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You are staring at the label of a prescription drug bottle and are trying to understand what you’re reading.
You are reading the doctor’s note with instructions for what to do after surgery, and you’re scratching your head over his words.
These are examples of what is called health communication.
I am going to introduce you to the concept of health literacy.
I will tell you how it's measured, and then I will allow you to measure your own health literacy.
Health Communication
So far, almost all my YouTube videos have focused on skills that you might use in everyday conversation or maybe at work to improve your relationships or succeed at work.
But a big part of what I do as a scientist and as a college professor is to study health communication. This is to look at communication problems in healthcare, and to try to use the communication arts and sciences to solve problems in healthcare.
One of the biggest problems we have in healthcare is that people cannot understand the health information and medical information that they're given.
The simplest and most common kind of health information people might get would be something like a piece of written information you get at the pharmacy when you pick up a prescription drug, or instructions on how to care for a wound after you've had an injury or surgery.
Health Literacy
One of the especially important common kinds of information people receive is how to take medication. Millions of people have difficulty understanding this information. Health literacy refers to the ability to understand written health information and artifacts that we encounter in healthcare, such as documents or interfaces.
When we think of literacy, we think of just the ability to read. But health literacy is more than the ability to read. It isn't that most people in America can't actually read, although a significant number of adults have trouble even with basic literacy.
The much more common thing is the inability to effectively process complicated documents, and to be able to both read them and have numeracy. Numeracy is the ability to make simple calculations with numbers or read graphs.
People must also have the ability to navigate documents, to find the section of the document that's relevant to your particular need or question.
Those things taken together are what we refer to as health literacy, the ability to examine and process written information, then extract from it the correct inferences and conclusions, and finally be able to follow the instructions in a way that you can take care of yourself.
Health literacy turns out to be extremely important and correlated with numerous good and bad outcomes. People with high literacy tend to have better outcomes. People with poor literacy tend to have worse outcomes in a variety of different domains.
At a very simple level, we'd just like people to be able to understand the information we give them in healthcare so they can take care of themselves. It is important to understand this on your own since so much of illness these days is chronic illness that you have to take care of at home, where you can’t be in the hospital with people taking care of you.
A New Vital Sign
How do we measure people's health literacy? When I first learned how people did this, I thought it was so interesting. I also found it amusing in a way, because it turns out the most common way of measuring health literacy these days is to treat it as a a new vital sign. The other vital signs are pulse and respiration rate and temperature and things like that. But health literacy is the newest vital sign.
If you just Google newest vital sign, you can read all about it. But it turns out it's a simple test with six questions. The basis for the test is the nutrition label from a Haagen-Dazs ice cream container. That seems amusing at first, but it makes sense when you think about it more carefully.
Nutrition labels are not unlike medication instructions and medication labels. If people can read one, they have to be able to read the other. So it turns out the research has shown that the nutrition label from a Haagen-Dazs ice cream container can be used as the basis for a very scientifically valid and reliable test of health literacy.
Health Literacy Test – Haagen-Dazs Nutrition Label
I'm going to give you a test. This is your typical nutrition label that you've seen a million times, the nutrition facts. It gives the serving size and all the other details you see on any standard nutritional label. You study that label as I ask you the following six questions, and we'll see how you do.
Question 1: If you eat the entire container, how many calories will you eat?
Question 2: If you are allowed to eat 60 grams of carbohydrates as a snack, how much ice cream could you have?
Question 3: Your doctor advises you to reduce the amount of saturated fat in your diet. You usually have 42 grams of saturated fat each day, which includes one serving of ice cream. If you stop eating ice cream, how many grams of saturated fat would you be consuming each day?
Question 4: If you usually eat 2,500 calories in a day, what percentage of your daily value of calories will you be eating if you eat one serving?
Question 5. Pretend that you are allergic to the following substances: penicillin, peanuts, latex gloves, and bee stings. Is it safe for you to eat this ice cream? Yes or no?
Question 6 (if you answered no to question 5): Why not? Why is it not safe for you to eat this ice cream?
Here are the answers - compare them with your own:
Answer 1: If you eat this entire container of ice cream, how many calories will eat? 1,000 calories. There's 250 calories per serving, four servings in a container, that's 1,000 calories.
Answer 2: If you're allowed to eat 60 grams of carbohydrates as a snack, how much ice cream could you eat? Well, there's 30 grams of carbohydrate in each serving. So you could eat two servings or one cup.
Answer 3: Your doctor advises you to reduce the amount of saturated fat in your diet. You usually have 42 grams of saturated fat, which includes one serving of ice cream. If you stop eating ice cream, how many grams would you consume each day? Well, there's 9 grams of saturated fat in a serving. So if you stop, you'd have 33 grams of saturated fat remaining in your diet.
Answer 4: You usually eat 2,500 calories in a day. What percentage of your daily value of calories will you be eating if you eat one serving? Well, there's 250 calories, 250 divided by 2,500, it's 10%.
Answer 5: You're allergic to penicillin, peanuts, latex gloves, and bee stings. Is it safe for you to eat this ice cream? Well, if you read the ingredients, you see that peanut oil is one of the ingredients.
Answer 6: No, it's not safe for you to eat this ice cream, because it contains peanut oil, which is one of your allergens.
Do You Have Health Literacy?
Generally, a score of 0 to 1 indicates high likelihood of limited literacy.
A score of 2 to 3 indicates the possibility of limited literacy.
A score of 4 to 6 normally indicates high or adequate health literacy.
So that's a brief post on how we measure health literacy. I hope you find it important. It's one of the basic facts in health communication. That's how we measure it by showing people a Haagen-Dazs ice cream nutrition label.
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