If you feel that “health literacy” goes hand in hand with the game “telephone,” you’re not alone. For those of you not acquainted, “telephone” starts with a phrase, like “Bobby goes bananas for bears and bunnies.” The sentence is whispered to one person, who then shares it with another person. By the time the message circulates through five people, it becomes “Bobby’s banana bread is full of bugs.” Anyone who’s ever been on the receiving end of a complicated (or even not so complicated) medical diagnosis or complex medical information may relate to this.

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According to the Internet Journal of Allied Health Sciences and Practice (IJAHSP), “80 million adults in the United States have limited health literacy.” Additionally, the Centers for Disease Control and Prevention (CDC) cites that an estimated nine out of ten adults have difficulty understanding and using personal and public health information containing unfamiliar or complex terms.” Furthermore, those 65 or older are most profoundly impacted by health literacy problems, holding a much higher percentage of “below basic” or “basic” knowledge of information.

The lack of understanding concerning health issues has significant impacts on people of all ages, leading to further confusion, misinformation and even dangerous outcomes. Knowing this, health leaders across the nation are identifying challenges and implementing solutions to improve health literacy — one patient at a time.

Health literacy deficit causes and concerns

The reasons for health literacy disparities are — lamentably — far and wide. The National Institutes of Health (NIH) describes “personal health literacy” as the “degree to which individuals have the ability to find, understand and use information and services to inform health-related decisions and actions for themselves and others.”

And, according to the Office of Disease Prevention and Health Promotion (ODPHP), some of the main factors that affect health literacy include poverty level, education, race/ethnicity, age and disability. These variables make tackling health literacy a weighty challenge for both patients and consumers as well as for professionals within the health community responsible for delivering information.

“It’s not just one [strategy],” explains Maryjo Whitfield, vice president of Integrated Health, Jewish Family & Children’s Service. “You develop a strategy based upon the age and background of your audience and then use the available resources that provide the most benefit.”

In terms of the more vulnerable bracket of adults ages 65 and older, Whitfield suggests that this demographic might be more receptive to “print media, public service announcements (PSAs) or information provided at their Primary Care Office (PCP) to take home.”

Alternately, younger generations may respond better to social media as a valuable information platform, according to Whitfield. “Social media is a great way to provide information about things they should be paying attention to, such as why it is important to have wellness checks or keeping up with vaccinations,” she says. “PSAs on social media platforms such as Tik Tok and other media outlets are a good way to get messages across to this younger audience.”

But, as the ODPHP points out, delivering digestible health information isn’t relegated to age. The organization states that health literacy commonly occurs among racial and ethnic minority groups from different cultural backgrounds as well as persons whose first language is not English.

Dr. Cara Christ is Chief Medical Officer at Blue Cross Blue Shield of Arizona. She previously served as Arizona Department of Health Services Director, leading the state’s COVID-19 response during the largest public health initiative in the nation’s history.

“Data released by the U.S. Census Bureau shows that 31.7% of Arizona’s population identifies as Hispanic or Latino,” says Dr. Cara Christ, chief medical officer for Blue Cross Blue Shield of Arizona and a former Az Business magazine Most Influential Woman. “This means we must work to introduce education in other languages and break down barriers for those with English as a second language.

Adds Whitfield, “Our second most spoken language is Spanish so our messaging is geared to both our English-speaking and Spanish-speaking audiences. In recent years, we find that Arabic translation of our information and materials has grown. The number of Arabic speakers has now increased so that Arabic is the third most common language of the people we serve.”

Language and accessibility factors

Going back to the telephone game, it’s important to remember the more complicated the phrase, the higher the probability of error in its retrieval and subsequent sharing. The same is often true in the delivery of health information — no matter the medium.

“We have a tendency to speak in the language of healthcare, which is often complex and hard to understand,” says Michael Jones, president and CEO of Delta Dental of Arizona. “We can work together to ensure health-related information is understandable to a broad group of health care consumers.”

Adds Kory Castro, board-certified hearing instrument specialist and co-owner at Beltone West, “What I’ve noticed, especially with the new patients that I see, is that there’s information overload with them. And sometimes I wonder, of everything that I talked about over the course of 60 minutes, how much of it actually sunk in and how much of it they’re going to recall?”

But, as Steven Sheets, president and chief executive officer of Southwest Behavioral & Health Services points out, “literacy is only one piece of the puzzle.”

“Sometimes it’s not that there is a lack of healthcare literacy but a lack of desire to seek out resources for help,” he says. “If we want to effectively reach all generations (not only those 65 and older) we may need to be more individualized in our approach rather than expecting different generations to just accept what is being provided to them.”

Castro includes additional perspective in that “There’s a lot of availability with medical providers now, but not as much accessibility. It’s easy to get in and see somebody who’s a professional,” he says, “but to actually get the information that you need specifically for your case is maybe not as easy to get.”

Michael Jones

COVID: Helper or hindrance to health literacy?

Although research on the pandemic’s impact on health literacy remains relatively new and somewhat limited, what has become clear is that the accuracy of health information and the way it was disseminated during COVID-19 remains a topic of debate.

“COVID-19 has temporarily transformed our trust or lack of trust in the healthcare system,” Sheets says. “There are so many pathways of information — some that are completely true, have shades of truth or are completely inaccurate.”

Adds Jones, “While the COVID-19 pandemic has highlighted the need for more easily understood, less complex information surrounding disease implications, at-risk medical conditions, associated precautions to protect yourself from illness, and so on, it also showed how important it is to get your information from reliable healthcare professionals.”

Positive takeaways gleaned by Christ are that more people are interested in learning about health, the virus and how to keep themselves and others protected. “It brought a better understanding of the systems and programming we have in place and pushed access to healthcare to the forefront,” she says.

Next steps

Whether good or bad in the way it affected the public’s health knowledge, the pandemic helped reignite a discussion about health literacy that started well before the global outbreak of coronavirus. In doing so, health community professionals are doing their part to come up with effective, innovative solutions.

“‘Ask Me Three’ is an approach that encourages patients and their families to ask their providers specific questions to better understand their health conditions and what they need to do to stay healthy: What is my main problem? What do I need to do? And why is it important for me to do this?” Jones explains. “ If we structured all of our healthcare conversations to directly address these three questions, and then asked patients to restate the information to confirm comprehension, we’d be off to a good start.”

Part of what all interviewed health experts emphasize as a crucial component of improving health literacy is early educational intervention. Christ, for example, says that providing access to health education as early as possible will help encourage improved understanding of health-related information for generations to come.

Adds Whitfield, “We have a lot more avenues for sharing information. It’s just about trying to find the right one. Not everyone learns in the same way. In all of our programs, we do a lot of education about why it is important to have an ongoing relationship with your physician.”

As part of effectively educating patients and the public, Sheets underscores the importance of preventative services and properly articulating how they can be accessed. “Individuals must be educated on what services are available, how to access care and how to utilize resources prior to needing emergency room services,” he says. “Finding ‘points of entry’ is vital to strategy. Healthcare education should start where people are looking for it: Google, schools and primary care offices, as examples.”