There's much more to health literacy than what most people, even health educators, think. As the president of Health Literacy Consulting and the founder of Health Literacy Month (coming up in October), and author of Health Literacy from A to Z, Helen Osborne shed some light on this vitally important issue for us.

Milner-Fenwick: What does the term “health literacy” mean to you?

Osborne: It goes beyond the well used definitions that are out there of what the individual patient can and cannot do. I think of health literacy as a shared responsibility. Patients and providers each need to communicate so that the other can understand.

M-F: So this is a “shared responsibility”?

Osborne: Yes, it goes through all the ways we communicate. We need to understand each others agenda, what's important, a sense of shared decision making, and we need to confirm understanding. That really has to happen on both sides.

M-F: Is there a certain group or groups that this issue affects the most?

Osborne: Well, I think of factors that impact health literacy in six different ways.

Often, people think of literacy, and that's easy because the term literacy is in health literacy. Certainly that is a problem because so much health information is in writing, but that's not the only problem.

We're dealing with health content and our information truly can affect a person's life. We have a huge responsibility to do this well.

Another factor is age. Literacy levels do go down as people age but beyond that, people are apt to have more illnesses, chronic conditions that might affect how they learn or remember, or how they see or hear. As people age, they may also be dealing with emotional issues, and stress as they go from being the caretaker of the family to the person who is being taken care of.

I also think of language and culture. When I say language I think of the words we use and that it takes two years to a lifetime to be fluent. That's beyond just saying hello, how are you and where's the grocery store. Culture is how we understand the words in the context of our values, beliefs, and traditions.

And then there is disability, whether people have diminished skills for seeing, or hearing or remembering, because we have one less way of communicating. We may learn new ways and that can be hard to do — like learning to use hearing aids or Braille or lip reading.

Another is emotions and I don't want to discount that one at all. I know that for myself, when I get bad news I just shut down for awhile. I think that it's very human, and it doesn't matter how savvy we are about health care. And it also includes when you're scared or in pain, your powers of concentration are quite diminished.

M-F: Why did this become such a big issue to you?

Osborne: As an occupational therapist, I discovered that patients often couldn't read well enough to understand the worksheets I was using. About the same time I stared to learn about health literacy. As a "program person," I wanted to make things better for patients and their families. I went looking for a model to follow and there wasn't any. Health literacy struck a chord in me. It's a big job but not an impossible one.

M-F: What's the first step educators can take?

Osborne: First of all, just be sensitive to how you are communicating. Don't assume that because you said it or wrote it that another person can understand it. Be humble that way.

M-F: Beyond that, is there anything that educators frequently overlook?

Osborne: I think the biggest step is we forget to find out if the other person can really understand us and if we can understand them. So verify understanding! If there isn't understanding, don't just repeat it or get impatient. Try a new way to communicate the essence of the same message.

M-F: Do you think this problem is getting better or worse?

Osborne: I don't know, but I think that the responsibility on patients and families to understand has increased. Today they’re expected to do a greater share of their care; to recognize warning symptoms, to take all their medications and follow all their treatments absolutely accurately, recognize symptoms and side effects and emergencies, and act 100% appropriately every time. That's a huge demand and it's not getting any easier.

M-F: How does one simplify their approach when health information by its very nature is often complex?

Osborne: Yes, it is hard. There are multisyllabic words and unfamiliar concepts. I’m not disagreeing with that, but sometimes there are ways to make things clearer or simpler. Instead of saying “frequently occurring side effects” we can say “here are some things that often happen.”

However, there are complicated words and concepts that people need to know and we’re not doing anyone a favor by avoiding them. What you can do is explain them in clearer simpler language. You can show pictures and diagrams, use metaphors or analogies, or show models. You can teach this in a variety of ways, but make sure you teach it.

M-F: Isn't that a lot to ask when people are so busy?

Osborne: What I tell a lot of writers, communicators and professionals that they, we, all of us, and your company too, are really very powerful and I don’t think people appreciate how much power we have. Because we really act as translators — taking this complicated, scientific, ever changing, number base, ambiguous information and communicate it in ways that people can understand and act on. We're dealing with health content and our information truly can affect a person's life. We have a huge responsibility to do this well.

M-F: As the founder of Health Literacy Month, why is it important for educators to participate?

Osborne: You might think of health communication as an evergreen topic because it is always an issue. Sometimes there doesn’t seem to be a sense of urgency to do anything about it because communication happens all the time. Health Literacy Month gives a reason for raising awareness now and it gives everyone a shared focus and that sense of urgency.

M-F: What are the main activities that define Health Literacy Month?

Osborne: Health Literacy Month is actually anything you want it to be. It’s any time you want it to be in October — from just an hour to the whole month. And it’s what organizations and individuals choose to do in their local area.

M-F: What are some of the more interesting things that people have done?

Osborne: At one end of the spectrum, a gentleman called me who lives in low income senior housing. He wanted a post card to put on his bulletin board where he lives so that his fellow residences would know about it. At another end, the Health Resources and Services Administration (HRSA), an agency within the US Department of Health and Human Services, did a series of workshops at health institutions around the country.

Another provider held a workshop where participants learned to read and interpret "tricky" food labels. Someone else received a grant and did computer health literacy for seniors, and another person did a "medicine checkup" at a local senior center.

M-F: Tell us about the Health Literacy Month map.

Osborne: Go to the map link at www.healthliteracy.com/hlmonth/map.html. That’s where you’ll find out what everyone’s doing. Beyond showing the scope and breathe of Health Literacy Month, the map is also a way for people to meet each other. You can search by state or country and find someone who intrigues you. It’s pretty amazing.

M-F: Any last thoughts?

Osborne: Health Literacy Month is really a way to have a louder collective voice. Working together, we can make a difference.