HealthEd Blog

Using Models and Theories to Drive Behavior Change

While reading recently about the US Department of Agriculture's new MyPlate campaign, I couldn’t help but wonder... This is an important message, but will a campaign that focuses only on awareness and the "how to" actually make a difference in the US obesity epidemic? Will it get the American public to eat better?

One of the first things we as health educators learn about behavior change—a core focus of our profession—is that increasing knowledge is only the first step. On its own, knowledge is not enough to cause the behavior change “tipping point” that Malcolm Gladwell describes so well in his best-selling book.

An educational piece, program, or intervention must address the barriers, motivators, and other influences that are keeping the individual or community from moving toward the behavior we wish for them to adopt. This is where models and theories of behavior change come in.

Why use theories and models?

Theories and models are important because they are backed by research and evidence. They also help make our jobs easier and more effective by serving as a road map for the steps we need to take. And they help keep health educators accountable when we evaluate the outcomes of tactics or programs.

When developing educational materials, programs, or campaigns, it is critical that theories and models serve as a foundation and weave throughout all aspects of our work. Otherwise, we simply develop content based on intuition rather than evidence. Using intuition alone can result in a campaign that may waste resources because it will have little chance of creating real behavior change.

Example

Social cognitive theory (SCT) is a popular theory often used in behavior change programs. Its main focus is on how people and their social and physical environments influence each other to affect behavior. Programs that use SCT:

• Inspire people to believe that they have the ability to change their behavior
• Help people understand why changing a certain behavior is in their own best interest
• Explain to people how their current behavior is affecting their health
• Provide people with relevant and accurate information about the behavior and its impact
• Explain to people how they have control over their behavior
• Help identify personal, social, and environmental barriers to behavior change
• Assist with developing a plan on how to overcome the barriers

Behavior-change programs that incorporate SCT also:

• Provide examples and success stories of those who have successfully changed their behavior
• Teach the skills necessary to achieve the desired behavior change
• Encourage people to reach out for support from family, friends, and others
• Focus on incremental changes
• Reward each milestone of change

Learn more

If you would like to learn more about theories and models and their application, a terrific, free downloadable book called Theories at a Glance is available from the National Cancer Institute.

Dominika Samojlik, MPH, CHES 
Community Manager, Health Education
HealthEd

 

 

Mobile Healtherati Convene in New Jersey; Pharma Forgets to RSVP

At last week’s mHealthcon, the soon-to-be-annual event that brings together mobile health entrepreneurs, marketers, patients, and investors to talk shop in New Brunswick, NJ, I couldn’t help but think, “Where is pharma?”

Yes, there were a couple of representatives from manufacturers like Bristol-Myers Squibb. But they were vastly outnumbered by their healthcare peers:

• Managed care organizations
• Large healthcare providers
• Physicians and researchers

Mobile is potentially the greatest opportunity for pharma to break out of its innovation funk. And “The Healthcare City,” as New Brunswick bills itself, would have been a great place for pharma to stoke its creative fires—right in the industry’s backyard.

It’s not as if patients aren’t asking for mobile solutions …

“We have the opportunity to drive an ‘Arab Spring’ in healthcare,” said blogger Casey Quinlan, author of Cancer for Christmas and an outspoken patient advocate. Quinlan, diagnosed with breast cancer in 2007, said there were not enough tools available to help her manage her disease and treatment side effects.

“If there had been an app that would have helped me manage my neutropenia (low white blood cell count) and anemia (low red or total blood cell count),” Quinlan told the audience, “I would have easily paid a couple hundred dollars for it.”

Amy Gurowitz, who is launching a learning community for people with MS, said she surveyed her beta testers about their use of tracker apps. Only one person reported using one. “They didn’t even know that these tools are out there,” Gurowitz said, suggesting there is a market for such tools if they can be promoted effectively to patients.

It’s not as if pharma companies are ignoring mobile opportunities…

To be fair, pharma has produced a growing number of mobile apps and tools. (Quick plug: You can read about some mobile pharma case studies in an earlier blog post I co-wrote with digital buddy Megan Beardsley). Some have been built for patients, while most target healthcare providers. 

Still, I’m not convinced that pharma is fully prepared for the coming mobile onslaught. And I’m not the only one.

At a conference break, I caught the attention of Paulo Machado, a leading voice in pharma innovation and the former Innovation Director at AstraZeneca. During our conversation, Paulo really helped crystallize pharma’s conundrum.

