Archive for the ‘Health literacy’ category

Seniors take charge of their health

January 13, 2011

Seniors taking an active role in their health

Health Watch program in Burnaby, British Columbia struck me as a really unique program for promoting wellness among seniors. This calendar outlines some of their weekly activities.  Healthwatch along with three other programs  is part of the Burnaby Partners in Seniors Wellness. It is an excellent model of what can be done when seniors come together and are supported to take charge of their own health.

  • The group is run by a volunteer board which plans and manages its activities. They request for funding from the Fraser Health Authority and have to report back on their activities.
  • The funding is used to hire a coordinator who is shared by two programs.
  • Retired health care workers have been recruited as volunteers to conduct screenings, monitor blood pressure and pulse etc.
  • The group has secured permission to collect and maintain the health records of the participants. Volunteers fill out a medical card with vital information and give participants a wallet card. Weight and blood pressure are recorded each visit and an uptodate record of medications is maintained.
  • Trained volunteers offer massage, conduct chair exercises
  • Speakers are regularly invited to speak on various topics of interest to seniors such as our medication safety session.
  • The seniors also enjoy socializing with their peers
  • Partnering with local pharmacists t0 run a clinic  where seniors can bring in their drugs and have the pharmacist “critique” them. One of the seniors brought 21 different medications.
  • Encourage their members to maintain an uptodate medication list.

Image credit: Used under creative common license Pocmont Resort and Conference Centre


Social media session at IHA Health Literacy Conference 2

May 15, 2010

I recently had the privilege to facilitate a social media session breakout session at the  9th IHA Health Literacy Conference. For the background, see earlier post.


With Rosetta Keeton, St. Louis ConnectCare

Rosetta Keeton planned to use FaceBook with her teen audience

It was very heartening to hear several participants say that the presentation encouraged them to think about using social media tools in ways they had not considered before. Rosetta came up to me during the reception and said that she had learned a lot of useful ideas. She was very enthusiastic about David Armano’s “listen, learn and adapt” cycle and was considering FaceBook for engaging teens in an upcoming theatre for HIV prevention project. To the extent that the session stimulated interest in social media tools and got participants thinking about new ways of reaching their audience, I consider the session highly successful. The participants expressed appreciation for the handout and I continue to receive positive feedback. I am in the process of moving the handout to Google Docs so that it can be collaboratively edited.

Lessons learned
  • Polling the participants ahead of time was a good idea. Pro: I was able to get a sense of the audience, learn about their needs and invite some advanced users to contribute their experiences. Con: There was no way to respond to all the fantastic issues in a 90 minute session.
  • I knew from the poll that participants were at different levels of experience but I was still thrown off by the challenge of engaging such a mixed crowd. Happily, they were all a model audience – enthusiastic and eager to learn. With the focus of the session on examples and strategies, there wasn’t enough time to address questions such as: what’s a Twitter hashtag in satisfactory detail as I worried about boring the advanced participants stiff with indepth explanations of  basic concepts.  Clearly, I was expecting too much when I asked the busy participants to review my social media 101 post as many beginners needed to learn what the tools are and how they work. There are many barriers to learning – for example, one participant  explained that she couldn’t review the post because her workplace blocks *all* blogs!! Beth Kanter, who is a social media training guru may have valuable input on how to address the challenge of mixed level groups and I wish to acknowledge her wisdom which she generously shares on her blog and social media lab wiki. The ideal scenario would be separate sessions for beginners and more advanced learners.
  • It may be helpful to divide the participants into loose groups based on their target audience. It was clear that those targeting patient groups face different challenges from those reaching health literacy practitioner communities.
  • I may have tried to cover too much content too quickly and with hindsight, it was overly ambitious to expect the participants to work on the  activity that I had planned for them – an exercise to brainstorm their audience, objectives, strategies and technologies [based on Forrester’s POST methodology].  There was not enough time to absorb the basic concepts and envision implementation particularly for the beginners.
  • Helen Osborne, who I respect a great deal, had valuable feedback for me. She was very interested in my analysis of my pre-session survey findings and would have liked us to spend more time on this.
Plenary session at the IHA conference

Plenary session at the IHA Conference

Next steps

The participants had lots of questions and we ran out of time while there was a clear appetite for animated discussion. Predictably, a common concern was how to address privacy and HIPAA regulations and my basic response was a) HIPAA applies to health care providers not patients b) get informed consent when interviewing patients for blogs c) use social media for general education not specific patient advice. Other concerns: What do you do with negative comments? How do you track all the FaceBook comments about your organization? How often should you post updates? Sara Browne, a physician made the valid observation that it’s challenging to keep up with all this information without experiencing an information overload.

