Designing instruction for health: a community affair

Only 12% of English-speaking adults in the US  have proficient health literacy skills (Kutner, Greenberg, Jin, & Paulson, 2006). This means that 88% of English-speaking adults face significant challenges when it comes to making informed health care decisions.

Poor health literacy is “a stronger predictor of a person’s health than age, income, employment status, education level, and race” (American Medical Association, 1999), although the  impact of limited health literacy disproportionately affects lower socioeconomic and minority groups (Kutner, Greenberg, Jin, & Paulson, 2006). The human and the economic costs—between between $106 and $236 billion  dollars a year, according to one study (Kelly & Haidet, 2007)— clearly justify a concerted, multi-prong societal effort .

Identifying performances

Goals for health education programs broadly include helping individuals to:

• Adopt healthy behaviors
• Manage health challenges and illness

Both goals can  drive multiple learning objectives, such as enabling learners to:

• Practice methods of self-care (e.g., through proper nutrition and exercise)
• Identify when to communicate with health care professionals (and how to make emergency medical calls)
• Identify and prioritize questions for doctors (and more generally, identify communication strategies for effective doctor-patient partnerships)
• Keep complete and accurate health records
• Adhere to treatment plans
• Identify resources that provide health care services and financial assistance
• Fill out health insurance and other financial assistance forms accurately and completely

The 3 A’ of content in support of these objectives

As noted in the National Action Plan to Improve Health Literacy, content in support of instructional objectives needs to be:

• Accurate – providing evidence-based information
• Accessible – supporting the variety of ways in which learners access health information
• Actionable – supporting lifelong learning skills to promote healthy behaviors

(US Department of Health and Human Services, 2010).

Communities of practice for health education

In the same way that we consider “communities of practice” when we consider organizational change, it’s worth considering the communities in which individuals develop their understanding of, and attitudes towards, the health care system. The degree to which health care providers (and health information providers) appear to exist outside of these communities, is the degree to which health literacy programs will fail.

Thus, patients are not the only audiences who need to receive education and training about health literacy issues since providers of health information are intimately involved in creating successful experiences for these individuals. Training the trainers is an important aspect of health literacy education.

Strategies for instructional designers who create health and safety learning materials

The National Action Plan to Improve Health Literacy suggests strategies for organizations and individuals who develop and share health and safety information (US Department of Health and Human Services, 2010). I’ve summarized how these strategies might be applied by instructional designers.

• Educate yourself on clear communication strategies and instructional design practices relating to health literacy (you can find some resources here)
• Involve the learner early and often in your design process
• Use appropriate technology to develop just-in-time programs and consider the environments where learners will access these programs
• When elearning is being developed, design and test health web sites for both usabilty and instruction, being mindful of the needs of those with health literacy challenges
• Remember to motivate and engage your learners with interactive content! Dull, irrelevant-seeming programs won’t be successful (true of any instructional program)
• Create programs that are culturally and linguistically relevant and motivating (this means more than simply translating a program into a different language)
• Use plain language – everyone at all literacy levels benefits from clear language
• Remember that your audience is heterogeneous and that learning programs should be developed in multiple formats (e.g., including audio, visual, and video aids)
• Become aware of  the services and supports that exist in your community (e.g., community organizations, faith-based programs, libraries, social networks,  etc.)
• Create synergies between your instructional program and these supports and services
• Promote your program by working with community programs, including professional and advocacy services

To this general list of strategies, I’d also add including health care professionals as a source you  tap into to assess common communication challenges and as a source of innovative ideas.

The bottom line: instructional design for health is a community affair.

References

American Medical Association. (1999). Report on the Council of Scientific Affairs, Ad Hoc Committee on Health Literacy for the Council on Scientific Affairs. Journal of the American Medical Association, 281(6), 552-7.

Health Literacy: A Prescription to End Confusion. Nielsen-Bohlman L, Panzer AM, Kindig DA, eds. Washington, DC: The National Academies Press. Available at: http:books.nap.edu/catalog/10883.html. Accessed June 19, 2010.

Kelly, P. A., & Haidet, P. (2007). Physician overestimation of patient literacy: A potential source of health care disparities. Patient Education and Counseling, 66(1), 119–122.

Kutner, M., Greenberg, E., Jin, Y., & Paulsen, C. (2006). The health literacy of America’s adults: Results from the 2003 National Assessment of Adult Literacy (NCES 2006-483). Washington, DC: U.S. Department of Education, National Center for Education Statistics.

US Department of Health and Human Services, Office of Disease Prevention and Health Promotion. (June 2010). National Action Plan to Improve Health Literacy. US Department of Health and Human Services. Retrieved from http://www.health.gov/communication/HLActionPlan/