It just asks the patient to say the words. And based on the level of complexity, you’ll get an idea of their level of health literacy, so really not a complete tool. Another tool is actually a little bit more in depth then the REALM is the TOHLA. And this tool actually assesses level of comprehension. So on the test, the patient is given a number of sentences and they need to fill in the blank with …. They have a selection of four options. And to complete the sentence, they need to fill it with a term. This is able to assess health literacy from the area of comprehension, because all of the information is related to health care concepts, using more words such as x-ray or diagnostic test. So then you’re able to assess a little bit more how well the patient is able to comprehend health information, and this is very important, again, when patients access the health care system, maybe usually health insurance cards. If they really don’t understand how to use the cards that is indicative of a low level of comprehension with using health information. So this tool is a little longer. It probably takes about 15 to 20 minutes, so it’s often used in clinical trials to assess the health literacy, but I think this tool is important for public health educators, because if you’re doing assessments of outcomes for a specific intervention, it’s a very nice way of standardizing the assessment of health literacy for those who are participating in the study. Now the example is the Newest Vital Sign. And actually, this is the newest screening tool that’s been promoted to assess level of health literacy. And the nice thing about this tool is that it is able to assess different parts of literacy. So it assesses word recognition. It also assesses comprehension, but it also assesses the patient’s ability to do some basic computations, based on a prescription label or a diet label, so on a box of cheerios or whatever. 

If the patient is able to look at that label and then be able to compute maybe what is a normal serving size, it’s a few skills that need to go into that. For example, if you’re using a liquid medication and you need to count how many milliliters you need to take, that requires you to be able to do some computation. And some patients may not be able to demonstrate that skill, although it seems as if they understand if you ask them. So I think those three tools are a nice example of different types of assessing health literacy, different types of instruments to assess health literacy, but it’s also important to recognize that the limitation is that they’re not a complete recognize that the limitation is that they’re not a complete assessment. Another part of the health literacy that probably no formal tool can assess is, again, the patient’s ability to put all of the information together. So it really, again, is down to the patient-provider communication skills, and how we’re communicating health information, and make sure that we’re having on going patient education for health promotion. 

Health literacy: Additional Content Attribution 

Music: Creative Support services

Los Angeles, CA

Dimension Sound Effects Library- Newnan, GA 

Narrator Tracks Music Library- Stevens Point, WI 

Signature Music, Inc

Chesterton, IN- Studio Cutz Music Library 

Carrolton, TX. 

Discussion Part 

Discussion: Health Literacy and Marketing

1. Janet is the health care administrator at a major hospital who is tasked with addressing an issue with recent prescription requests of a particular drug and complaints of overdoses in patients seen in the last three months. This issue is a top priority, not only for patient safety, but also because this prescription drug has received extensive marketing and promotion in the hospital over the past three months. Patients are now complaining that the marketing that promotes the prescription drug as being extremely safe is a direct lie. After speaking with several of the patients and providers of care, Janet has requested copies of each prescription ordered for the patients who have been screened.

After poring over hundreds of prescription orders, Janet has arrived at three conclusions. All overdoses occurred in one department with four providers who primarily see and treat patients that are non-native English speakers and who do not have family members or relatives at home to assist with providing care. Specifically, Janet notices that the issue is linked with the directions on the quantity of medication administered and that this quantity has been misinterpreted by the patients who have suffered an overdose. With a solution in mind, Janet is calling the department and pharmacy to implement a fix to avoid potential overdoses within the next few hours.

In what ways might health literacy account for the issues described in the scenario? What considerations should you keep in mind as a health care administrator to ensure that marketing of programs or services are consistent with the health literacy levels of your target population?

For this Discussion, review the resources for this week. Reflect on potential consequences that health care administrators might face when developing communications that do not account for health literacy in target audiences. Then, consider how health literacy might influence decisions that health care administrators might make when proposing services or programs for health care delivery.

By Day 3

· Post a brief explanation of the consequences health care administrators might face when developing communications that do not account for health literacy in target audiences. Explain how health literacy might influence the decisions health care administrators make when proposing services and programs for health care delivery. Be specific and provide examples. 

By Day 5

Continue the Discussion and suggest a possible solution health care administrators might implement to address the consequences described by your colleagues.

Submission and Grading Information:

Grading Criteria: To access your rubric

Week 6 Discussion Rubric: Post by Day 3 and respond by Day 5.

To participate in this Discussion: Week 6 Discussion 

Assignment Part: Assignment: Impact of Health Literacy on Marketing Plan

1. Person-centered health care means people have both the knowledge required to make decisions about their care and the support of providers and family who respect their needs and preferences.

—Hurtado, Swift, & Corrigan (2001)

“In what ways might health literacy affect an agency’s marketing plan to promote health care services or health care delivery?”

2. Before marketing a health care service or program, health care administrators must first consider the target audience that will most likely use the service or program. In identifying the target audience, the health care administrator also must determine the health literacy of the target audience and devise strategies to market the service or program appropriately within this respective target audience. Therefore, the ability of the target audience to decipher the health message, determine the service or program being offered, and identify how to best access this service or program represents the important considerations that inform how the message should be communicated.

3. For this Assignment, consider what impact the health literacy of your intended target audience might have on your plan. Reflect on how you will determine your target audience’s health literacy and what considerations you will need to address in your plan.

Note: The completion of this Assignment will consist of the elements necessary for Component 4 of your Final Project.

The Assignment (2–5 pages) 

· Describe the health literacy of your target audience for your marketing plan.

· Explain how your marketing plan will address the health literacy of your target audience.

· Describe two strategies you might take to best tailor the messages in your marketing plan to promote uptake within your target audience and explain why.

By Day 7

Submit your Assignment.

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