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Health Literacy Insights for Public
Health Practice: Case Studies in
Preparedness & Disaster Management
Dr. Rima E. Rudd
Senior Lecturer on Health Literacy, Education, & Policy
Department of Social & Behavioral Sciences
Harvard T.H. Chan School of Public Health
Three Cases
The critical value of health literacy studies and
application of findings:
• Anthrax: An Act of Terrorism
• Hurricane Katrina: A Natural & Political Disaster
• Fukushima City Disaster: Earthquake, Tsunami, and
Nuclear Radiation
Dr. Rima Rudd - IHA - May 2016
Objectives
• Identify and describe, with examples, at least 4
insights from health literacy research that can be
integrated into public health practice for disaster
management
• Identify and describe three mechanisms for enhancing
the match between a public health message and the
public
• Outline and describe a health literacy training
program to improve public health communication
efforts
Dr. Rima Rudd - IHA - May 2016
2013 PIAAC OECD
Country Score
Japan
296.2
Finland 287.5
Netherlands 284.0
Australia 280.4
Sweden 279.2
Norway 278.4
Estonia 275.9
Czech Republic 274.0
Slovak Republic 273.8
Canada 273.5
England (UK) 272.6
Country Score
Korea 272.6
Denmark
270.8
Germany 269.8
United States 269.8
Austria 269.5
Poland 266.9
Ireland 266.5
France
262.1
Spain
251.8
Italy 250.5
Reminder
Average Score: 272.8 Dr. Rima Rudd - IHA - May 2016
Health Literacy:
An Evolving Concept Don Nutbeam, Social Science and Medicine, 2008
the cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand and use information in ways which promote and maintain good health Nutbeam, WHO, 1998
the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions USDHHS,
2010
engagement in a wide range of health actions that extend from personal behaviors to social action to address the determinants of health Nutbeam, SSM, 2008
Dr. Rima Rudd - IHA - May 2016
Conceptual Errors
Dr. Rima Rudd - IHA - May 2016
Change
Limited
Focus &
Measures
Misplaced
Responsibility
Neglected
Context
Expanded Understanding
Expanded Definitions: Health Literacy as an
interaction HHS, 2003; IOM 2004; Rudd 2004
Consider a shift in focus:
The abilities of health professionals and the
capability of health systems to support and
actively encourage effective social, political, and
individual action for health. Rudd, McCray, Nutbeam, 2012
Dr. Rima Rudd - IHA - May 2016
Change & Action
Shifting Focus
Literacy skills of individuals
Focus on the
Mismatch
Public’s Capabilities
Professionals’ Skills
Practitioners’ Actions
Institutional Culture
& Literacy Environment Dr. Rima Rudd - IHA - May 2016
Who/What Carried the Burden
of Responsibility & Change?
Game: Connect All the Dots
Use 4 straight connected lines
Once you begin: Do not lift pen from
paper Dr. Rima Rudd - IHA - May 2016
Current Health Literacy Work
Health Literacy in Health Care
Contexts
Dr. Rima Rudd - IHA - May 2016
Health
Systems
Health
Professionals
Patients
Working Outside the Box
Dr. Rima Rudd - IHA - May 2016
Health
Systems
Health
Professionals
Patients
Public Health
Health Literacy & Public Health
Dr. Rima Rudd - IHA - May 2016
Health
Systems
Health
Professionals
Patients
Public Health
Policies
Regulations
Health Literacy & Public Health
Dr. Rima Rudd - IHA - May 2016
Health
Systems
Health
Professionals
Patients
Public Health
Work
Places Community
Policies
Regulations
Health Literacy & Public Health
Dr. Rima Rudd - IHA - May 2016
Health
Systems
Health
Professionals
Patients
Public Health
Work
Places Community
Policies
Regulations Programs
Communications
•Accessible
Information
•Respectful
Exchanges
•Participation
•Engagement
New Horizons
Continue and Expand Health
Literacy Efforts in Health
Care
• Redress the mismatch
• Measure and improve
health professionals’
communication skills
• Measure norms and
institutional characteristics
to identify and remove
literacy related barriers
Bring Health Literacy
Inquiry & Practice to the
Outside World
Focus on public health
communication and
programs for Community
Health and Safety as well
as for Preparedness &
Disaster Management
Dr. Rima Rudd - IHA - May 2016
Critical Needs: Preparedness
& Disaster Management
Consider Current Events • War
• Terrorism
• Migration
• Climate Change
• Air quality
• Water access and quality
• Viruses
• Infrastructure Neglect
. . . . . .
