10 Health Literacy Tips for Reporting Data

A social worker and senior woman seated on a couch, looking at a tablet device.

We live in a complex world. Just as humans have left an impact on the environment, the environment also leaves an impact on us. Being exposed to certain physical and social environmental factors, like chemicals in the water, secondhand smoke, or poverty, can affect our health.

Understanding oral health data in MinnesotaCDC’s National Environmental Public Health Tracking Program helps to better understand the connections between our health and the environment by bringing together data and information about the population, the environment and related health effects.

The Minnesota Department of Health (MDH) Oral Health Program is committed to communicating data in a way that is understandable and easy to use. As part of the CDC’s Tracking Program, the MN Tracking Program allows us to do that by hosting our Minnesota Oral Health Statistics System (MNOHSS) data on the Minnesota Public Health Data Access portal.

The MN Data Access portal allows users to quickly find, interact, download, and visualize data through charts, infographics and maps. We also have been able to shed light on oral health disparities and use chronic disease data about diabetes, heart disease and cancer from the portal to look at shared risk factors with dental disease.

Oral health is key to overall health and the MN Public Health Data Access portal has brought greater visibility to this hidden chronic disease.

Taking health literacy into account

Nearly 90% of people struggle to understand health communication messages. This means that the data and reports we publish from our data tracking systems should take health literacy into account and provide health information that is easy to find, understand, evaluate, communicate, and use. Based on my experience, I have compiled 10 easy ways you can consider health literacy when you’re reporting data.

 

  1. Consider audience and outcome. Think about what actions or interventions you are hoping to achieve from your data and who needs to know about the data in order to make those changes. Your data should be presented in a way that is understandable, relevant and action-oriented for your target audience. This could include the media, policymakers, educators, researchers, students, clinicians and other health professionals, as well as the general public.

 

  1. Use storytelling to convey key messages. Think about your favorite novel, television show, or website. What keeps your attention and motivates you to tune in for more? I am learning a lot from communications and behavior change theories and from professionals such as Dr. Neil deGrasse Tyson, Alan Alda, and Dr. Randy Olson who are able to bring science to life through storytelling. Communicating data is a science, as well as an art. We can all take cues from Hollywood’s narrative structure to tell compelling stories that humanize our data and drive action.

 

  1. Reach people where they are. Research your target audience to find the best outreach strategies. You will need to use different strategies depending on their existing level of knowledge, motivating factors, and whether or not they are information seekers and early adopters. Does your audience prefer to receive information verbally (e.g. town hall meeting, webinar, television, radio or podcast), in writing (e.g. website, data brief, social media), or both? As an example, the Minnesota Department of Health’s MN Tracking Program developed a social media campaign that communicates data on the MN Public Health Data Access portal — Land of Healthy Kids — targeting public health professionals, schools, parents/guardians and caregivers of school age children.

 

  1. Make data digestible. When communicating your findings present data in bites, snacks, and meals. Not everyone who looks at your data is going to have the time or expertise to read your entire report so you need to make sure they can find information that is relevant and understandable.
    • Bite: Use anchors and headers to help users quickly find data and information. Brief headers that use a declarative statement to interpret a chart or map helps with data literacy.
    • Snack: Develop simple charts and maps with clear titles, legends, and axes. Charts and maps should be standalone features that do not require additional text to understand. They should communicate the who, what, where and when of the data you are presenting. Do not overwhelm viewers with p-values and confidence intervals. These can be added to accompanying tables and information pages.
    • Meal: Tables, data downloads, and information pages should be added for researchers, health professionals, and those who want to dig deeper into the data. You might include additional information about study design, sample and weighting methodologies, indicator definitions, sample or population size, confidence intervals, unreliable estimates or data suppression to help this audience to further analyze and interpret the data.

 

  1. Numbers count. Adults in the United States have lower numeracy skills than adults in other developed countries. Many do not understand percentages or ratios, have difficulty making comparisons (across years, geographies, or against a target goal), and do not know the difference between absolute versus relative risk. Dashboards, infographics or icon arrays, risk tables, ladders and scales help to visually display data, the magnitude of effect or risk, and can help individuals make comparisons if presented on the same scale.

 

  1. Think about accessibility. To ensure everyone has the same access to your data, familiarize yourself with 508 Standards for Electronic and Information Technology. People with visual, auditory, and motor skill impairments may not be able to access information on the web, even using assistive devices. Simple modifications can make a big difference, such as:

 

  1. Report data in meaningful, culturally, and linguistically appropriate way. Analyzing and presenting data by geography, sexual orientation and gender identity (SOGI), age, race/ethnicity, preferred language, disability, and chronic disease status helps to identify health disparities and prioritize resources. This should be done in concert with the affected community to ensure that data is collected, analyzed, interpreted, and reported accurately, meaningfully and in a culturally and linguistically appropriate way.

