Health Literacy and Digital Health Communication

1. Health Literacy and Digital Health Communication PhD student: Inge Dubbeldam Supervisors: Frans J. Meijman (VU Metamedica) José Sanders & Wilbert Spooren (LCC)

2. Structure of our talk • Introduction: • health communication and health literacy • Outline of our project: • methodology and some first observations • Discussion: • relevance in LCC context and other fields of interest in health communication

3. Health communication • Field of growing attention in academic education and research • Health care and health care systems are subject to rapid changes in many countries • Role of health communication is ever more important.

4. Current challenges • aging population • increasingly cultural diverse population • tension between traditional and new, alternative/holistic/integrative approaches to healthcare • changes to health insurance and managed care • impact of new technologies on healthcare (Wright, Sparks & O'Hair, 2008).

5. Health literacy • An implication of these developments is the impact of health literacy: • the capacity to obtain, process, and understand basic health communication information and health services • needed to make appropriate health decisions.   • Poor health literacy is widespread and has negative influence on both health and care.

6. Role of patient is changing • Patient is now “health consumer” • who wants to know more • who is supposed to know more • Health consumer plays an active role in • health management and • health decision making

7. Emergence of online or E-health • Three groups participate in e-health exchange of information: • Health care providers (professionals) • Patients and their caregivers • Others, interested in health and staying healthy • There are various barriers to effective comsumer e-health communication (Keselman, Logan, Arnott, Leroy & Zeng-Treitler 2008)

8. Effective use of e-health requisites On the side of providers: • Understanding of the public’s information needs • Tailoring of and interaction about information On the side of consumers: • Access to and experience with electronic media • Significant lay knowledge

9. Current study: Health literacy and digital health communication Starting date April 1, 2008 ( April 1, 2012) Participants: LCC CAMeRA • VU-Metamedica Large city hospital

10. Research project Aim identifying succesful methods for communication with patients who have various degrees of health literacy Context Large city hospital with multicultural patient population

11. Research questions • Acces to media/sources: which groups of the public look where for answers to the health communication needs, based on which motivations and capacities? • Genre: which genres have been developed in health communication on the internet; how do users recognize, evaluate and use these genres? • Effect: which applications of internet in health communication are both effective and satisfactory to various groups of the public?

12. Methodological design of our study Our study will include • interviews with health professionals (June-September 2008) • analysis of genres within various health web sites (Fall 2008/Spring 2009); • observance of health consumers exploring digital health communication (2009); • testing the effect of systematically varied communication on specific health consumer groups (2009/2010).

13. Interviews: Some first observations Contents • Collaboration with hospital • Findings from interviews • Conclusions and next steps

14. Collaboration with hospital • Research proposal approved • Find the appropriate context: interviews with 9 healthprofessionals

15. Findings MD’s and NP’s • Communication with patients from non-Dutch backgrounds • Exaggeration that majority of patients refer to online medical information • Online information both useful and inconvenient • Patient education not ‘tailored’ • Selecting good online sources is based on few variables

16. Findings coordinator patient education • No protocol or procedure for patient education • Units decide for themselves how they deal with patient education • Patient education is not ‘tailored’ to individual patients (is desirable) • No (pre or post) tests of patient education material

17. Conclusion and next steps • Hospital appears to be a good choice for conducting our research • Patient education is designed and used ‘instinctive’ • No tailoring • No testing of patient education material • Next steps: • Determining the target group in dialogue with the hospital • Writing a protocol for medical-ethical commision • Starting the observance of the target group

18. Further research in LCC context • Health vocabulary barrier • Emotional and social aspects of information seeking and aquisition behaviors • Interaction between user groups

19. Health vocabulary aspects • Lay-professional vocabulary barrier • requires health education for consumers • and communication education for health providers • Relates to research on (among others) • Comprehension with lay versus expert knowledge • Readability: role of concrete language and coherence in discourse • Automatic research of lexical data

20. Interactional aspects • Health communication no longer top-down or unidirectional, but horizontal • How can users interact • with providers: health professionals, health insurance • within peergroups: patients / caregivers / ethnic minority; • and with the public? • Relates to research on • Dialogue and group (e-)interaction • Chatting and blogging language behaviour • Health journalism and civic journalism

21. Emotional and social aspects • What makes health consumers • Select / read / learn from / behave like written information • Relates to research on features and effects of genres • Interest and attractiveness of informative discourse • Identification and transportation while reading (narrative) discourse • Guilt appeal, anecdotal versus statistical evidence, images and other mechanisms in persuasive discourse

22. Further research in LCC context • Aspects of health literacy • Health vocabulary barrier • Instructive health communication with images • Effective health communication • Interaction between user groups • Emotional and social aspects of information seeking and aquisition behaviors

23. Health vocabulary aspects • Lay-professional vocabulary barrier • requires health education for consumers • and communication education for health providers • Relates to research on (among others) • Comprehension with lay versus expert knowledge • Readability: role of concrete language and coherence in discourse • Automatic research of lexical data

24. Lay-professional image barrier Relates to research on multi-modality: how to use various types of images Instructive health communication