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Health Technology Literacy

Society For Public Health Educators

Washington, DC

November 14-15, 1998

John Studach

American University - National Center for Health Fitness

Preface: I became interested in this area because I think not enough attention is being given to the level of technology literacy of people who are interested in accessing information to improve their health or quality of life. After reviewing the literature, and communicating with authorities in the field my assumptions have been confirmed. I found that reading literacy has received a considerable amount of attention. Practitioners are becoming increasingly aware of the importance of health literacy, especailly for print material. However, programs that prepare, assess, or even consider attributes of tehcnology and health literacy for practitioners or consumers extremely rare.

This page contains material that relates to my investigation. The relevant topics for this study have been organized into the following sections:

  • The Powerpoint version of this poster

Overview - There has been an explosion of programs on the Internet and in the marketplace designed to help users improve their health. Often, people make decisions about whether to continue exploring technology-based health information during their first exposure to these programs. Therefore, it is essential that health professionals understand the critical issues from the user's perspective. Every health educator should develop literacy about the newest generation of sophisticated health technologies. By preparing themselves and the populations they serve, health educators can maximize the impact of these powerful programs. Moreover, it is important that educational institutions prepare health practitioners who are aware of and literate about the latest health promoting technologies. Finally, It is extremely important that health practitioners begin to educate those that they serve in as part of their general services, counseling sessions, through regular program offerings, and special events and promotions.

The questions - what is important to ask

  • Is there a relationship between health status and technology literacy?
  • Is technology literacy a barrier for individuals seeking to improve their health?
  • Should health practitioners be responsible for preparing themselves and their "customers" to be savvy about the emerging technologies that could improve their health?
  • How should practitioners prepare themselves and their "customers" to be proficient in using technology?
  • How can practitioners assess levels of technology readiness of their clients?
  • Where can practitioners get additional information on the topic?
  • What is the role of educational institutions in preparing students to be competant in health promoting technologies in the 21st Century?

The problem: - the need

  • There is a strong relationship between poor health and illiteracy (National Institute for Literacy, 1998; Weiss, 1992).
  • Approximately 21% of American adults are functionally illiterate, and another 27% have marginal literacy skills (Davis, 1998).
  • Illiteracy has a strong relationship with a variety of social ills (Prothrow-Stith, 1991).
  • There is often a mismatch of culture and skills between low literacy populations and providers who serve them (Baker, 1997).
  • Approximately 50 million Americans are not prepared for the technology of the new age. (Caibattari, 1998).
  • The level of technology literacy of the target audience for computer-based health interventions is rarely considered (Ratzan, 1998).
  • Individuals can not take full advantage of health services if they can't access health information and services. There is currently an enormous gap between the haves and have nots (Valenti, 1995).
  • There are no "quick and dirty" assessments for technology literacy in health care (Studach, 1998). Technology literacy is seldom addressed in training of health care professionals (Anderson, 1992).

Literacy table - a graph that summarizes the amount of illiteracy in America. Click on the figure to see a larger version.

The barriers for practitioners and users
For practitioners

  • Lack of formal training and scarcity of inservice opportunities
  • Few resources and little technical support
  • Lack of assessment tools
  • Competing priorities - time, workload etc.
  • Lack of institutional support for developing personal skills or promoting skill development for clients

For consumers

  • Technology literacy and consumer health informatics training is not offered by provider organizations
  • Limited access, resources, or training
  • Glut of information and lack of credible sites

The conclusions- some summary thoughts

  • Assess health technology literacy of providers and target groups.
  • Teach technology literacy skills.
  • Educational institutions must integrate technology training in the curriculum.
  • Academics and practitioners must provide education, training, and support for practitioners in the information age.

The recommendations - suggerstions

For health practitioners:

  • Integrate technology literacy training in educational programs before graduation.
  • Provide inservice and continuuing education opportunities.
  • Develop self-help and support networks and materials.
  • Develop linkages with professionals in other fields.

For user groups:

  • Provide greater access to computer-based services.
  • Provide training and support for target populations.
  • Develop self-help and support networks and materials.

