Saturday, September 6, 2014

Inadequate Health Insurance Literacy: Yes, but….

As Drew Altman declares in the WSJ this week, [there is]   “A Perilous Gap in Health Insurance Literacy. He’s referring to some of the sobering statistics from The Kaiser Family Foundation Survey of Non-Group Health Insurance released this past June - a treasure trove of information about who enrolled in private non-group health insurance in ACA and how people value and understand their insurance.

To demonstrate the low health insurance literacy among enrollees Altman sites one of the Survey findings - 37% of enrollees don’t even know the amount of their deductible”. 
The consequences of this knowledge gap are mind boggling [my term] when one realizes that deductibles on the so-called “cheaper” Bronze and Silver plans are jaw-droppingly large – something like  $2,300 for single coverage in a Silver Plan.   

It’s no surprise that millions of enrollees were going to have trouble understanding the financial information about the insurance plans. There’s decades of concrete evidence showing that roughly 50% of adults in the US have inadequate health literacy, which includes numeracy – the ability to work with numbers. (Kirsch et al. 1993; Kutner et al. 2006).

From low health literacy to low financial literacy, and now to low health insurance literacy, we do find it easy to identify what the patients/consumers/enrollees can’t do, can’t understand.



I’d like to reframe the problem a bit by calling it - A Perilous Lack of Clear Communication about Health Insurance.

Just take a look at 2 different Exchanges presenting information about deductibles.

























Can we really say that this information has been written and designed for the average to low literacy, underserved adult in the US?  The adult we know to have real difficulties with computation, math concepts, health, heath concepts, insurance, insurance concepts? 

The KFF Survey along with information from the many CBOs and community groups around the country who know well the barriers people experienced during Open Enrollment Season One,  should be causing every state Exchange, the Federal site and every Navigator training program to take notice and seriously retool how they are explaining co-pays, co-insurance and deductibles. 

Are they? 

 “When our tools don’t work, we tend to blame ourselves. When our tools are broken we feel broken. And when somebody fixes one, we feel a tiny bit more whole”   Steve Jobs



Saturday, August 23, 2014

Scatology of a Health Communication: so which is it? “Poo” or “Poop”?


For those of us who burrow in similar holes trying to produce easier-to- understood language to explain health information, one place we find ourselves provincially tongue tied is when discussing any and all things scatological. 
 excrement       stool
 secretions        solid bathroom waste
 bowels             waste
 defecation        crap

The committees we’ve convened to decide how to say what we mean are legend.

Ebola has us at it again.
According to WHO, (my highlighting/coloring) 
“Ebola then spreads in the community through human-to-human transmission, with infection resulting from direct contact (through broken skin or mucous membranes) with the blood, secretions, organs or other bodily fluids of infected people, and indirect contact with environments contaminated with such fluids.”
     And in their Q/A they state:
“Infection occurs from direct contact through broken skin or mucous membranes with the blood, or other bodily fluids or secretions (stool, urine, saliva, semen) of infected people.”

A few days ago a talented colleague who strives to communicate health clearly to a broad national audience shared a statement her organization had settled on:
“You can get Ebola by touching the vomit, blood, spit, sweat, pee, or poop of someone who is sick with or died from Ebola.”
YES! Finally  The frankness, the downright street worthiness of that word “poop.”

Ah, but over that second cup of coffee, when my linguistic component kicks in - which is it – 
Poo or Poop?
Isn’t poop more used as the verb. 
As in, mother to child, Did you poop? 
And isn’t poo more the noun.  “Did you have a lot of poo?”
            Bottom line – which is more appropriate to use for understandability.  Would poop offend less than poo?
A dictionary search shed little light.
MacMillan Dictionary reports thus:
 poop noun

The OED doesn’t list the word “poo” but places poop’s origin in the 1930s and define it as “to defecate” as in “take a poop”.

A wasteful linguistic exercise?   Not really.
I’m more than curious about this specific word choice. 
Which do people prefer?
Is there a chance some readers/listeners would be offended?  Think we’re being infantilizing?

Do we care if the result is that the larger public gets the message?

Monday, August 18, 2014

HPV information worth checking out

I write a lot about the mounds of health information that fails to communicate clearly to the majority of the US public  -  not highly science and health literate and who labor to read well.

When NYC City Council Speaker Melissa Mark-Viverito tweeted last night that she had been diagnosed with "high risk" HPV, I knew that many women would not know exactly what this meant. But social media would spread the word and women would want to know.

My google search hit on the CDC Fact Sheet first, and so I took a look.

The language and text elements used here result in a message that is  meaningfully useful to a broad audience of readers.
Excerpt of first paragraph -

"HPV is the most common sexually transmitted infection (STI). HPV is a different virus than HIV and HSV (herpes).  HPV is so common that nearly all sexually active men and women get it at some point in their lives. There are many different types of HPV. Some types can cause health problems including genital warts and cancers. But there are vaccines that can stop these health problems from happening."

The current CDC HPV Fact Sheet has a number of things to commend it:

  1. generally easy vocabulary ( 6th-8th grade) with no medical jargon
  2. mostly simple and compound sentence structures - avoiding disjointed, staccato-like simple sentences
  3. helpful repetition of the key topic noun so people know what is being referred to - good coherence
  4. a thoughtful strategy - 
    • normalizes HPV at the start instead of striking dread into readers.  Dread predisposes many not to read on 
    • clearly distinguishes HPV from HIV and HSV within the first two sentences - orthographically ( referring to the visual array of the abbreviated letters) - helping readers not confuse these medical acronyms. 
To balance my enthusiasm, it's probably time to steel myself and take a look at what the SANEVAX folks have brewed up.