To address these and other issues raised in the pre-survey, I offered to start a forum where we would continue this conversation. I am considering creating a FaceBook page where participants can hone their skills with this platform as they share their experiences with and learn from like-minded colleagues. I wish to acknowledge the wonderful contributions of all those who I have consulted on my journey to IHA where I gained rich insights. I am particularly grateful to Erin Macartney of Palo Alto Medical Foundation for diligently compiling excellent content which I am working into a blog post. And of course, a big thank you to my wonderful audience many of whom spoke to me afterwards and planned on staying in touch.

I welcome thoughts from all: the session participants and those who have facilitated similar sessions on how to sustain these great conversations.

Social media session at IHA Health Literacy Conference 1

May 15, 2010

My journey to IHA, California

Gloria Mayer and Michael Villaire, Institute of Healthcare Advancement

With Gloria Mayer and Michael Villaire, authors of "Health Literacy in Primary Care: a Clinician's Guide"

About 6 months ago, Michael Villaire, Director of Programs & Operations, Institute of Health Care Advancement [IHA] asked me to facilitate a social media session at the  9th IHA Health Literacy Conference. He approached me based on Farrah Schwartz’s recommendation which was in turn based on following my blog and tweets! Now, there’s an incentive to blog and tweet!!

The “social media and health literacy” brief sounded straightforward but as I started to delve into the presentation, it dawned on me that I was not sure how best to approach this. For ideas, I contacted expert social media trainers such as AIDSgov staff [Jennie Anderson, Josie Halpern-Finnerty & Michelle Samplin-Salgado], Lee Aase of Mayo Clinic and Beth Kanter, We Are Media project. I also reached into my #hcsm network where I connected with @emacartney, @macobgyn, @pfanderson and @mindofandre among other great minds. Everyone was very helpful. I then polled my participants, posted the results and  compiled a brief primer for the beginners in the group.  In my preparation, I borrowed heavily from WeareMedia and AIDSgov resources and quoted liberally from Lee Aase’s social media theses. In the spirit of crowdsourcing, all I did was synthesize these great ideas, compile these resources and then facilitate a conversation.

Finally, Thursday, May 6 arrived and with it, a mixture of trepidation and excitement. There were two sessions of about 70 each, filled to maximum capacity. Technology worked smoothly with a [not so] minor exception: having to change a few minutes prior to the presentation on finding out that you cannot wear a dress and use a wireless mic because it comes with a heavy gadget that needs to be clipped to a belt!!


With Bonnie Graham, Knox County Health Department

Bonnie was very keen to explore social media tools for her health literacy work

To my delight, social media proved to be a topic that engaged everyone a great deal regardless of their knowledge base. Based on participants’ responses to my poll, I focused on a) examples of social media use in various settings and b) strategies for social media execution. I begun with Pew and Forrester data on the adoption of these platforms by different demographic & psychographic profiles. I  then highlighted examples of social media use to reach both patients and health professionals.

The widespread use of cellphones and their potential for engaging low literate populations struck a chord with many participants as I discussed the intriguing Dietary Intake Monitoring Application (DIMA), a mobile, electronic food diary for low-literacy patients developed by Kay Connelly’s team [Thanks to @pfanderson for highlighting this on her blog].  Among others, I  featured the Mayo clinic culture blog, AIDSgov, Erin Macartney’s Palo Alto Medical Foundation’s FaceBook/Twitter successes, Dr. Susan Giurleo’s psychotherapy practice and @MacObgyn’s fantastic patient education portal. A participant pointed out that health providers have tended to neglect the health information needs of the deaf and hard of hearing, a growing population. She pointed out the helpful resource which provides health information in American Sign Language [ASL].

I also asked the more advanced users of these technologies in the audience to share their own experiences. For example:

  • Sam Petitjohn explained how Health Literacy Missouri is using FaceBook and Twitter to build a community of health literacy practitioners.
  • Manisha Shah, National Patient Safety Foundation mentioned how they are using FaceBook to share patient safety information
  • Helen Osborne chimed in with a great example of how she had used Twitter to elicit questions for her Health Literacy Aloud podcast interviews [and received input from quite a few people including myself].

It is noteworthy that the above examples are targeting health professionals and not consumers/patients, implying that barriers [real or perceived] are lower in using these tools to engage health professionals. Many participants were interested in strategies to communicate with patients/consumers while respecting HIPAA concerns.