References and Resources - some publications and places to check

  • Anderson, Sandra K.Computer Literacy for Health Care Professionals. Delmar Publications Inc.: Albany New York, 1992.
  • Baker DW, Parker RM, Williams MV, Clark S, Nurss JR. The relationship of patient reading ability to self-reported health and use of health services. American Journal of Public Health 87(6):1027-1030, 1997.
  • Baker DW, Parker, RM, Williams MV, Coates WC, and Pitkin K. Use and effectiveness of interpreters in an emergency department. JAMA 275(10):783-788, 1996.
  • Baker DW, Parker RM, Williams MV, Pitkin K, Parikh NS, Coates W, and Imara M. The health care experience of patients with low literacy. Archives of Family Medicine 5:329-334, 1996.
  • Caibattari, Jane. Washington Post Parade Section Intelligence Report, October 25, 1998.
  • Covvey, Dominic H., Craven, Nancy H., McAlister, Neil H. Concepts and issues in Health Care Computing: (Computers in health care; Volume I). The C. V. Mosby Company: St. Louis, Missouri, 1985.
  • Davis TC, Long SW, Jackson RH, et al. (1993) Rapid Estimate of Adults Literacy in Medicine: a shortened screening instrument. Fam Med; 25:391-395.
  • Doak CC, Doak LG, Root JH. (1996) Teaching patients with low literacy skills (2nd edition). J.B. Lippincott Company. Philadelphia.
  • Thomas R. Eng, VMD, MPH; Andrew Maxfield, PhD; Kevin Patrick, MD, MS; Mary Jo Deering, PhD; Scott C. Ratzan, MD, MPA, MA; David H. Gustafson, PhD Policy Perspectives - October 21, 1998 Access to Health Information and Support: A Public Highway or a Private Road? JAMA. 1998;280:1371-1375.
  • Ley P, Florio T. (1996) The Use of Readability Formulas in Health Care. Psychology, Health and Medicine; 1(1):7-28. National Institute for Literacy, Margins to the Mainstream: An Action Agenda for Literacy, 1998
  • Nurss JR, Baker DW, Davis TC, Parker RM, Williams MV. Difficulties in functional health literacy screening on Spanish-speaking adults. Journal of Reading, 38(8):632-637, 1995.
  • Parker RM, Williams MV, Baker DW, and Nurss JR. Literacy and contraception: Exploring the link. Obstetrics and Gynecology 88(3):72S-77S, September, 1996.
  • Parker RM, DW Baker, MV Williams, JR Nurss. The test of functional health literacy in adults (TOFHLA): a new instrument for measuring patients' literacy skills. J of Gen Intern Med, 10(10):537-541, 1995.
  • Parikh NS, Parker RM, Baker DW, Williams MV, Nurss JR. Shame and Health Literacy: The unspoken connection. Patient Education and Counseling 27:33-39, 1996.
  • Weiss BD, Hart G, McGee DL, and D'Estelle. (1992) Health status of illiterate adults: Relation between literacy and health status among persons with low literacy skills. J Am Board Fam Pract 5, 257-264.
  • Williams MV, Parker RM, Baker DW, Parikh NS, Pitkin K, Coates WC, and Nurss JR. Inadequate functional health literacy among patients at two public hospitals. JAMA 274(21):1677-1682, 1995.
  • Williams MV, Baker DW, Parker RM, Nurss JR. The relationship of functional health literacy to hypertensive and diabetic patients' knowledge of their disease. Archives of Internal Medicine 152(2):166-172, 1998.
  • Turner, TC. Literacy and Machines: An Overview of the Use of Technology in Adult Literacy Programs, Technical Report TR93-3. Saint Paul Lifelong Literacy, April, 1993.

