Public pools – may be stomach churning but good for preventing skin infections

November 15th, 2012

Due to our involvement in a Ministry of Health project on health literacy and skin infections this year, we read with interest the article in the New Zealand Herald in October about how our public pools are ‘festering cesspits of infection’.

We have all experienced some sort of discomfort about what might be “in” the water in public pools but we may not have experienced all the disgusting elements mentioned in the article.  This reminds me of a scene from the movie Grown Ups when one of the fathers shamed the children by turning the swimming pool a deeper shade of blue (who knew they added these sorts of chemicals to swimming pools?).

However, one of the good things about chlorine swimming pools is that they help prevent skin infections.  Regular bathing in chlorine treated water helps treat minor skin infections and prevent the infection getting worse.  One of the downsides of the closure of school pools was an increase in skin infections.

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Can you name your body’s largest organ?

November 13th, 2012

Your largest internal organs are your lungs, but your largest organ overall is your skin.  A recent newspaper article in the New Zealand Herald revealed that in a survey of 2000 British people, 75% did not know that the skin was the correct answer.  In addition, many people were unable to correctly locate their spleen or their liver.

These results remind me of an earlier blog I wrote about an Australian poster of human anatomy, which was developed for indigenous programmes, and had a number of errors in relation to parts of the body (i.e. labeling the ovaries as kidneys).

So where should people be acquiring basic information about the human body?  In basic science classes at school?  For many this may have been a long time ago, and without regular exposure, is easily forgotten.

With television medical shows such as ER, House, Private Practice and Casualty, people are being provided with a new exposure to the human anatomy.

While the article goes on to state that these television medical shows can be useful, they are also causing more people to self diagnose their illnesses rather than consult a GP.  Please leave a comment below and tell us if you believe the popularity of television medical shows is a positive or negative influence on health literacy.

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Improving the accuracy of medical news reporting

November 11th, 2012

It is easy to accept the words we read in newspapers and online publications as robust information, especially when it comes to health information published by credible sources. It would not often cross our minds to question the validity of the messages we are reading.

However, a group of Australian professionals working within various realms of the healthcare industry are asking us to question what we read in health related media. At their health media review website, Media Doctor, health articles provided in mainstream publications are scrutinised for robustness of message and methodology. They claim that they are “improving the accuracy of medical news reporting”.

Media Doctor‘s specific objectives include: ensuring that all important information concerning new treatments is provided; alerting GPs to media coverage of new treatments, and; providing feedback to journalists. Each article is rated out of 10 by one of the Media Doctor health professionals, either scoring a “Satisfactory” (1) or “Not Satisfactory” (0) for ten individual criteria (e.g. evidence, harms of treatment, cost of treatment). The reviewer then adds their comments to address their score decision.

In a time when there are countless information providers, often dealing in conflicting or scare-mongering information, it is great to see that websites such as Media Doctor are making sure the public have the opportunity to access robust and accurate health messages.

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A framework for the evaluation of patient information leaflets

November 8th, 2012

I often get asked by people for a way to evaluate patient education materials. I always respond that there isn’t a specific framework. Instead people have to work out why they are evaluating the resources. If they want to know if patients read the resources then they need to ask the patients directly.

So I was interested to read this article from Scottish and Chinese researchers who have developed an evaluation framework. Unsurprisingly, the researchers are from linguistics, foreign languages and health psychology fields.

Their framework has three elements – readability, comprehensibility, and communicative effectiveness. Readability is no surprise – for some people it is the cornerstone of resource development. I get frustrated when I hear people tell me that the majority of New Zealanders read at a seven to ten year old level. These sorts of generalisations aren’t correct. Adults are not children and using these children’s reading ages to determine how to write patient materials gives a false sense of security. These reading ages are based on vocabulary – what vocabulary would a five year old be expected to read, and so on. In fact, children can develop quite sophisticated vocabulary depending on the sorts of children’s books they are exposed to – Eric Carle’s The Hungry Caterpillar is a good example. And J.K. Rowling’s Harry Potter books would have increased children’s vocabulary significantly.

Low literacy adults may have lower reading vocabulary than children but adults have greater life experience than children, and therefore are more likely to understand conceptual matters if they are properly explained to them.

Readability formulae measure two things – sentence length and number of multi-syllabic words. Readability formulae are based on the premise that long sentences (often containing multiple clauses) are harder to understand, and multiple syllable words lead to higher readability scores. So to reduce readability scores use short sentences and single syllable words.

How realistic is that in health situations with commonly used multiple syllable words such as cholesterol, diabetes and respiratory?

And shortening sentences and replacing multiple syllable words don’t guarantee that the text will make sense. Christina Zarcadoolas has been a fierce critic of “simple” writing. Better to have a “higher” readability score because of the use of required medical terminology and provide explanations of those terms.