Dr. Rima Rudd - IHA - May 2016
Questions
How can current health literacy finding
contribute to preparedness and disaster
management ?
What new studies are needed?
What new tools can be development?
What new efforts can we launch?
Dr. Rima Rudd - IHA - May 2016
Learning from the Past Case Studies
Communication in the wake of Disaster
Considerations: Development Processes, Quality,
Lessons
Dr. Rima Rudd - IHA - May 2016
Case 1: Anthrax, 2001
• Event: Anthrax laced letters
• Communication needs: nature of substance, risk, health implications, treatment, preventive action
• Problems: clearance system, rumors, misspeaks, leaks…
Case Focus: A Message to Americans, a postcard, sent to all households in the US by the Postmaster General
Purpose: immediate precautionary action
Analysis: RGL: 10-11 Design: clear and spacious
but with san serif font and reverse text style
Vocabulary: sophisticated use of uncommon words
Action: unnecessarily abstract
Journal of Health Communication, 8;1-2, 2003. Dr. Rima Rudd - IHA - May 2016
Lessons Learned & Insights
When rigor is abandoned in the name of expediency,
effectiveness suffers
• Match the reading demand of materials with the reading
skills of the average person
• Apply formative research and rigorous piloting
• Use ‘plain language’
• Develop a communication plan
Dr. Rima Rudd - IHA - May 2016
Case 2: Hurricane Katrina
• Event: Natural disaster
compounded by political
neglect
• Communication need:
basic information related
to status, medicine, food &
water, return home
• Problem: Available
materials not suitable for
general public
• Case Focus: Application of
1st Responders;
Coordinators Ceci and Len
Doak
• Purpose: Prepare accessible
information; Assess, rewrite,
restructure materials for
immediate distribution
• Analysis: 1st Responders
improved clarity of
information
Publication in process Dr. Rima Rudd - IHA - May 2016
Lessons Learned & Insights
• Production of critical information for the public did not/does not follow recommended protocols
• The demands of many health materials far exceed the reading skills of the public
• Assessment tools [SAM, SMOG] yielded insight into needed change
• Assessment tools [SAM, SMOG] provided guidance for restructuring materials
Dr. Rima Rudd - IHA - May 2016
Case 3: Fukushima City
Disaster
• Event: Multi-level disaster
• Communication Need:
Public health nurses
response to community
mothers re: radiation
danger
• Problem: Scientific
information not ‘translated’
for pubic health nurses;
nurses’ communication not
understood by community;
lack of trust
• Case Focus: Health literacy training program for public health nurses, glossary of terms
• Purpose: Improve health professionals’ communication skills
• Analysis: Improved skills, systemic barriers uncovered
Goto, Lai, Rudd. Japan Medical
Association Journal 58(3):1-9. 2015.
Dr. Rima Rudd - IHA - May 2016
Lessons Learned & Insights
• Communication clarity influences trust
• Scientific information must be ‘translated’ for health
professionals and practitioners
• Positive response to health literacy skill development
• Training professionals without changing systemic
inhibitors places undue stress on professionals
• Needed attention to a social ecological model for
change strategies
Dr. Rima Rudd - IHA - May 2016
Insights for Health Literate
Preparedness/Disaster Management A mismatch between the
demands of health information and the literacy skills of the public makes information inaccessible
Information/materials must be designed with respect and rigor
Assessment tools provide cues for design instructions, e.g.
• CDC Index: knowledge of audience, focus on Action
• PMOSE/IKIRSCH: Format & structure
Literacy is based on interactions
Health literacy involves multi-lingual skills on multiple levels
Health literacy requires a supportive political/normative environment
Dr. Rima Rudd - IHA - May 2016
Mechanisms for Change
• Dissemination of information re: range of literacy
skills and assessment results
• Regulations for text production
• Clear protocols involving formative research
• Articulated strategies for times of chaos
• Required training for scientists for dissemination of
information
• Required training for all health communicators - that
includes health literacy findings
Dr. Rima Rudd - IHA - May 2016
Training Programs
How to assess health
information
• Need for match: Demands
of materials / Skills of the
public
• Tools for prose materials
• Tools for documents
• Tools for videos
• Adaptations for speech
• Insights for math displays
See: CDC on line training
How to prepare health
information
• Formative research
• Piloting – in times of calm
& chaos
• Use of assessment tools
• Cues from assessment tools
Dr. Rima Rudd - IHA - May 2016