 

  1. Conduct audience testing. The best way to ensure your data can be found, accessed, and understood is to test your communication product with your target audience. Generally 5-8 people will suffice. The key is to make sure the group is representative.
    • Usability testing identifies whether or not your audience can find data and information, successfully complete specified tasks, and helps you to understand how your audience searches for information or completes tasks. You can also observe how long it takes them to complete tasks and determine ways to modify or enhance user experience.
    • Accessibility testing determines whether or not online content is 508 compliant. Using a screen reader or only a keyboard (not mouse), can you still navigate and access web content? Consider testing products with individuals who use assistive devices.
    • Health literacy testing identifies whether or not your data and information is understandable. Can your audience easily interpret the data in charts, tables, and maps? Is your narrative description of the data clear?

 

  1. Evaluate your work. To improve future communication about data, you should always evaluate your work.
    • Web and digital analytics applications allow you to monitor audience reach and user engagement. They can help you set goals, tell you what search engine terms are common, and whether or not users are accessing your page directly or are being directed from a different website. It can also tell you which pages are popular and which are not. Infrequent traffic or high bounce rates on a particular page may indicate lack of interest, lack of awareness, or perhaps a usability or health literacy issue.
    • Track different modes of communications. How many presentations, webinars, social media posts, etc. have you delivered in a specified amount of time? Who was the audience? Are there groups you have not yet reached?
    • Monitor how your data is being used. User surveys, in-person interviews, and external communications such as articles, reports, website links, and social media posts can tell you how your data is being used and if it is being used appropriately.

 

  1. Share best practices. Talking and listening to others is a great way to discuss new methods, share resources, and spark inspiration.
    • Join professional organizations and working groups on surveillance, epidemiology, and health literacy and discuss the importance of data literacy.
    • Engage with programs, like CDC’s Tracking Program, who use health literacy and numeracy principles to inform how they communicate about data.

Communicating data can be difficult and takes time and practice. But remember, we all appreciate clear communication. When you address health literacy, you improve data quality and consumer satisfaction and make data truly accessible to everybody.

The Minnesota Public Health Data Access portal is managed by the Minnesota Environmental Public Health Tracking Program (MN Tracking). MN Tracking is part of the CDC’s National Environmental Health Public Health Tracking Program, which collects, integrates, and analyzes environmental hazard and public health data from a nationwide network of partners.

Learn more

The Communication Research and Evaluation blog series highlights innovative research and evaluation methods used at CDC to improve behavior change campaigns.

Public health labs aren’t just on the frontlines of vaccine-preventable outbreaks. They’re often the only line.

Public health labs aren’t just on the frontlines of vaccine-preventable outbreaks. They’re often the only line. | www.APHLblog.org

by Kim Krisberg

In the U.S., rates of vaccine-preventable diseases are so low that many commercial labs don’t even have the ability to test for them anymore. The shift reflects the hard work of decades-long immunization efforts. But it also means that when there is a vaccine-preventable outbreak, just about all of our rapid diagnostic capacity resides in one place: the public health lab.

The latest example of this is in Minnesota, where a measles outbreak hit 78 confirmed cases as of June 16. The state is typically home to less than a handful of measles cases each year — most years, the case count is between zero and two. At the Minnesota Department of Health’s Public Health Laboratory, which is the only lab in the state that can do real-time reverse-transcription polymerase chain reaction (rRT-PCR) testing for measles, staff have received more than 800 specimens for measles testing since April, with a goal of fully processing each one the same day it’s received. To stop an outbreak, both speed and accuracy are critical.

Fortunately, Minnesota lab workers are trained and ready to provide both. But sustaining that kind of surge capacity over the long run and in the face of new and emerging disease threats is always challenging — even in the best funding environments.

“We’ve spent a lot of time increasing our capacity over the last 10 years and we’re seeing that capacity being put to work,” said Sara Vetter, PhD, manager for infectious diseases at the Minnesota Public Health Laboratory. Vetter noted that Minnesota last experienced a measles outbreak in 2011 — “and that one seemed huge and it was just 26 cases of measles.”

This year’s measles outbreak is almost entirely concentrated in a Somali community in Minnesota’s Hennepin County, home to more than 1 million residents. The outbreak officially began on April 10, the same day the lab confirmed the first positive case. Nearly all the cases are among unvaccinated children younger than 4 years old. No deaths have occurred, though about a quarter of infections have led to hospitalization.