Tough questions

Understandably, some participants were skeptical about whether these tools would work for their audiences:

  • One said that neither she nor her audience was using these tools but she saw the potential of cellphones.
  • Chellappa Kumar said that his low literate patients were not necessarily using these platforms but the tools were valuable for reaching his physician faculty with health literacy messages.
  • Janet Ohene-Frempong asked whether there was data was available on the use of these tools in low-literate populations.
  • My response was: “indeed, I haven’t found hard data proving that all low literate populations are active users of these platforms because different audiences are on different media as clearly evidenced by the Pew research reports. However, one thing we can be sure of is that these tools offer valuable potential such as rendering health messages into audiovisual formats that are more accessible than traditional print and very importantly, shareable.” I haven’t found much data on the outcomes but this Health literacy, ehealth and communication workshop report which addresses e-health  outcomes and challenges is useful. Chapter 4 is particularly pertinent.
  • Martha Torres-Montoya, State of California wanted to know whether there were any studies comparing the impact and ROI of  traditional vs social media. I promised to look into this and welcome any thoughts from those health communication gurus who are using a multipronged strategy of print, broadcast and other traditional media alongside new/social media tools.

For more reflections on lessons learned and next steps, see the next post.

IHA Health Literacy Conference connections

May 14, 2010

Last week, I had the privilege of attending the 9th annual Institute of Health Advancement Health Literacy Conference where  I was graciously invited to do a  “social media for health literacy” session by Michael Villaire. Not only did I have a really wonderful time with my session participants but I must say that the conference as a whole was one of the most enlightening and enjoyable I have attended. It was an incredibly enriching experience to share perspectives with both researchers and practitioners: health professionals, health educators, communication specialists, health librarians and medical education faculty in their noble quest to ensure health information is made accessible to patients.

Below are some of  the delightful people I was privileged to meet.

With Helen Osborne

With Helen Osborne

  • I was thrilled to finally meet health literacy guru Helen Osborne, Health Literacy Consulting  in person. It’s exciting that Helen has just signed a contract to radically revise her phenomenal book Health Literacy A – Z. I can’t wait to see the new book! Helen is a very generous mentor and I will be tapping into her wisdom at every opportunity.

IHA staff

With Liz Collins, Tobi Aclaro, Yoly Herrera, Michael Villaire and IHA staff

  • The wonderful IHA Health Literacy Conference Team including Michael Villaire, Gloria Mayer, Mario Melia, Liz Collins, Yoly Herrera and Tobi Aclaro were all incredibly kind and helpful throughout the planning process and the conference itself. The conference was extremely well organized.

With Bonnie Graham, Knox County Health Department

Bonnie was very keen to explore social media tools for her health literacy work

  • Bonnie Graham attended my social media session and had a most interesting poster on The Occurrence of Adverse  Childhood Events and Health Literacy on Repeat Sexually Transmitted Infections
Ros, Rhodes University, South Africa

Ros Dowse, Associate Prof, Rhodes University Faculty of Pharmacy is devoted to medication literacy projects in South Africa

  • Ros Dowse, Rhodes University and Sarah Browne, University of California had a poster on Exploring health literacy in a Xhosa-speaking South African population: Is the REALM an appropriate assessment tool? What a thoughtful research question! I am very interested in e-health and health literacy projects in Africa so Sarah and Ros are excellent connections with their South African expertise. Sarah and Ros are very concerned about the lack of accessible drug information for patients and the HIFA2015 community is an excellent forum for expressing these concerns and connecting with likeminded health professionals.
  • Toyosi Adekeye, University of N. Carolina Greensboro had an interesting poster Understanding Health Literacy from the Perspective of the African Immigrant Youth and Elderly: A Photovoice Project. I will be following up with both Toyosi and Roy Sahali of Washington University on their interest in mobile health technologies in Africa.
  • Farrah Schwartz, Toronto institute of Rehabilitation kindly recommended me to Michael as a speaker. It’s very powerful that we can connect with peers virtually and then extend those relationships to real life.
  • Librarians Jean Shipman, Gail Kouame, Kelli Ham and Kathleen Amos. It was so refreshing to see the librarians’ contribution to health literacy discourse and learn about their integral initiatives in health information dissemination. Kathleen is a National Library of Medicine Fellow with the University of Utah Kathleen is a National Library of Medicine Fellow with the University of Utah and has lots of great contacts working  in Africa/global health.
  • Beth Davis of Fraser Health and Lisa of BC Children’s hospital. Is it not fascinating and ironic that it took coming to the conference in California for me to connect with these BC colleagues?

My next few posts will reflect on sessions I attended.

