Archive | Information design

The Problem With Health Literacy

At Creek Content, we spend most of our days deep in the world of health care. We work with clients in highly regulated, complex industries, and for the most part, that means we’re working in health care. A fundamental issue for the health care industry is the idea of “health literacy.”

Health literacy is the idea of not just “literacy” — which we tend to think of as the ability to read and comprehend written material — but also includes computational abilities related to health-care self-management. It means, you can find, evaluate, understand and act upon the information you need to manage your own health successfully. It includes the ability to understand your doctor’s instructions, the ability to navigate the insurance and payment systems, and lots more.

Health literacy is a pretty new term, and it’s been the subject of a number of research efforts in the past 20 years. There’s a lot of information now being created to help health-care providers better communicate with their patients, and all of that is for the good.

However, as we work with clients and content [in the United States], I see a fundamental perspective flaw in the way health literacy is often discussed. Usually the message is, your patients are health illiterate, so you must a. educate them or b. dumb down your info. To an extent, I will agree to the factual truth of the first part of that assumption: the U.S. population is not as literate as we might assume. Angela Colter has done some great work not only researching how people with low levels of literacy search, but also bringing together some critical statistics that everyone in public communications should understand. If you work with the general public, about half your audience has low literacy skills.

And in the health care arena, we see a lot of wailing and gnashing of teeth over these issues — understandably, to a degree. As a society, our health care knowledge has advanced rapidly in the past 100 years. Cutting-edge research is often incredibly specialized, conducted by researchers with years of post-graduate training. It’s not easy to explain that to the rest of us — the majority of the population without multiple advanced degrees in health topics.

Here’s my problem, though. A lot of the discussion in the realm of health literacy has to do with how we educate patients — how do we make them health literate. And that’s exactly wrong-headed to me. Think about this: Do car manufacturers bemoan the fact that fewer Americans than ever repair their own cars, or could even explain how an internal combustion engine works? Do you see phone companies complaining that we don’t understand the realities of managing complex data networks? Nope — they’ve just figured out how to make us as expert as we need to be to successfully use their products.

Health care is different than buying a car, but we shouldn’t need an advanced degree to manage our own health. If that’s the standard, we might as well give up now. Traditionally, the health care industry has viewed itself [with good reason] as an expert whom we should consult for the right answers. What I think the industry is learning is, that that approach isn’t very effective. If  we all want to be healthier, we have to learn how to communicate better — with each other.

Let me be clear — I think Americans should be more literate, health literate and otherwise. But that’s a systemic educational and cultural issue that I don’t think we can ask the health care industry, or patients alone, to solve. Most importantly, we’re doing patients a disservice by suggesting to each other [and sometimes to patients themselves] that they aren’t literate. That’s blaming the victim, to my mind. No one sets out to be less than fully literate.

Instead, I’d prefer to frame the health literacy issue as a health communication issue. How do we create health communications in forms that are easy for our patients [of all education levels] to understand? How do we carefully structure provider-patient interactions in a way that makes it easy for us to communicate clearly and honestly? How do we make the doctor-patient relationship feel like a partnership?

These things are happening in health care, but not nearly enough. When we figure out how to make health care information accessible to all our patients, then we’ll have done a good day’s work.

0

IA Summit: Search Strategies of Users With Low Literacy Skills | Angela Colter

I’m here EARLY Sunday morning for a session with Angela Colter of Electronic Ink. I saw Angela present last summer at Confab on measuring content and it was fabulous. And this topic really applies to my work so I’m really excited this morning. More on users with low-literacy skills in her article in Contents Magazine. 

Two things she wants us to know:

In the US, nearly half the population has low literacy skills. People push back when Colter says this — but she’s not saying they can’t read. But, their literacy skills are deficient to the point where they cannot easily understand and apply printed material.

Literacy includes skills like

  • Word recognition
  • Understanding sentence structure
  • Text search
  • Inference
  • Application
  • Calculations

Canada, UK and Australia have similar levels — in the upper 40s. Switzerland is lucky — only 25%. Portugal is 80%.

Good news: As designers, we can accommodate this population.

There’s a decent body of knowledge about people’s reading printed and online material. Kathryn Summers has done research on how to design online for people with low literacy.

Hasn’t been a lot of research on how they use search.

Colter did exploratory study with 27 people who read at or below 8th grade with three tasks:

  1. Watched them search
  2. “Will it rain tomorrow? Use Google to find out.”
  3. Pretend your doctor prescribed a new drug for diabetes…find out about this drug.

We get to watch an eye tracking study of a man trying to find out whether it will rain tomorrow. First thing he does is scan the entire Google home page. He wants to figure out the answer without having to come up with a keyword. Low-literacy users prefer to browse. When he did type a keyword, he looks at his keyboard, so he doesn’t notice the type-ahead suggestions on the screen.

He gets a search that tells the answer in an icon, but he’s not sure it’s the right answer, so he wants to click on the icon to go to the next page to confirm — but the icon’s not clickable.

Question from audience: Is his desire to confirm partly test effect? Colter says, yes, she’ll talk more about the challenges of moderation at the end, but seeking confirmation of first guess is still common behavior among this population.

This population completed their tasks successfully about 25% of the time.

Now we’re watching a woman looking for information on a drug.

She’s on a results page — she scans all page titles but reads descriptions on sponsored links only. On this page, they are the only ones with sentences and therefore are easiest to understand. They’re also at the top, of course.

Got to a page that had the information, but the first text on the page is the section of Google ad links. She cannot get the scent of information…we see her scanning the non-content-rich parts of the page for a painfully long period of time before she scrolls, and then finally she finds the information. From the eye-tracking, she reads it repeatedly, word for word — sometimes looking away and coming back. She has to be prompted to give the answer — she is not confident in her search either. She can share the information, but she does not paraphrase when explaining — she reads/says the sentence exactly.

Behaviors and Strategies of Low-Literacy Population

  • Failing to complete task/recover from errors
  • Formulating poor search queries
  • Avoiding typing
  • Revisiting visited links
  • Reading every word
  • Avoiding reading
  • Disguising problems

Moderating issues: People would forget the task, they would make up a new task that they could successfully complete, avoiding issues [my son does that for me, I left my glasses at home]. Think-aloud protocols are a cognitive burden for this population, so they can’t talk through what they’re doing while they’re doing it.

Suggestions to Help:

Many of the strategies to make your web page better for a low-literacy population are also the strategies you use to make your web page better for people.

  • Provide type ahead but let it stay
  • Make it easy to read
  • Make it look easy to read
  • Reduce distractions — make it easy to figure out where they information is
  • Address likely questions
  • Summarize, then elaborate
  • One point per page
0

Powered by WordPress. Designed by WooThemes