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How to Assess the Effectiveness of Health Literacy Efforts

woman-witing-clipboardWith Health Literacy Month just ending, now is the perfect time to evaluate whether your current health literacy efforts are effective. One of the key metrics that can help measure your success is the level of patient activation being achieved.

In a health policy brief published last year, Health Affairs defines patient activation as “a patient’s knowledge, skills, ability and willingness to manage his or her own health and care.” Once an healthcare-related organization accomplishes this crucial step, it is easier to engage patients in taking a more proactive role in their own wellness, a strategy that Health Affairs notes is critical to reaching the “‘triple aim’ of improved health outcomes, better patient care and lower costs.”

The Barriers to Health Literacy

Nearly half of all American adults — 90 million people — have difficulty understanding and following health information. Of this number, an estimated 40 million Americans read at the fifth-grade level. The other 50 million adults have marginal reading skills and read at a seventh-grade level… yet the majority of health materials are written at the ninth-grade level and above!

In a study conducted by researchers at the University of Oregon, more than 30,000 patients were surveyed to determine their skills and comfort level with managing their own health and care.

Analysis revealed a clear link between patients who lacked confidence and the costs of care. Patients with the highest health literacy and patient activation levels experienced costs that were 8 to 21 percent lower than their less engaged counterparts.

Navigating today’s healthcare system, however, can be a challenge for anyone– even physicians have been known to complain about how difficult it can be when they find themselves in a hospital bed rather than at the bedside. There are, as the Health Affairs brief notes, five distinct factors that can inhibit health literacy and, ultimately, patient activation. 

  1. Physicians assume that patients understand their diagnosis and possible treatments and intend to follow up on the information provided.
  2. Cultural differences, socioeconomic status, sex, age and education can all play a role in whether a patient understands health-related information and becomes engaged.
  3. Cognitive issues — ranging from attention spans to decision-making skills — can thwart health literacy efforts.
  4. Patients are averse to considering cost when making decisions about their own healthcare and are especially resistant to lower cost options which they view as inferior.
  5. The lack of training and time pressures among healthcare providers often lead to less than optimum information sharing and patient engagement.

Many of these challenges can be addressed with a structured approach that leverages deep consumer insights with some user-friendly practices.

Tips for Communicating with Today’s Consumer-Patients

What can healthcare providers, insurers and other organizations related to this industry do to improve the clarity of educational materials?

One way to assess the readability of communications such as letters, patient education or insurance documents is the apply the SMOG test, or “Simplified Measure of Gobbledygook.”

  1. Pick 10 sentences in a row at the beginning, middle and end of the document (a total of 30 sentences).
  2. Count every word in the sentence that has three or more syllables. Words that repeat count each time they appear. Proper nouns and hyphenated words also count. Abbreviations are counted as the whole word they represent.
  3. Figure the square root of the total number of words with three or more syllables.
  4. Add three to the square root.

This is the grade level of your document!

General guidelines for effective communications include:

  1. Know your audience. Will they prefer a postcard or a text message? Do they look to social media for feedback or some other channel?
  2. Test your messaging. Sometimes the reason a message fails can be as simple as one word. Do you need to say blood pressure instead of hypertension to be clear for the widest audience? Have members of your target audience review materials before they are broadly executed. Whether this is done by focus group or less formally to test comprehension, this is an important step.
  3. Steer clear of information overload. Instead of overwhelming a patient with details, provide sources for additional information — a phone number or a web site — so once the patient absorbs the information that’s already been shared, he or she can seek out more information if needed.
  4. Present information at the appropriate literacy level. To reach 75 percent of the population, your health education materials need to be written at the 6th grade level.
  5. Avoid talking down to your audience. Consumers need to feel respected, regardless of their education or socioeconomic status.
  6. Make your content interactive. Patient activation is more likely if the information you share includes opportunities for engagement, such as an online weight loss chart that offers choices for appropriate food choices and alternatives at each stage of fitness.

Combined, health literacy and patient activation are critical steps in achieving better patient outcomes and lower costs. As healthcare continues to move towards a value-based reimbursement model, it will be more important than ever for healthcare organizations to address health literacy and patient activation. But absent a university research team, how can organizations gain the insights need to drive higher levels of health literacy and patient activation?

The c2b Consumer Classifier uses 12 quick questions that help organizations categorize individual healthcare consumers based on c2b’s proprietary psychographic segmentation model. This psychographic segmentation model looks beyond typical consumer demographics to capture insights into lifestyles, motivators, attitudes towards health and wellness, and media/information source preferences, all of which impact patient engagement and activation.

Psychographic Segmentation and its Practical Application in Patient Engagement and Behavior Change


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