From left to right: Janet Ohene-Frempong, MS, Jann Keenan, EdS
Jann Keenan, Ed.S & Janet Ohene-Frempong, MS, IHA Strategic Partners
Jann Keenan and Janet Ohene-Frempong gave a daylong workshop on strategies for communicating effectively with constituents through both print and online materials. They used many samples created throughout their careers to illustrate what works and what doesn’t work. Ohene-Frempong stressed the health communication and health literacy must incorporate a reader-centered approach. This is the best way to engage, support, and motivate readers. They offered tips for how to implement this approach in both writing and designing materials in different media.
The presenters discussed how to write effective materials by offering tips on content, organization, and style. They also discussed effective design and page layout techniques to engage readers and increase understanding. If you aren’t designing your own materials, then it’s important to raise awareness in your designer about why design needs to be done a certain way. Keenan emphasized that an early buy-in from all partners in the creation of patient materials is key to creating health literate communication.
The presenters explained how to assess the readability of text and design and explored how to use readability tools and field-testing. They discussed how to revise text and design to improve readability. They also coached participants on how to plan a writing project. They encouraged attendees to be advocates for their readers. If there is crucial information you want to include, but limited space, the writer must fight to keep content that will benefit the end-user.
The workshop included two group exercises: a writing exercise and a revising exercise. The presenters led the group through the exercises step by step. The main take away from the session was that we must write for our readers and end-users. Being focused on the end-user is crucial to the creation of clear and effective communication.
Xanthi Scrimgeour, MHEd, MCHES
Xanthi Scrimgeour, MHEd, MCHES & Stacy Robison, MHEd, MCHES, CommunicateHealth, Inc.
Xanthi Scrimgeour and Stacy Robison facilitated a pre-conference workshop titled, “User Centered Design for Audiences with Limited Literacy Skills: An Introduction to Research and Testing Methods for Print and Online Materials.”
The definition of User Centered Design (UCD) was provided as “Involving end-users (your audience) in the design and development of a product, message, or campaign.”
Stacy Robison, MHEd, MCHES
The workshop focused on the following:
- Steps to the User Centered Design process (Co-creation, Participatory design)
- Methods in getting to know your audience (or clients) in order to involve them in serving as “co-creators” in designing key marketing tools to be used by actual clients
- Methods to conduct user research and organizing information gathered
- Testing Methods for getting feedback from your target audiences
- How to involve participants with limited literacy
- Ways to save time and money on user research and testing
The facilitators provided 5 reasons to involve your actual “audience” as part of the co-creation/participatory design:
- Just because you think your material is awesome doesn’t mean that your audience has the same opinion.
- You can waste a lot of time and money developing materials and products that your actual audience will not use.
- Involving your current audience will allow you to assess whether or not your messages will be understood.
- Target audience members will be empowered and invested in the success of your product.
- It will make you a better communicator.
Both facilitators discussed the importance of talking directly to your audience (client, patient, etc.) to create “personas.” Personas are created based on a mix of people. It is based on actual research with your audience to prevent the persona from being a “stereotype” – and not necessarily related to people. One can achieve creating this step by performing focus groups, one on one client interviews, collage exercises, etc. It is important to also create a specialized group of individuals (recruits) to develop personas.
Our facilitators engaged attendees of the session in interactive exercises to further describe and understand the value of creating personas.
Amy DeMarco, MPA
Amy DeMarco, MPA, Institute for Healthcare Advancement
Amy DeMarco led this interactive train-the-trainer session on the OERU model (Outreach, Enrollment, Retention and Utilization) for coordinating health care access for the uninsured and newly insured. This model was originally created for the Healthy Families Program, also known as California’s State Children’s Health Plan. Best practices on how to reach and engage the uninsured were introduced in conjunction with experience-based guidelines on how to enroll consumers into health care coverage through a healthcare marketplace, like Covered California, California’s state-based healthcare exchange.
DeMarco stressed the importance of following up with clients and how getting them in for an appointment may require different techniques. She also shared tips on personalizing documents for clients such as highlighting keywords, writing the clients name, and underlining important information to help them retain and act on the information provided. Attendees were asked to share what works best for them and what has received a positive response from the client.