In essence, he said, pharma companies are manufacturers. And it’s much harder for manufacturers to evolve away from a product-centric mindset than it is for service providers—your payers, hospitals, clinics, and most other health organizations.

Paulo said that healthcare reform is driving service companies away from the fee-for-service model. “They actually have to run profitable businesses now,” he observed.

Translation: Payers, not pharma, may end up leading the charge into mobile health.

Any tool that helps patients improve outcomes and lower costs will be mission-critical

Sure enough, later in the day Michael Monson, SVP Performance & Innovation at the Visiting Nurse Service of New York (VNSNY), encouraged mobile health entrepreneurs to bring him innovative ideas… like, now.

Headquartered in Manhattan, VNSNY is the country’s largest not-for-profit home healthcare service. It is both a provider and a payer. Monson explained that innovation is a large component of the company’s strategic approach. As healthcare evolves in the US, mobile seems to be a major way forward.

 “We really like using behavioral science,” Monson said, referencing partner Welldoc, which is running a mobile adherence pilot for VNSNY with diabetes patients. Welldoc was in the news recently when Ford announced a beta test in which diabetic drivers could “ask” their cars to check their blood glucose levels. The Ford beta is being powered by a Welldoc wireless health monitoring platform.

It’s innovations like these—“software devices that enhance consumers’ lives,” Monson said—that are going to power the future of mobile health.

Mobilization can work for pharma too

The economic rewards for innovation certainly favor companies like Monson’s. But I believe pharma also needs to stand up and put the industry’s significant weight behind mobile health initiatives. Apps would be the logical place to start—they are the most “product-like” side of mobile—and the FDA already issued guidance for health apps this summer.

For pharma innovators interested in going mobile, some next steps should include:

• Familiarizing yourself with the FDA mobile app guidelines
• Getting outside the pharma space
  • Download and use some of the mobile tools that other healthcare organizations have built
  • Look for parallels that could be applicable to branded/unbranded product marketing

Finally, challenge your agencies to think blue sky—have them bring their strongest ideas for mobile to the table, and explore opportunities to pilot in 2012.

Jeff Greene
Director, Digital Strategy
HealthEd

 

 

A Health Educator’s Experience as a Patient

Informed, active, empowered—these characteristics describe the people I’ve worked with during my 30-year career as a certified clinical social worker and health educator. I have counseled people young and old during their acute, chronic, and life-threatening illnesses.

So will being “empowered,” “active,” and “informed” lead to better outcomes for me as I fight my illness? As a health educator, I should know how to be an “active patient,” right? I am certainly doing my best to actively participate in my health care, but it is challenging at times. I have new empathy for those who are frightened by their illness and have limited understanding and support. 

After my diagnosis, one of the first steps I took to actively participate in my medical care was to understand my illness and my treatment. This was more complicated than I thought. For instance, it took me 4 attempts to wrap my head around using a nebulizer and the medications. In the hospital I had three different respiratory therapists (RTs) who set up my inhalant medications each day. I had another RT once I got home. 

I had to ask each of them how the medications worked, the differences in the medications, and what I could expect from them. It would have been best if I told them I did not understand what they were saying. I should have asked them to use plain language. But I also realized that some clinicians are not skilled at this. Unfortunately, it wasn’t until I was at home that I received a clear explanation that helped me understand the hows and the whats of treatment. The visiting RT used an analogy and a visual image of what was happening in my lungs and how the medicine would help.

Learning more about my illness, I realized there were numerous resources to turn to—the Web, my family, and different members of my healthcare team. I just had to ask. However that is not a simple statement. What did I really want to know, and how would these answers make me more empowered? I searched the Web for clinical trial results related to my illness and wrote down questions about the treatment I may be eligible to receive. I had prepared a litany of questions citing the studies, the articles, and centers from where the information was gleaned. This made me feel more credible and prepared in case I was shot down for asking too many questions.

Imagine me worrying about not being taken seriously, being dismissed for asking questions! I am the person who helped her patients write the lists, showed them how to research their illnesses, and instilled them with a sense of confidence to talk with their healthcare providers (HCPs). Yes, I too was reticent. My little blue book of notes and questions bolstered my confidence and demonstrated to my nurse and doctor I was a partner in my care.