Websites

  • American Medical Association - Steering Committee for its campaign "Partnership in Health ? Improving the Patient?Physician Relationship Through Health Literacy." 1998.
  • National Center on Adult Literacy - Webiste devoted to literacy.
  • National Institute for Literacy - Website includes discussions about literacy in health education and health care
  • The California Wellness Foundation (http://www.tcwf.org/) is an independent, private grantmaker, funded in 1992 by a substantial endowment from Health Net, one of California's largest health maintenance organizations. The Foundation's mission is to improve the health of the people of California.
  • The APHA WebSite (http://www.apha.org/news/publications/nation/headit.html) ? the nation's health ? previous headlines ? 16 issues ? none dealth with technology/computing ? only healht and disease issues
  • New York Access to Health - NOAH (http://noah.cuny.edu/) ? health-related information and resources in English and Spanish.
  • Boston University Medical Center Community Outreach Health Information System ? (http://www.bu.edu/cohis/about.htm) last updated 1996
  • Institute for the Study of Adult Literacy, Pennsylvania State University. Computer literacy course Michael Silverberg medical informatics
  • PBS Literacy Link - links and resources for general literacy Empowerment Health Education in Adult Literacy - by Martha Hohn Altavista and Altavista World - can translate english into 6 languages ? via systrans.
  • Usable Web - a website devoted to design factors and human-to-computer interactions.

Resources and Projects - from Laurie Schneider, MPH AMC Cancer Research Center and other sources

  • US Department of Health and Human Services, National Institutes of Health, National Cancer Institute. (1995) Clear & Simple: Developing Effective Print Materials for Low-Literate Readers. NIH Publication No.95-3594. Online at http://nex.nci.nih.gov/nci_pub_index/pub_index_doc.html
  • Health Literacy Center, University of New England, Area Health Education Center Program, Hills Beach Road, Biddeford, ME 04005 (207) 283-0171, x.205.
  • Interactive Technologies, Inc. - This organization has focused on developing multimedia programs for low literate adults. Some partners have included industry(textile), media (PBS), and health (breast cancer education). AMC Cancer Research Center Partnered with IK to develop a breast cancer awareness CD-ROM for adult literacy students. CDs that can be used with low literacy adults. MSU's Communication Technology Lab (www.comtechlab.msu.edu) especially the CD "The Breast Cancer Lighthouse." Contact: Tim Songer-President PO Box 560865 Charlotte, NC 28256 704-344-0055 tim@interactive knowledge.com
  • La Plaza Telecommunity - a multifaceted telecommunity project in rural Northern New Mexico, this organization developed a multimedia program on diabetes-accessible through its website (www.laplaza.org/dwc/) Contact: Barbara Hau 222 Cruz Alta, Suite E Taos, NM 87571 bhau@laplaza.org
  • An excellent CD-ROM presented at the Tampa conference was the "Retratos de la vida real" - a breast cancer CD for high risk hispanic women. This CD was created to look like an interactive photonovela. Contact: Maria Jibaaja, EdD Baylor College of Medicine Division of Allied Health Sciences, Room 633E Houston, Texas 77030 mariaj@bcm.tmc.edu

 

Take-aways:

  • There is a literacy crisis in America (25% of the population is either functionally or marginally illiterate).
  • 50 million people are technologically illiterate.
  • There is a strong relationship between health and literacy.
  • Technology has the potential to be a powerful solution as well as a barrier to enhancing the health and quality of life of Americans.
  • Little attention is given to the level of technology literacy of users who are accessing on-line or stand-alone computer-based systems and programs during the design, implementation, training, or evaluation phase.
  • Very few health practitioners receive training for or exposure to health promoting technologies.
  • Very few agencies or organizations offer programs or services that use technology or provide the means to educate their service population.

In the future, it is essential that greater attention be paid to this area since it will be a key to the success of interventions that will become part of "the way we do business" in the information age.

I am a Ph. D. candidate who is studying and advocating for more development and research in the areas of health promoting technologies. For further information please visit the Health Technology Literacy Webpage http://www.healthy.american.edu/sophe.html which will be updated at the conclusion of this conference. Any reactions, comments, or suggestions can be sent to me via e-mail me (jsutdac@american.edu), fax it to me ((202) 885-6288, or make a comment on the Webpage. Thank you for your assistance and interest. John Studach

. Last updated November 19, 1998.

 

 

Last Updated: December 10, 2001