Tackling eHealth Literacy

A female doctor discussing records with a senior female patient.

Photo of Lourdes M. Martinez, PhD, Health Communications Specialist, Office of the Associate Director for Communication
Lourdes M. Martinez, PhD, Health Communications Specialist, Office of the Associate Director for Communication

As I waited in the exam room on a recent visit to my doctor’s office, I noticed there was a large wall display with an interactive screen. It resembled a smartphone and I could use the touchscreen to scroll and learn about various conditions, diabetes, heart disease, Alzheimer’s, and colon health. Each menu included signs and symptoms of illness, and information on diagnosis, treatment, and prognosis. The designs were bright, jargon was kept to a minimum and defined when used, and navigating was simple for routine smartphone users. The display also included short videos supporting the on-screen text.

“Great!” I thought, “But what about patients who don’t have strong English skills or those who don’t feel confident engaging with the display? How do they get the information if they don’t directly ask for it?”

As a health communication specialist in CDC’s health literacy program, my job requires me to think about answers to those questions. Findings from the 2003 National Assessment of Adult Literacy suggest limited health literacy is a problem for many people and an issue that public health and health care professionals can take action to improve.

Understanding eHealth

These days it seems like everyone has a smartphone. Health services are increasingly being delivered through web-based and mobile resources. Examples of electronic health (eHealth) services include electronic communication between patients and providers, electronic medical records, patient portals, and personal health records. Mobile health (mHealth), a subcategory of eHealth, includes using tablets and phones to access apps and wearable tracking devices.

Health literacy refers to a person's ability to find, understand, and use health information to make informed decisions about their health.As these technical advancements increase so do the demands on a person’s health literacy. As a result, people with limited health literacy may have more challenges accessing health information. It is important to understand how a person’s level of health literacy can influence use. Equally important is how health professionals and communication specialists can provide support for those who may have difficulty using eHealth systems.

Learning from research

We recently posted a research summary called eHealth literacy: Playing catch-up with eHealth on CDC’s Health Literacy website. There are a few important lessons from these studies, including

  • A growing number of studies are exploring the use of eHealth resources and self-management of chronic conditions.
  • Three common characteristics that may limit use of eHealth resources were older age, lower household income level, and limited health literacy.
  • Even when research participants reported high confidence in knowing where to go to find health information, they did not report the same level of confidence in assessing the quality of materials or using them to make health-related decisions.

Taking action

As organizations continue to develop and promote use of eHealth resources we must consider how health literacy and eHealth literacy influence how they are being used.

Health professionals can:

  • Ask your patient how confident they feel managing their own health
  • Identify the knowledge or skill gaps and create a plan with your patient
  • Give your patient a recommendation for top sources of health information on the web
  • Ask your patient about their preferred and available communication options – in person, email, apps, patient portal
  • Be familiar with your organization’s language translation services
  • Evaluate your office’s web content

Communication professionals can:

  • Use plain language strategies
  • Assess readability of all materials
  • Use Health Literacy Online recommendations
  • Incorporate images and graphics that complement and reinforce text
  • Design materials for people with limited English skills
  • Consider demographic characteristics when determining the channel and source for different audience segments

People can:

  • Ask questions and repeat information when talking to your doctor or nurse to make sure you understand what they are telling you
  • Bring all of your medicines, including vitamins and herbal medicine, to your next doctor’s visit to review how to take them
  • Let the doctor’s office know if you need an interpreter if you don’t speak or understand English

Lourdes M. Martinez, PhD is a health communication specialist in the Office of the Associate Director for Communication. In her role, Dr. Martinez leads staff training on plain language principles to facilitate understanding and application of clear health communication for web, social and digital media projects, and print materials. She also assists programs across the agency to develop and implement strategic communication plans to advance clear communication practices.

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

Responding to Emergencies One Behavior at a Time

A group of Ebola response volunteers in Nigeria.

To improve the health and safety of people in the United States and around the world, we have to influence and change behaviors. It can be difficult to try new things, or stop old things as behaviors range from simple to complex, but one way to consider behavior change is to think of any change as a passive or active choice.

Public health practitioners must think about interventions in terms of the behaviors they are asking people to adopt, stop or continue. What would encourage someone to change what they are currently doing? Before you can influence someone’s behavior or change their choices about a behavior (risky or protective) you need to know how their judgments and decisions are made about that behavior in the first place.

Behaviors are rooted in traditions

During the Ebola response behavior change was critical to prevent people from getting sick and ultimately stop a disease threat. In the wake of the outbreak, communities in West Africa were encouraged to give up or change their traditional burial practices. Some of these longstanding rituals, like washing the body, proved dangerous because the virus can live on the skin of a victim after death. Communicators developed public health messaging to help change social norms and customs for burials. It was important to understand behavioral science and anthropology in order to communicate about safe burial practices in a way that would make people choose to change a behavior that was ingrained in their culture.

Behaviors are rooted in social 7 Things to Consider When Communicating About Health. Trust: Will people trust the information? Who is the best source to put the information out? Information: What information is necessary, and how will people find it? How much is enough, or too much? Motivation: How relevant is the information to the people we’re trying to reach? Environment: What are the conditions that surround and affect the audience? Capacity: What is people’s ability to act on the information? Are there barriers? Perception: What will the audience think about the information? What will inspire them to act on it? Response: How will people respond? What can we do to stay engaged with them and give them support as they take action?norms

The 2016 Zika virus outbreak is the first time in more than 50 years that a virus has been linked to serious birth defects. Due to the impact of Zika virus infection during pregnancy, social norms and perceptions around provider visits had to be addressed to alleviate concerns about the cost of screening. Clinicians were educated about the risks associated with Zika virus, how to prevent infections, and reporting suspected cases to their state, local, or territorial health departments and women were offered free clinical services, education, and access to Zika prevention kits.

Behaviors are rooted in beliefs

The fight to eradicate polio teaches us the importance of beliefs in behavior change during a response to a public health threat. Creating an effective polio vaccine was only the first step in the effort to eradicate polio. Of course an effective vaccine was necessary to prevent polio virus infections, but getting communities to accept the vaccine was equally important. Public health practitioners created messages that build on cognitive, developmental, and social psychology to persuade parents to bring their children into clinics to get vaccinated.

Behaviors inform preparedness and response

Responding to emergencies effectively requires combined expertise in many fields, including behavioral science. Epidemiology, for example, allows us to understand how many people have a disease and characterize the disease, while behavioral science identifies the role of human behavior and psychosocial factors. Behavioral science expertise can identify methods to communicate and design campaigns to change behavior that are culturally and socially acceptable.

It is important that we maintain humility when we try to understand why people do or think what they do. We often assume that we understand human behavior, but we must remain open-minded when working with people from all different backgrounds and cultures. Who’s to say that what our culture considers right and true necessarily translates to the same belief systems elsewhere? Thus public health ethics is also an important consideration when suggesting behavioral change interventions. When we are in situations that are particularly dangerous or stressful, our assumptions about other people’s behavior can lead to recommendations or actions that seem counterintuitive or wrong to them. Careful application of behavioral science is critical to any mission that seeks to improve public health and safety, here and around the world.

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