Thankfully, I do have the resources to help me take an active role in my healthcare. I am fortunate, but what about those that don’t have the internal or external resources… where do they turn? I hope they have the support of their doctors, nurses, social workers or other HCPs to figure out what to research, questions to ask, and the confidence in themselves to participate in their healthcare. The HCPs can be a strong ally when lost in a sea of foreign words and phrases that frighten any of us. I hope all HCPs incorporate analogies, visuals, and write out information as needed.

Other ways to learn is by teaching back what you were taught to demonstrate what you heard. While it is often used when a nurse teaches a skill or health related behavior—self injections, catheter care, or medication regimens—it can be useful in describing complicated medical information. The use of illustrations to describe body anatomy and mapping out a diagnostic workup and treatment plan is a fundamental step. This can be highly effective if medical information is new and learning is compromised due to heightened anxiety and stress.

My advice to other patients is to write down your questions and your thoughts about treatment relative to you. This reframes the issue from the abstract to you personally. Share what is important in your life with your healthcare team. It gives them a richer perspective on what is important to you and factors that you will consider in making your treatment decisions. Make note of your reactions to treatment—it improves your accuracy as a historian.

Being an informed patient and an active participant in my healthcare, I hope this plays a role in my treatment outcomes. However what is critically important is that I realize I have developed a deep trust in my doctors and my healthcare team. We have respect for each other and have built a partnership that I believe will contribute to a positive outcome.

Ide Mills 
Senior Vice President, Health Education
HealthEd

 

Of Mustaches and Men's Health

“What’s that fuzz under your nose?” “Is that a new look for you?” “Trying to bring back the Tom Selleck look?” “Is that the iconic Mr. Clean growing a mustache?”

Those are just a few comments men are hearing from their families, friends, and colleagues during November. And that’s the point—to get people talking about why men are growing mustaches this month.

Turning November into Movember

Movember is a global initiative to heighten awareness of men’s health issues. It began in Australia in 2003. In 2010 in the United States, 64,500 men and women joined Movember, and they raised $7.5 million. More and more people are talking about how important it is for men to pay closer attention to their health.  

Globally, Movember focuses on men’s health in general, which makes sense when you think of the number of men who are diagnosed with cancer, heart disease, diabetes, and mental illness. In addition to those men living with chronic or life-threatening illnesses, it critically important to heighten awareness of preventive health measures men can take. Movember’s primary focus, however, is raising awareness about and raising money for prostate cancer. 

Raising awareness for men’s health

According to a Movember study, the US campaign has successfully raised awareness of men’s health issues.  It has also convinced men to take a more proactive approach to their health. When Movember participants were surveyed:

• 96 of 100 spent time thinking about improving their general health
• 87 of 100 understood that their health depends on how well they take care of themselves
• 86 of 100 had a general checkup
• 77 of 100 discussed men’s health with their family, friends, or colleagues during Movember
• 64 of 100 worried about their general health
• 59 of 100 carried out personal research on men’s health issues during Movember

Despite this progress, the research shows that 1 of 2 men would rather ignore a health-related issue than go to a doctor.

Supporting Movember at HealthEd

riThis is HealthEd’s first year supporting the Movember movement. Several Mo Bros (as they are called) are growing mustaches, and their Mo Sistas are supporting their Mo Bros' trials and tribulations.

You know the initiative is taking hold when the women (and men) in the office have brought home the information to their spouses, partners, brothers, fathers, and sons. Some of these men have joined Movember and are growing mustaches too.

Last week a staff member brought her 12-year-old son to the office. He proudly shared that he knew all about Movember because his teacher was growing a mustache for the cause. It is important for all men, young and old, to talk about and take action when it comes to their health.

Learning is step 1

The first step is to learn about diseases that have a big impact on men, and how those conditions can affect men’s physical and emotional well-being. Men, and those who care about them, need to:

• Recognize the signs and symptoms of the disorders
• Learn about screening tests for early detection
• Make lifestyle changes to prevent or manage illnesses

Helping men take action is step 2

To move someone to action means changing his or her attitudes and beliefs. With its resources, open discussions, and support, the Movember movement can help men change their behaviors and improve their health by motivating them to:

• Go to regular well-care visits
• Perform appropriate self-exams
• Discuss health risk factors with their healthcare provider
• Eat a balanced diet
• Exercise regularly
• Stop smoking
• Limit their use of alcohol

At HealthEd, we apply the Health Belief model in educating our staff about men’s health issues. In the process of developing newsletters to share with staff, family, and friends, we consider the basic constructs of the model:

• Perceived susceptibility
• Perceived severity
• Perceived benefits
• Perceived barriers
• Cues to action
• Self-efficacy

Some people think that because we are a healthcare marketing agency, the staff is more aware than others of men’s health and health concerns in general. And that the men of HealthEd are being proactive in their care. While our men may have a heightened awareness of the issues, Movember can reinforce what our staff already knows and inspire them to take action for better health. 