Social media awareness among health literacy educators

April 25, 2010

By now, anyone who will listen [perhaps to the annoyance of my loyal Twitter followers] has heard that I will be speaking at the IHA Health Literacy conference in California on social media and health communication on May 6 2010 [see an earlier post]. I feel utterly humbled to be so honored. To prepare, I polled the registrants to find out a) What they know and b) What they want to know. The participation rate was a respectable 50 % which goes to show what a dynamic and engaged group they are. This posting is primarily for their benefit as well as input by all who are interested in social media.

Audience: comprises health educators, librarians, health professionals involved in direct patient care, writers and health literacy advocates working for varied agencies such as government, health care providers, HMO/health insurance companies and academic institutions. The majority of participants work in a program public education role – rather than professional communication/PR function.

Experience with social media:  Most of the respondents have had limited exposure to social media: 55% [hardly]; 32% [a bit]; 13% [a lot] some were a little skeptical but all were enthusiastic and eager to learn. One promised to sign up for a FaceBook account before the session which was lovely. Some are actively using these tools:

  • Facebook campaign to promote public health week; Fan page to inform, network and share resources regarding patient safety
  • FaceBook for posting events and communication with faculty and students
  • Twitter for updating staff teams regarding conferences – content used as press releases
  • Creation of podcasts
  • Wiki community to promote evidence-based practice information
  • Story telling using multimedia to promote health literacy month
  • Use of RSS feeds for health care classes, tracking blog postings
  • Locating health education videos on YouTube

The most popular tools are: FaceBook, YouTube and blogs. Quite a few mentioned LinkedIn. While it is tricky that participants have mixed skill levels, I am sure the more experienced ones will patiently help the rest of us and chime in with examples based on their experience. In fact, some participants have eagerly offered to share their experience and expertise which should make for a lively session.

Areas of interest

  • What are the state-of-the art technologies being used in health communication? How can these be applied to developing countries?
  • What tools can be used to reach
    • the general public
    • specific demographic groups – teens, African-American populations, seniors, K-12 education…
    • particular audiences with personal health improvement programs – reminders to exercise, do food logs…
  • What strategies do you use to connect with your audience ie. create and maintain quality dialogue? How do you get started?
  • How can social media tools be integrated into academics?
  • How do you grow your FaceBook presence for a health literacy partnership?

The most common question was how to know what tools to use for what settings, audiences or targets – essentially, how to create a social media strategy. I plan on allocating plenty of time to discuss this. The diversity of communication activity with faculty and students was enlightening because I had expected a health literacy conference audience to be mainly interested in communicating with consumers/patients/the public.


  • Legal concerns: what are the privacy and security implications of social media?
  • How do you prove value and quantify benefit?
  • How do you handle inappropriate use and abuse – such as students posting inappropriate content?
  • Aren’t social media tools associated with a digital divide – for those with limited English skills and access to technology?
  • Government computer systems restrict access to social media
  • Is this not yet one more thing to do with limited staff resources?
  • Social media tools are “incredible time wasters”
  • Some  residents would prefer to receive articles via e-mail rather than a blog
  • There seems to be an increasing focus on these tools at the expense of traditional channels which most of the population uses at this point

I am pleased to see this rich commentary from the participants who are thinking deeply about these pertinent issues. I welcome your input which will contribute to our conversation at the IHA conference.   In the next post, I have outlined some  resources for the participants [particularly those new to social media tools] to review prior to the conference.

IHA’s 9th Health Literacy Conference, Irvine California

February 21, 2010

Health Literacy advocates all over North America will want to take note of the Institute for Healthcare Advancement’s Ninth Annual Health Literacy Conference, “Health Literacy in the Real World: Programs & Solutions That Work,” May 6-7, 2010, at the Hyatt Regency in Irvine, California. Speakers will discuss programs and solutions to improve health communication, review programs of critical importance to improving health literacy, and teach attendees skill sets to better serve their clients. Conference attendees include health educators, nurses, physicians, dentists, dieticians, public health professionals, researchers, writers, librarians and other health literacy advocates.

At the end of the conference, attendees will be able to:

1. Identify one practice they can implement based on what they have learned.

2. Evaluate three components of their patient/client education program related to health literacy, to determine how any of the solutions learned would be appropriate.

3. Demonstrate the application of one learned skill to the needs of their organization and/or patient/client population.

The deadline to submit a Poster Abstract is Feb 26, 2010 while early bird registration is available until April 7 2010. Complete conference information is available here.

Judging from the offerings, it certainly is a conference worth attending. I have the privilege of presenting breakout session A so I am eagerly looking forward to connecting with my health literacy peers there. The concurrent breakout sessions will be offered twice, ensuring that as many delegates as possible get to benefit. Below, is a listing of selected sessions.


