Harnessing the 4 A’s of health literacy: Accessibility, Authority, Advocacy, and Action
Amidst a crush of misleading misinformation and deliberate disinformation, navigating health information has never been more perilous or more crucial. During the pandemic, according to the U.S. Surgeon General, “Misinformation has…led people to decline COVID-19 vaccines, reject public health measures such as masking and physical distancing, and use unproven treatments.” The healthcare industry now has an even greater responsibility to do everything in its power to ensure patients are informed and empowered.
In this context, understanding the challenges facing those with low health literacy and how to overcome those challenges is pivotal to countering misinformation and supporting patients’ abilities to be involved in their own care as they strive for better health and wellbeing.
What is health literacy?
Health literacy is the ability to read and understand health information. It’s a common misconception that only people with low reading or writing skills benefit when health information is made easy to understand. The truth is, no matter what degree or grade level, health literacy benefits everyone. “In a healthcare setting,” says Nimble Works behaviorist Anne Jani, “Even basic literacy changes significantly because of stress, difficulty understanding medical terminology, and the way doctors and nurses talk to patients.”
The four A’s of health literacy you can use to engage patients
A group of Nimble Works team members with diverse specialties sat down to discuss health literacy and how applying health literacy principles can help healthcare companies as well as the providers and patients they serve. Together, the team focused on four areas –– the 4 A’s of health literacy –– they consider when creating educational materials for patients: Accessibility, Authority, Advocacy, and Action.
Accessibility
The first A of health literacy is accessibility. Sharing health information with people in a way they can understand and use is the first step to empowering them. Patients are being increasingly asked to receive important medical information in digital formats. We must juggle user experience concerns with other methods, like using plain language, appealing to a variety of learning styles by including visuals and other media, and offering translations for other languages.
Sean Bumgarner, Managing Partner, Head of Digital: From my perspective in terms of digital accessibility, I ask a lot of questions when creating a product. Can everyone access, understand, and act on the information that is provided to them digitally? For example, am I as a user able to download an app? Do I have a device? Is it at a font size that I can read? Are the accessibility settings correct, so that I can easily tab through information? Thinking about this broader definition of literacy to include digital accessibility for patients is going to be vital going forward.
Megan Beardsley, Director of Strategic Planning: A complete intertwining of digital and health literacy, right? Both of them come hand in hand now.
Sean B: Absolutely. It's so frustrating to me that my New York Times app lets me set the font size to larger-than-life proportions, but MyChart doesn't. It’s an information overload. All of your test results, without any summary or information hierarchy design. As technology and medicine advance, there’s such an incredible responsibility for marketers and businesses to provide materials that are designed in a thoughtful way.
Megan B: In a thoughtful, usable way. I was laughing the other day because I was given a prescription, a new prescription, and I literally could not read it until I put two pairs of readers on. Have you tried this before? [puts readers on over glasses] That's just nuts. This was serious medicine, and I couldn’t read the instructions. I really couldn’t.
I also want to mention health numeracy, or the ability to understand and act on data, in terms of accessibility. Numbers show up a lot, from managing medicine doses to understanding risk. A 50% increase in risk might sound like a lot, but if the initial absolute risk was just 2%, then the new risk is only 3%. A better way to explain this might be to say, "this risk will affect 3 out of 100 people instead of 2 out of 100." We should make numbers enlightening, not intimidating.
Authority
COVID-19 caused not only a global pandemic but also an infodemic, a deluge of information about the novel coronavirus. Some of the information is credible and vital, some not fully accurate, and some manipulated to mislead. But who is equipped to tell whether information is accurate or not, and how do they know? According to GoodRx, 73% of Americans have seen medical misinformation, but up to 44% of people aren’t confident in their ability to tell whether it is or isn’t true. As healthcare marketers, we strive to create materials that harness authority people will be able to trust, whether they encounter them online, in a magazine, or at their doctor’s office.
Lisa Weisberg, Creative Lead of Copy: We all know this is copywriting 101: ensure stats and data are coming from a credible source … and that source is not social media. It's so much easier for misinformation to spread like wildfire. When you're sharing facts, that takes a little longer. You have to make sure they’re accurate. Credible facts are not necessarily as timely as rumors. That's one area that marketers might need to improve, being a little quicker with getting the right facts out there.
Lisa Calanni, Creative Director: Visually, how can I tell at a glance if something is credible or not? Having a seal or stamp of approval, the thing that says this has been verified, certified by whoever has the most clout. You visually catch people by saying certified, accurate information. But to put that in action takes a while.
Lisa Reid, Cofounder: There are some efforts afoot to put information, particularly health information, through independent fact checking. That's why you see media platforms like Facebook saying, this is misinformation. That's from an independent body, reviewing content to flag as misinformation. That's a huge step forward, but still tricky to navigate. It's one thing for people to understand what is ultimately credible information; it's another thing for them to decipher among what we know to be misinformation, which is information that's just wrong or not clear, and quite frankly, active disinformation which is designed to be misleading. As if patients weren't wrangling enough, right?
Megan B: It's also really important to think about diffusion, reaching communities with valid information they can relate to. Like the African American community, which suffered much more during the pandemic. We have to work with communities and work with the partners those communities trust. It's not just credible sources, it's who are the people that are the source of authority in your life, and how do we work with them?
Advocacy
When confronted with a health scare, we are at our most vulnerable and most in need of someone on our side. Health literacy extends not just to the patient but also to the loved one who may be there taking notes and asking the questions patients can’t. A deep understanding of the patient journey and situation, how race, socioeconomic status, comorbidities, etc., affect health literacy, cultivates deep empathy and allows us to craft communication that can empower patients.