Inside the public health lab’s Virology/Immunology Unit, technicians track the measles outbreak using a rRT-PCR test, which allows them to detect the highly contagious virus much quicker than private labs that can perform serological testing for measles antibodies. That quickness is key, said Anna Strain, PhD, supervisor of the Virology/Immunology Unit, because it means the health agency’s epidemiology team can then quickly locate people who may have been infected and get ahead of the outbreak before it spreads.

The rRT-PCR test may be quicker than serological testing — it detects measles RNA, as opposed to measles antibodies, and is less confounding than serology — but it’s not completely definitive, Strain said. After conducting rRT-PCR testing on each of the more than 800 specimens that come into the lab, any positive specimens undergo genotyping to determine if the patient is infected with a wild-type measles strain or if the rRT-PCR is simply picking up on the live attenuated virus that’s contained in the measles-mumps-rubella vaccine. Genotyping can also determine if the case is related to the larger outbreak. (On a side note: In addition to its regular testing responsibilities, the Minnesota Public Health Lab is partnering with the Centers for Disease Control and Prevention and Canadian public health officials to develop a PCR test that’s specific to the vaccine strain of measles. Such an test would be particularly helpful in an outbreak, Strain said, because technicians could then forgo the extra step of genotyping.)

“It’s actually meant quite a lot of maneuvering,” Strain said, referring to the logistics of responding to the surge in measles testing. “In some ways, we were lucky that it happened in April when flu season was dying down — otherwise a number of testing staff trained for measles testing would have also been doing flu testing. If the (measles outbreak) had happened any sooner, it would have been really hard to keep up.”

From start to finish, the measles test takes about five hours, Strain said. Lab staff can process 10 measles specimens at a time and up to 30 specimens in day — though that’s a stretch, she noted. In comparison, the lab can process up to 150 flu samples in day and often does.

“As hard as it’s been in the lab, it’s been even harder for our epidemiologists — they’ve had more than 7,000 contacts to trace and to follow up on,” said Joanne Bartkus, PhD, director of the Minnesota Public Health Laboratory. “It’s been daunting for all of us.”

Vetter said that most of the lab’s current surge and response capacity is thanks to federal public health preparedness funding as well as funding from CDC’s Epidemiology and Laboratory Capacity for Infectious Diseases (ELC) Program, both of which currently sit on the budgetary chopping block. On preparedness, President Trump’s fiscal year 2018 budget proposal calls for cutting CDC’s emergency preparedness budget by $136 million — that’s on top of years of preparedness cuts public health agencies have already absorbed. (In total, Trump’s budget calls for cutting CDC’s budget by $1.2 billion, or a whopping 17 percent.) The ELC, on the other hand, is wholly entwined with the Affordable Care Act’s Prevention and Public Health Fund, which allocates $40 million in annual ELC funds to state and local health departments in every state. Under current ACA repeal-and-replace bills in Congress, the Prevention and Public Health Fund would disappear.

And while ELC and preparedness monies don’t categorically support the Minnesota lab’s vaccine-preventable disease work, Vetter said the funds have been essential in ensuring the lab can quickly scale up its response, regardless of whether the emergency is vaccine-preventable or not. In other words, the Minnesota lab has spent years building an all-hazards response system that readies it to face any health threat that lands at its doorstep. Being able to sustain that nimbleness, however, would be at risk if funding declined.

“Without that funding, we’d probably have to choose what we respond to because we’d run out of people and out of machines — we just couldn’t keep up,” Vetter said. “If our funding gets cut, we can’t maintain our machines, we can’t replace machines, we can’t train more people … what we do is very complex.”

At the same time the Minnesota Virology/Immunology Unit has been responding to the measles outbreak, it’s also been responding to a mumps outbreak on the University of Minnesota-Twin Cities campus, providing surge testing for a mumps outbreak in Washington state that recently hit nearly 900 cases, and taking in and testing about 20 specimens a week for Zika virus. All of that is in addition to its more regular duties, like rabies and West Nile monitoring.

In the wake of the measles outbreak, Minnesota Health Commissioner Edward Ehlinger, MD, MSPH, called on state policymakers to create and support a public health response contingency fund. Such a bill was introduced into the Minnesota House of Representatives for consideration in May.

“Our commissioner always says that data are the coins of public health,” Bartkus said. “And it’s the public health lab that creates that data.”

As of late May, Strain said the Minnesota measles outbreak — which exceeded total U.S. cases for all of 2016 — seemed to be entering a “tapering phase.” As she said that, however, she paused — and quickly added “we all just knocked on wood.”

 

For more on the Minnesota measles outbreak, visit www.health.state.mn.us/divs/idepc/diseases/measles.

 

 

 

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