  • Beyond Plain Language: Advances in the Design of Health Literacy Tools David Baker, M.D. Northwestern University
  • Panel: Positive Results from Easy-to-Use Tools Linda Neuhauser, Dr.P.H. University of California-Berkeley; James Glauber, M.D., MPH Neighborhood Health Plan, Massachusetts; Kara Jacobson, MPH, CHES Emory University
  • Applying the ‘National Action Plan to Improve Health Literacy’ in Your Organization Cynthia Baur, Ph.D Centers for Disease Control and Prevention
  • How to Integrate Health Literacy into Health Professionals’ Curriculum Charlotte Nath, RN, Ed.D West Virginia University

    Breakout Sessions

    • A – Using Social Media to Reach People with Health Information Elisheba Muturi, M.Sc., MLIS British Columbia Ministry of Health Services
    • B – Developing Community Coalitions to Support the Health Information Needs of At-Risk Consumers Gary L. Kreps, Ph.D George Mason University
    • C – Demonstrating the Strategic Value of Your Health Literacy Program Farrah Schwartz, MA Toronto Rehabilitation Institute
    • D – Improving Readability with Appropriate Design: 7 Critical Elements Douglas Seubert Marshfield Clinic, Wisconsin
    • E – Improving Health Education Outcomes with the Right Learning Model Lorraine S. Wallace, Ph.D University of Tennessee

      FRIDAY, MAY 7

        • Can I Rewrite This? Medical Documents and Low Literacy James G. Hodge, Jr., J.D., LL.M. Arizona State University
        • Implementing Health Literacy Universal Precautions in Primary Care Darren A. DeWalt, M.D., MPH University of North Carolina-Chapel Hill
        • From Medical Dialogue to Plain Talk: Reducing the Oral Literacy Burden of Medical Visit Communication Debra Roter, Dr.PH Johns Hopkins University

          Breakout Sessions
          • K – Learner-Developed Fotonovelas: An Empowering Product John Comings, Ed.D Harvard University
          • L – Making the Case for a Cost-Effective Language Access Plan Elizabeth Abraham, M.A., M.Sc., C.Tran. University Health Network-Toronto
          • M – Using New Technology to Improve Providers’ Health Literacy Skills Cliff Coleman, M.D., MPH Oregon Health & Science University
          • N – Developing a Health Literacy Action Plan Stacy Robison, MPH CommunicateHealth, Inc.
          • O – Looking for Health Literacy Solutions? Ask a Librarian Sabrina Kurtz-Rossi, M.Ed Kurtz-Rossi & Associates Jean P. Shipman, MSLS University of Utah Gail M. Kouame, MLIS NN/LM, Pacific Northwest Region Kelli Ham, MLIS NN/LM, Pacific Southwest Region

            Douglas College health literacy partnerships

            February 5, 2010

            We have been thinking about how to build partnerships in order to improve health literacy. My team and I recently met with Marina Niks and Joy Page of Douglas College Centre for Health and Community Partnerships (CHCP)  to discuss their projects and potential for partnership. What is unique and impressive about CHCP is that:

            • It promotes healthy communities through community health promotion activities.  A community advisory committee proposes projects.
            •  It uses a service-learning framework, that matches students and faculty with agencies to work on specific agency projects. Students work on interdisciplinary projects that meet agency needs as well as their own learning objectives.
            • It serves as a link for faculty, students and agencies in community-based research. See Centre for Community based research for more on this.
            • Evaluation is a very strong component of their projects.

            Current community health promotion activities include:

            • Fraser Health Authority Breast feeding Support Clinic every Tuesday and Thursday afternoon;
            • Ministry of Families and Children Eating Disorders Group weekly;
            • Douglas College CE Prenatal Classes.

            Many of these health promotion projects have a  Health Literacy thematic focus:

            • ACTION for Health sought to achieve a fuller understanding of the ways health information is  produced, consumed and used by lay people and health sector professionals in order to inform  the design of processes and systems.
            • BC Literacy and Health Research Project sought to create a comprehensive agenda and develop capacity on literacy and health research in British Columbia.
            • Health Literacy Among Diabetes Patients in a Primary Care Practice sought to determine the prevalence of low health literacy among a sample of patients receiving treatment for diabetes within a primary care practice in Victoria, British Columbia.
            • Measurement of Health Literacy in Schools aimed to develop and validate measures of health literacy for middle and high school populations in British Columbia.
            • Measurement of Health Literacy in Different Population Groups developed an operational definition of health literacy and a conceptual framework, mapped the domain of health literacy and developed an instrument for measuring health literacy among older adults living in the community.

            CHCP’s recently launched website is a particularly valuable resource on health literacy initiatives in BC. They are working with an impressive array of community partners on various projects.