Difficult health care terms were explained in plain language. The presenter also ran through several common enrollment scenarios and asked participants to role play as the CEC and the client. Then these scenarios were discussed in the larger group so attendees could learn from others’ experiences.
Emphasis was placed on the Retention and Utilization portions of the trainings because there has been a great push by the marketplaces to increase enrollment, but little support provided to enrollers or healthcare workers to help these clients use their coverage and retain their insurance long term. Suggestions for helping clients remember to pay their bill each month and renew their coverage each year were discussed. Reasons and solutions for why clients might not retain their coverage were also discussed.
Using the teach-back method was suggested to help clients understand their coverage and what they need to do to keep it. The Ask Me 3 technique was an audience suggestion on how to ensure that clients understood the health insurance information provided to them. This technique helps enrollment counsellors identity the client’s main concern , develop next steps for the client,, and establish why it is important for them to take these necessary steps to get, keep and use their coverage.
The Utilization section kicked off with role-play scenarios where an audience member explained to a client how they could effectively navigate the healthcare system to use their coverage. The different types of care were discussed and the presenter explained in plain language terms the attendees could use with clients to explain when go to the ER, urgent care, and primary care provider (PCP) and how seeing their PCP first in non-emergency situations could save a client money.
Left to Right: Kara Jacobson, MPH and Heather Turkoz, M.A.
Heather Turkoz, M.A., Merck & Kara Jacobson, MPH, Emory University
Heather Turkoz and Kara Jacobson used their experience to illustrate to other healthcare professionals how a collaborative approach to testing can create highly effective health communication material. Their collaboration is a case study on how a company, like Merck, can partner with a diverse set of stakeholders, like Emory University and Northwestern University, to improve its patient communication. In this case they partnered to improve Merck’s patient labelling process through evidence based market research facilitated by Emory. Their collaborative approach included the application of health literacy principles into a newly designed patient package insert and implementing new market research methodologies to solicit and incorporate feedback from respondents of all health literacy levels.
After implementing health literacy best practices into the patient package insert, research showed that the average comprehension scores were 93% across all subjects with no meaningful differences between those with limited health literacy and those with adequate health literacy. Turkoz and Jacobson provided new perspectives and insights on a model for building an effective partnership between industry and academia to affect real change and improvement in health literacy.
In order to develop patient labelling that was well understood and actionable, application of best practices from the field of health literacy was required. These methods are commonly used within the field, but not within the pharmaceutical industry. These included identifying and recruiting patients with limited health literacy into the research and refining the methodologies to assess comprehension of medication information. The presenters also emphasized the importance of including an iterative method to incorporate patient and caregiver feedback into the development process of patient communication. The recruitment and screening techniques for populations with limited health literacy were shared and can be applied by participants from other large organizations within the health industry. Furthermore, their testing methodologies can be used with a broad range of patients, inclusive of all health literacy levels. Lastly, they shared implications for future development of patient communications that go beyond the patient package insert.
Diana Gonzalez, MPH
Diana Peña, MPH, Institute for Healthcare Advancement
Diana Peña’s preconference session began with a brief introduction to the Institute for Healthcare Advancement and the production of their “What To Do” book series. The book “What To Do When Your Child Gets Sick” was chosen for the training since it is the organization’s flagship book. She then gave an introduction to the mock training with a discussion on how a trainer would prepare to administer the class. She mentioned strategies to increase the probability of a successful class such as providing childcare and sending reminders to participants.
The mock training was delivered as though Peña were facilitating training to consumers who would use the book at home with their families. The training began with a video created by the Kansas Head Start Association. The movie gave expert insight on the effectiveness of the book as well as its utility for parents. Later participants were introduced to the easy to use format of the book and practiced using the book with real life scenarios.