Ide Mills 
Senior Vice President, Health Education
HealthEd

Data, Empowered Patients, and Health Literacy: an Early Review of Social Health 2011

One day. One conference. So many powerful ideas, my head is still spinning.

This year’s Social Health (SXSH) 2011 unconference in Philadelphia was one of my favorite healthcare events in recent memory. Kudos to the “industry-side” organizers, Shwen Gwee and Dana Lewis, and the “patient-side” organizers, Jenni Prokopy and Kerri Spalding (better known in social media circles as @ChronicBabe and @sixuntilme). They assembled a dynamic group of speakers who brought crisp presentations packed with good stuff to a diverse audience of healthcare marketers, physicians, patient advocates, wellness specialists, and others.

There are so many ways to parse what we learned, I could probably write 10 articles on Social Health. A few core themes in particular stuck with me; they are rich in implications for all who work in healthcare, pharma communications, and patient education. It’s going to take me a few blogs to digest it all for you. For starters:

Healthcare is entering a crisis of comprehension.

While drug patent expirations and hazy FDA guidance get all of the headlines, a larger issue will undoubtedly be whether health literacy impacts Washington’s goal of empowering patients with their own medical data. Todd Park, the chief technology officer of the US Department of Health and Human Services, excitedly shared the administration’s many data initiatives, including giving Bluebutton access to US veterans—more than 400,000 of whom have used the service to download e-copies of their health data. When you look at the actual documents produced and sent to vets—a sample is here—you’ll understand why I use the phrase “crisis of comprehension.” Consider this snippet:

Test Name: COAGULATION TISSUE FACTOR INDUCED
Result: 9.9 Low
Units: SEC
Reference Range: (11.9-14.5)
Interpretation: SEE INR FOR CRITICAL VALUE CUT-OFF.
Performing Location: PORTLAND, OREGON VA MEDICAL CENTER 3710 SW US VETERANS
HOSPTL RD , PORTLAND, OR 97239
Status: Amended
-----------------------------------------------------------------------
Comments: PT. reported incorrectly as 9.0 by [104353-VA648].
Changed to 9.9 on Jun 06, 2011@12:08 by [87277-VA648].

Hearkens back to the days of teletype machines and ASCII printouts, doesn’t it?  Imagine you’re the veteran to whom this data belongs. Or imagine you’re a caregiver hoping to learn more about your loved one’s medical history. Reading the above, should you panic? Should you look up coagulation tissue factor induced on WebMD? Call the doctor to find out why the result was “low”? Not worry about it because—whatever this all means—the result was “reported incorrectly"?

To his credit, Park told the audience that for matters of health literacy, he’s relying on us—the communicators, health educators, experts—to dress up this medically oriented data and “skin” it for the public’s view. If the supply of untethered data accelerates at the pace Park and others are projecting, a huge lag will open up between when health consumers receive it and when educational tools are built to help them understand it. Our job, then, is to analyze this growing swell of patient data initiatives and anticipate the health literacy stumbling blocks. Making patient data meaningful to everyday people struggling with medical conditions is a great challenge and opportunity.

Or, in the words of Park at SXSH: “I think this is the greatest opportunity since the Internet itself.”

We'd better get moving.

Jeff Greene will write additional articles on Social Health (SXSH) for the HealthEd Blog.

 

Jeff Greene
Director, Digital Strategy
HealthEd

 

 

 

Improving the Nation’s Nutrition Standards

2010 Dietary Guidelines for Americans

With the release of the 2010 Dietary Guidelines for Americans, it is apparent that a shift is occurring in the approach to address the nation’s obesity epidemic. Differing from previous dietary guidelines, which focused solely on nutrition intervention, the new guidelines take a holistic approach to improving health outcomes. The approach both is refreshing and helps to set a new standard for improving the nation’s nutrition status.