Lisa R: At a human level when you're encountering a health condition, you're afraid and stressed. So providing information that is clear, comprehensible, and actionable helps everyone. My first day or so with COVID, I was coughing to the point that my chest hurt. I was trying to read the prescription for the antiviral I received to see if this was a side effect. I have a Master's degree. I've worked many years in the healthcare industry. I have tremendous advantages, but I was sick and had a fever. I'm gonna admit it, I was afraid in the middle of the night. Why is my chest hurting? Turns out it was musculoskeletal. I was coughing so much I'd almost pulled a muscle. We're all scared when things happen like that to ourselves, to our loved ones. So I want us to resist the misconception that improving health literacy is only about helping people who are disadvantaged in some way. It surely is, and I have a tremendous compassion for what people go through to navigate on a daily basis. But that said, this is good practice for all of us.
Anne Jani, Behaviorist: We have to meet people where they are. For example, if you tell someone to “eat less red meat,” they might think: Okay. I'll eat less beef, or they might think, I'll cook my steak more. Really what we mean is to choose more meals that are plant-based or have chicken or fish. So if we don't understand where people are coming from, we could give someone the wrong information. Normalizing challenges also is important because anyone can read the wrong dose and can make a mistake because of the situation.
Megan B: And we have to think about so many factors as we seek to communicate with people — the individual, family, community, social situation, historical context. We can't necessarily communicate to every individual situation, but awareness helps us be more sensitive to what we're going through together.
Lisa W: Sometimes as marketers, we fall into this trap where we get so laser focused on a cardiovascular drug, for example, that we don't realize that many of these patients are also dealing with diabetes or arthritis, so on and so forth, and they're balancing all those other medications and other types of doctors. It's so easy to feel overwhelmed. But we have tools and resources to help guide them step by step and offer empathy and reassurance.
Lisa R: No question. You've all hit upon it. This idea of empathy and compassion and having that bigger picture of what people are going through in mind. Health literacy is not just a reading level. It's not just words on a page. It is truly about human beings and their lives and their health.
Action
Health-literate information should focus on answering the questions: what do I do, and how do I do it? We break down actions into small steps so health decisions don’t feel insurmountable. We help set expectations so patients understand what it will take to follow their treatment plan. Helping patients push past their fears, anxieties, and reservations in order to take action on health information is the culmination of our work.
Lisa W: Health information needs to be understandable and actionable, and that health information could be about a medicine. It could be about a condition, a procedure, a device. We need to be able to break it down, so that people understand the steps they can take.
Megan B: People also learn differently, and so we need to think about that when we create materials. The products have to be easy to read but also have to look easy to read. The effort you think you have to put into reading something can be very dissuasive. You don't want to look at it and think, I'm going to have to work hard to understand. It's going to be too much effort. That's a very big piece of health literacy.
Sean B: Finding the right mediums that strike the right audience at the right moment is also crucial. It's a challenging time to fit a word in. All of a sudden, healthcare is within the attention economy. The information that you need to read about your diagnosis might be competing with Facebook. But there are so many different opportunities to convey information: video content, animations, click-throughs, self-guided journeys, quizzes. All of those interactive elements can drive engagement and action. Take a video for example. Someone will watch a two-minute video if it’s well done, they see themselves in it, and it's speaking a language that resonates with them.
The 4 A’s of health literacy are important signposts you can use to judge whether the health information you produce is clear, credible, and motivating. Guiding your copy and design choices with accessibility, authority, advocacy, and action in mind can lead to improved patient understanding, adherence, and even outcomes.
Our health literacy experts are here to help you bridge the gap between your innovative product and the patients who might need it. From launching campaigns to auditing current materials while harnessing health literacy, we can help. Contact Nimble Works today.
The Nimble Works Experts
Lisa Reid, Cofounder of Nimble Works: Lisa has built creative departments from the ground up for several agencies serving the health technology and pharmaceutical industries, and she loves to inspire and guide creative professionals to create materials and tools that empower patients and their care teams. Two Beagle-mix rescue pups boss her around, and she’s better for it.
Sean Bumgarner, Managing Partner, Head of Digital: Sean is a strong believer in the power of design to shape experiences and tell powerful stories. He worked in product design and at the executive level for Rodale, Condé Nast, Galvanized, and Ooney before bringing his skills to Nimble Works, where he’s inspired by the opportunity to employ design to help people improve their health.
Lisa Weisberg, Creative Lead of Copy: Lisa has spent the past 15 years in healthcare marketing developing award-winning creative materials that help engage, inspire, and educate. Prior to this, she worked on consumer goods (including two different coffee brands which she also considers a necessary medical drug).
Lisa Calanni, Creative Director: Lisa has worked in patient education and engagement for over a decade, honing her mastery of health literacy design principles. With a portfolio of award-winning work in healthcare, her passion lies in tapping into the emotions of her audience and delivering creative that resonates and changes behavior.
Anne Jani, Behaviorist: Anne has a Master's degree in public health with an emphasis in health promotion. Her speciality is translating health information to help the consumer/patient learn about their condition and take medication or use medical devices correctly and increase adherence. Anne has worked in healthcare marketing and translated her skills in understanding behavior change to the healthcare marketing space for 15 years.
Megan Beardsley, Director of Strategic Planning: Half of Megan’s 25-year marketing career has been in healthcare marketing. She maintains a deep interest in planning and crafting communications that help patients learn and process life-critical skills and information that will help them engage with their care for better health. And now that she needs readers, she feels a visceral dislike of small print on pill bottles.