Lastly the train-the-trainer model was delivered as though the participants in the session were trainers for the book. Peña reviewed subject matters needed to deliver an effective session such as health literacy, culture, and adult learning. She discussed the importance of understanding and teaching in a manner that acknowledges the health literacy levels of adults. Participants were then given the opportunity to practice two techniques that acknowledge participant health literacy levels, teach back and plain language. The remaining of the session focused on managing classroom situations such as too many question, limited time, and managing disagreements.
Discussion on managing classroom situations allowed participants to share experiences and knowledge as well as brainstorm new ideas. The session ended with a wrap up activity that brought all ideas together. Participants were to pick a section of the book and use plain language to describe this section to another participant. Then participants checked to see how well they explained the section by using teach-back. This was a great way for participants to practice with the book as well as practice newly learned skills.
Amy DeMarco, MPA
Amy DeMarco, MPA, Institute for Healthcare Advancement
This Train-the-Trainer session lead by Amy DeMarco walked attendees through the process of providing the “Your Health Insurance” training to current or potential clients. This training covered:
- What it means to have it
- What it is and how it works
- What it covers and what it may not cover
- How to use it to stay as healthy as possible
- How to keep it now that you have it
DeMarco introduced some scenarios clients may have faced if they were uninsured and how their new benefits can protect them from high hospital costs or putting off getting care. She then explained common health insurance terms in plain language and asked participants to share how they have explained these terms to clients.
The ten essential health benefits were explained as well as what a typical marketplace plan may not cover. Attendees shared their remedies for covering these gaps in coverage, like taking vision prescriptions to big box stores that can make glasses at a lower rate or adding on dental coverage outside of the marketplace with their new insurer. She shared instructions on where clients can get more information on their benefits, costs, and providers.
The presenter discussed 8 steps clients can take to stay healthy:
- Understand your health coverage.
- Know where to go for care when you are sick
- Find a provider.
- Make an appointment.
- Be prepared for the visit.
- Decide if the provider is right for you.
- Follow the health plan you and your doctor agreed on.
- Take the time to read about your prescription plans.
Lastly, 5 tips to helps consumers keep their health insurance were shared:
- Pay your premium(s) on time.
- Understand your medical bills and pay them on time.
- Tell your marketplace and health insurer about any changes in your contact information.
- Tell your marketplace when you have a life change.
- Renew your coverage.
The session closed with feedback, scenarios, and examples from participants on what strategies they have employed to help clients understand and use their health coverage. Attendees also discussed the different barriers faced throughout the nation in their states and communities and how they have worked to help clients overcome these barriers.
Michael Villaire, MSLM
Michael Villaire, MSLM, Institute for Healthcare Advancement
Michael Villaire gave an introduction to the field of health literacy. He began by defining health literacy. His favorite definition is the one from the 2008 Calgary Charter: “Health literacy allows the public and personnel working in all health-related contexts to find, understand, evaluate, communicate, and use information.” Villaire prefers this definition because “it puts the onus for health literacy on the provider, as well as the consumer.”
The healthcare system is bewildering to many people, Villaire said. He gave the example of the challenges people face in signing up for health insurance under the Affordable Care Act. Villaire talked about the components of health literacy: reading and writing, listening and verbal communication, numeracy, and self-efficacy. He gave some illustrations of how challenging numeracy is for many of us.
Villaire talked about the relationship between health literacy and culture. He noted that there is often a mismatch between provider demand and patient skill level, as well as between reading level and materials. And he discussed health literacy’s strong relationship with safety, quality, and health disparities. It can be hard to move an organization forward to health literacy. But “there are certain terms that will help you move forward with your goals. Two words: safety, quality,” Villaire said.
Examples were shared of how patients can be harmed when providers fail to give clear instructions. He put the burden on providers to improve their communication. “The fact that someone does not understand the way we choose to communicate is not their problem. It’s a barrier. It’s something we need to address,” Villaire said. “Health literacy is about dealing with the barriers.”
Villaire discussed health literacy myths and listed the barriers to health literacy. He also offered health literacy statistics and noted that people don’t like to admit they don’t read well because they are ashamed, therefore limited literacy is under-reported. He closed the session by explaining why health literacy matters and discussed the impact of low health literacy.