Health Literacy and Effective Communication:
Building Blocks for Healthier Families
June 15, 2003

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Session Summary

Welcome (Barbara Plager and Janet Ohene-Frempong)

Defining Healthy Literacy and Effective Communnication (Terry Davis)

Literacy In Context (Christina Zarcadoolas)

"Baby Basics" (Lisa Bernstein)

Maternal Literacy and Prenatal Health (Ian Bennett)

Session Summary

The final session of Maternity Care Coalition's (MCC) 2003 Women's Health, Children's Futures Professional Education Series, "Health Literacy and Effective Communication: Building Blocks for Healthier Families" was held Tuesday, June 3, 2003 at Moore College of Art and Design. By sharing personal stories, health statistics, and the latest research, nationally-known experts defined and described the concept of health literacy, defined by Healthy People 2010 as the "degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions", and its importance to health care and maternal and child health today.

Barbara Plager, MCC Board Member
Janet Ohene-Frempong, MCC Board Member and J.O. Frempong & Associates

Barbara Plager, health consultant and MCC Board Member, opened the session by highlighting MCC's work in promoting health literacy. By employing Community Health Workers who know how to communicate with the high-risk mothers that MCC serves, and by continuing to advocate for low-income mothers and families on the local, state, and national levels, MCC's work helps make clear health information available to its clients and to the general public. With the proliferation of welfare to work programs, increased emphasis on health maintenance, and with changing conceptions of work, which place a greater burden on employees, there is an increased need to encourage and ensure adequate health literacy. Finally, Plager noted that increased literacy is an integral component to empowerment and feelings of self-sufficiency and efficacy.

Janet Ohene-Frempong, president of J.O. Frempong and Associates, moderated the session. Before introducing the speakers, Ohene-Frempong shared some words on the importance of reading in her life. She described how reading serves several important purposes - not only does reading provide information on health, history, science, anything and everything, but it provides an escape from everyday life; a pleasurable hobby. Encouraging literacy and reading among mothers can improve both their mental and physical health and that of their children.

Defining Healthy Literacy and Effective Communication
Terry Davis, Louisiana State University Health Sciences Center

Ohene-Frempong first introduced Terry Davis, PhD, Professor of Medicine and Pediatrics, and Head of the Behavioral Science Unit of the Feist-Weiller Cancer Center at Louisiana State University Health Sciences Center in Shreveport. Davis began her presentation by discussing the abysmal literacy rates in the United States. In the U.S., there are exceedingly high school dropout rates, and 1 in 3 adults are functionally illiterate, with rate even higher among elderly and low-income populations. Such statistics undoubtedly affect health comprehension among the public. While average Americans struggle to understand the information they receive from their doctors and in medical literature and packaging, people with low literacy are especially affected. Even with controls for gender, socioeconomic class, and location, people with low literacy suffer a 52% higher rate of hospitalization than those with high literacy. The effects of such striking disparities only further burden the entrenched health care system. It is estimated that low health literacy costs $50 billion a year, with Medicaid incurring $10 billion of these costs.

Throughout her presentation, Davis showed clips of an American Medical Association and AMA Foundation-produced video titled "Help Your Patients Understand" that featured real people sharing their struggles communicating in the medical world. The video highlighted the disconnect between the information that is given and what the patients truly understand. Davis shared some suggestions for providers to ameliorate their communication with patients. Red flags that convey misunderstanding, such as missed appointments, incomplete registrations, and lack of follow-through can all point to a patient who does not fully understand the information given to them. In order to make sure that patients understand their messages, health care providers need to also see themselves as teachers, using practical solutions such as teach-back and demonstrations to ensure that the critical information that they are sharing with their patients is understood and put into practice.

Literacy In Context
Christina Zarcadoolas, Brown University

Christina Zarcadoolas, PhD, faculty member at Brown University's Center for Environmental Studies, followed Davis with her presentation titled "Health Literacy in Context." Zarcadoolas began by pointing out the necessity of contextualizing health literacy. Fundamental literacy, science knowledge, civic understanding, cultural identity issues, and relevancy contexts all influence a given person's ability to understand health communication. Zarcadoolas explained that readers persist and try to make meaning out of texts that they might not fully understand, using the factors listed above to inform their understanding of challenging materials. Language and literacy constitute ways of seeing the world, molded and shaped by differing cultures, education, and exposure. Being health literate, according to Zarcadoolas, means being able to use health concepts and information generatively, to apply health information to novel situations.

Encouraging health literacy requires a clear and systematic presentation of information. Zarcadoolas shared some tips on creating materials that are actually understandable, not just simple. Putting the most important message in the beginning of a text and using advance organizers to explain what information is to follow were two suggestions that she shared. In addition, sentence structure is more important than length. Sentences do not need to be short to be clear; writers need to remember that sentences should be unpacked and that there should be clear cohesion between all ideas. Providers also should be cognizant of how their translated materials respect and communicate with clients who have a different culture, language, or belief system. Zarcadoolas closed by emphasizing the importance of spoken language, and by encouraging providers to see every communication encounter as an opportunity to advance health literacy.

"Baby Basics" Prenatal Health Literacy Program
Lisa Bernstein, The What To Expect Foundation

The third speaker of the session, Lisa Bernstein, Executive Director and co-founder of The What To Expect Foundation, discussed the development and relevance of the Baby Basics Guide to a Healthy Pregnancy for low-income, low-literate moms. Bernstein explained that most low-income expectant moms receive pamphlets and Xeroxes of information that are oftentimes difficult to read, and do not equal the aesthetic beauty of a book. According to Bernstein, reading is the last big stigma, and about one-third of mothers on Medicaid are illiterate. Through community literacy programs and Baby Basics discussion groups, women across the nation are learning about maternal and child health as they learn to read. Overall, Bernstein concluded, literacy does affect birth outcomes, and most importantly, a parent who can read can raise a child who can read.

Maternal Literacy and Prenatal Health
Ian Bennett, University of Pennsylvania Health System

Ian Bennett, MD, PhD, clinical instructor in the Department of Family Practice and Community Medicine at the Hospital of the University of Pennsylvania, gave the last presentation of the session, titled "Maternal Literacy and Prenatal Health." Bennett explained the moment when a woman becomes a new mother, or is about to give birth, is the perfect juncture for a literacy intervention. Because pregnancy represents a transitional period in a woman's life, she may be more willing to take on the challenge of learning to read during the perinatal time frame. Health providers can teach literacy during the continuum of perinatal care, from conception through to the baby's first pediatric visits and beyond. Some points of intervention that Bennett outlined are obstetrician and pediatric visits, where both the mother and her young child can learn how to read. Unfortunately, he noted, little research has been done on health literacy and maternal and child health. Studies have shown that parental illiteracy leads to children's academic failure. Academic failure leads to poor health status, thus creating a generational cycle leading to an undeniable impact on economic status. In addition, low literacy rates are also connected to mental health status. Increased educational and economic failure leads to mental vulnerability and depression, weakening the immune system and affecting health outcomes. Pregnancy, however, presents the perfect time to break these cycles.