Health literacy research and practice over these last two decades are enabling us to enrich the clinical encounter, transform health care settings and, hopefully, remove barriers to care and services. It is time however, to adopt and adapt these insights for public health practice. This presentation focuses on three case studies [anthrax, a hurricane, and a tsunami] related to disaster management illustrating the critical value of health literacy inquiry and application of findings.
Rima Rudd, Sc.D
Senior Lecturer on Health Literacy, Education, and Policy, Harvard School of Public Health
We have to think outside the box to help with:
Preparedness, community health and safety and disaster management
Case 1 Anthrax event of 2001:
Anthrax-laced letters sent to people in communications. We needed to communicate the nature of the substance, risk, health implications, treatment, preventive action. There were problems in the clearance system, rumors, misspeaks, and leaks.
A postcard was sent to all households by the Postmaster General for immediate precautionary action. The language used was uncommon and calls to action were vague and abstract. The design was not great either. The case study identified these needs:
- Match level of communication with the average person.
- Use plain language
- Develop a communication plan
- Apply formative research and rigorous piloting. – We know about this and we don’t do it.
- Need for ‘first responders’ – Call for help from health literacy experts as part of the first responder team.
Case 2 Hurricane Katrina:
National disaster compounded by political neglect.
They needed basic information.
The available materials were not suitable for the general public. (From HHS, CDC, etc.) They paid no attention to health literacy.
Len and Ceci Doak coordinated a volunteer effort with CDC to prepare accessible information with a 6-24 hour turnaround from submission of originals, and pilot test where possible.
The first responders improved the clarity of the information.
- We must demand rigor in our work.
- Health materials far exceed the reading skills of most members of the public.
- Assessment tools can help identify needs.
Case 3 Fukushima City Disaster:
This was a multi-level disaster. Many people left the city, including families with children, but most people were still there. The Public Health Nurses were left to deal with the population. The nurses had difficult scientific info they could not adequately translate. The result was loss of trust and worsening of the situation. The nurses needed to get a glossary of terms and improved health communication skills. Skills were improved; systemic barriers were uncovered for the nurses to engage in the work they need to do.
- Communication clarity influences trust.
- Scientific info must be translated for health professionals, and further translated for the public.
- People’s professional abilities were developed and they responded positively to health literacy skill developemt.
- But training professionals without changing systemic inhibitors places undue stress on professionals.
- You must pay attention to the institutions that shape peoples (e.g. professionals’) abilities to perform.
- There’s a mismatch in demands of health info and literacy skills.
- We must develop materials with respect and vigor.
- We can learn from assessment tools, but need to develop new ones.
- Literacy is based on interactions.
- Health literacy involves multilingual skills on multiple levels.
- Health Lit requires a supportive political/ normative environment.
Mechanisms for Change
- Dissemination of info and discussion
- Regulations for text production including strategies for times of chaos. Materials must be pilot-tested as part of development process.
- Required training for scientists on how to share information, as well as health communicators and educators.
We need training programs to assess health information and prepare health information. Not just written materials.
We need tools for calibrating math demands, assessing risk communication, assessing entry forms and documents for evaluations and research.
We need studies for communicating to the next level of the public: science, risk, reporting medical and scientific findings, displaying findings, reporting test and study results.
WE HL experts need to work together with other organizations such as volunteer orgs, first respondrs, CDC, FEMA, etc.
“The word is as important as any tool.”