The second element of the framework is comprehensibility. It is great that the researchers realise that readability in itself does not ensure reader comprehension. (A lot of people writing health education pamphlets need to understand this). The researchers define comprehensibility as a reader being able to integrate vocabulary and grammatical structures to create contextual meaning. Vocabulary refers to words and groups of words (phrases) such as General Practitioner. Grammatical structures relate to how sentences and paragraphs are put together. This second element makes sense. The researchers rightly identify that comprehensibility is a function of the interaction between the reader and the text. However the way the researchers assess this second element is through written questions. But assessing that interaction based on written questions places a higher cognitive load (writing) on the reader than an oral interaction would and may in fact cause incorrect responses.

The third and final element of the framework is what the authors call “communicative effectiveness”. They define this as a function of the reader’s cognition (expectations and understandings), affect (concerns, worries), as well as intentions and behaviour. The authors say all these things are formed by the reader as the result of reading the text. The authors identify that for this element it is important to ask questions of the target audience. Communicative effectiveness is drawn from the concept of “usability” or “optimal usability design”. The authors do agree that this element is more complex than the other two elements – readability and comprehensibility. The authors suggest that this element is measured based on the intentions of the target audience. If the audience’s intentions correspond with the objectives of the resources then there is communicative effectiveness.

However this is no simple task. The authors suggest assessing this element using recorded interviews which will identify if the target audience first grasp the objectives of the resource (first two elements) and then indicate whether the audience intend to follow the resource.

The authors of this article have pulled on a range of linguistic, psychological and behavioural concepts. However the framework is not simple to implement. A much better approach is that which is described in Rauemi Atawhai. This involves engaging with the target audience BEFORE developing any concepts or draft materials. And then the concepts and draft materials are assessed with the target audience until the materials meet the purpose required. If the process in Rauemi Atawhai is followed then you won’t need a framework to assess resources, the process will have taken care of it.

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What literacy learners have taught me over the years

November 4th, 2012

Recently I was asked to access an online e-learning module and give feedback on it. Despite the explicit instructions given and a subsequent email giving different instructions, I just couldn’t get into the module. It kept sending me a message wanting me to update my profile which I thought was bizarre because in my mind I’d never got into the proper page in the first place. So I was ready to give up, thinking I had wasted quite enough of my time. Then I thought back to those 1000 plus literacy learners I worked with over the years. I had asked them to do much more difficult things including navigating new systems. I had watched them fail and then struggle and persist and persevere – sometimes well and sometimes not. And I have walked ahead and behind and beside pushing and pulling and admiring because that is what I signed up for when I became an adult educator.

So with my adult learner status firmly in my face I did what I always suggested my learners to do when they got really stuck – I asked for help. I think the administrator thinks I am a technophobe (an opinion shared by my daughter) but I don’t really care. Here’s hoping the new and different set of instructions I have been given work.

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Women more likely to defer health care for financial reasons

November 4th, 2012

In July 2012 the results of a University of Otago study were published showing women were more likely to defer health care for financial reasons.

Professor Peter Crampton, one of the study’s authors, identified that the results of the study were a concern not just because women weren’t accessing care for themselves, but the financial issues were possibly acting as a barrier for any children and older people cared for by this group of women. The study also confirmed that women had more long term conditions than men which meant women should in fact be accessing more health care rather than less.

The study identified critical factors why women didn’t access primary care – being younger, lower income, more deprived, smokers and having two or more illnesses.

In this study Māori women were not affected when it came to visiting the doctor, however, if the women were Māori or Pacific they were less likely to pick up prescriptions.

Crampton and co-author Dr Santosh Jatrama suggested that providing free or very low cost primary health care would help address the costs barriers for a population group who are more likely to be carers for other people in their whānau.

When it comes to health literacy statistics women have better literacy (reading) skills than men. However, men have better numeracy and document skills (form filling, reading tables) than women.

My concern is the fact that these women are more likely to have long term conditions. To self manage long term conditions properly requires a lot of knowledge and skill. That knowledge can be gleaned from good reliable sites on the internet or publications. But mostly this knowledge and skill will be developed through a number of interactions with health professionals where the women can ask questions and confirm understandings.

So I support Crampton and Jatrana’s call to provide solutions to enable this group to access primary health care.

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New participation in disease prevention programmes in general practice

October 26th, 2012

The other day I read an article from Dutch researchers looking at reasons for non-participation in disease preventions programmes in general practice. Their research identified that the differences in participation levels may partly be due to differences in recruitment strategies. The authors identified that more active personalised strategies resulted in higher participation levels compared to an invitation letter.

A couple of days after I read this article I recalled a letter in the mail inviting me to participate in research investigating the prevention of osteoporosis and fractures. According to the letter my name was randomly selected from the Electoral Roll.

If I am interested in participating in the study then I have to read a one page letter, fill in form and send it back to the University of Auckland. Now if I had low health literacy there is no way I would be able to understand the letter enough to respond appropriately and so I would probably just have ignored the letter.

With the Dutch article fresh in my mind I wondered what would have happened if someone had rung me or approached me in my GP’s office. If I had low health literacy this would be the only method which would encourage me to participate in this sort of trial. I realise the Dutch article did not refer to research trials but instead letters encouraging people to take part in screening or other programmes. However as long as we rely on written reminders participation rates may be variable.

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