With a newfound focus on health promotion and chronic disease risk reduction, the updated guidelines reflect the importance of establishing healthy eating patterns and physical activity behaviors as preventive measures to combat obesity. 

As stated in the guidelines:

The ultimate goal…is to improve the health of our Nation’s current and future generations by facilitating and promoting healthy eating and physical activity choices so that these behaviors become the norm among all individuals.

Creating a new norm for the American population will undoubtedly be an arduous task. However, there are clear indications that the dietary guidelines are fundamentally headed in the right direction.

From a health education perspective, the integration and development of the dietary guideline recommendations were based upon Social-Ecological Model (Dahlberg & Krug, 2002). This is the primary indication of how the guidelines can help Americans to make healthier choices. Basing the guidelines on the Social-Ecological model allows for the development of strategies that focus on the relationship among behavioral, environmental, and social ecological influences that can lead to effective and sustainable behavioral and lifestyle modifications. This is very telling because it demonstrates that to improve the nation’s nutrition standards, it is vital to understand that diet and exercise are not the sole contributors to the problem; rather, the problem results from an interplay of many health influences.

The emphasis on and priority for improving the nation’s health now rests with transforming the way Americans view nutrition. Leveraging health education principles—by incorporating behavior change models and providing useful tools to support this change—can do more than inform and guide Americans through this nutrition transformation. Health education helps to ensure that Americans can understand the basic nutrition information and feel empowered to take action to improve their health in ways they may have never imagined. With action comes the shift that the 2010 Dietary Guidelines for Americans aim to achieve—improved health for the nation.

For more information on the 2010 Dietary Guidelines for Americans, visit http://www.dietaryguidelines.gov.

Laura Catalusci
Specialist, Health Education
HealthEd

Making difficult decisions: How cancer patients play a role in their treatment choices

Many discussions revolve around how active cancer patients are in decisions about their treatment. In my experience working with cancer patients, I have observed that we often try to quantify how many patients play an active role. However, for a better understanding of the roles that patients play in treatment decisions, it’s important to have a shared language about how to categorize patient engagement. A model that I find useful is the Decisional Processing Model, which describes four styles of decision making:

• Information seeking: People who actively seek information and think about it carefully before making decisions
• Information processing: People who do not seek additional information but carefully think about the information presented to them before they make decisions
• Advice following: People who do not spend much time thinking about the information provided but follow the recommendations of others
• Ruminating: People who avoid making decisions

We know that greater patient participation in treatment decision making can lead to improved health outcomes. This leads us to try to empower patients to play a more active role in their care. However, in looking back on their own treatment experiences, many patients have reported that they wanted to participate more than they actually did. This discrepancy may result from healthcare providers’ assumptions about how involved patients want to be or from patients’ lack of awareness about the roles they can play in their treatment choices. Either way, there clearly is a need for skill building so that healthcare providers and patients can communicate effectively.

Then again, patients who are advice following and ruminating may not want to actively participate in treatment decisions. In fact, research suggests that even if we wanted to encourage such patients to be more involved, in the midst of a major life event such as a cancer diagnosis, a person’s decisional style remains fairly constant, regardless of his or her level of anxiety or depression. This may mean that a person’s decision making style is like an inherent personality trait, rather than a style based on the situation. In fact, over time people tend to revert again and again to the same method of making decisions.

Although we may not be able to promote more active participation from a ruminating patient, we can try to ensure that all patients experience their desired level of engagement. The discrepancy between what patients prefer and what actually occurs highlights a need for improved communication between patients and healthcare providers so that patients are engaged in the ways they want to be. Tools such as decision aids are one way to help patients be more involved and informed throughout the treatment continuum. As health educators, we can and must recommend programs and resources to help facilitate these conversations.

Tara Rice
Manager, Health Education
Encore, a HealthEd company

Building a pharma app? Find a buddy!

At the Business Development Institute (BDI) mobile conference in New York City in January, we saw and heard many thoughtful approaches to creating mobile apps for patients and healthcare providers. For pharma marketers, it’s no longer about whether or not to create apps; it’s about when. Monique Levy, senior director of research with Manhattan Research, noted her firm had found that by the end of 2011, 82 percent of physicians will own a smart phone. And Apple’s recent announcement that iPhone will be offered through Verizon will only pique consumer interest in smart phones (and tablets) further.

In front of this backdrop, marketers and health educators displayed case studies that seemed to suggest that mobile efforts have shifted. We’re past the “wow” stage; now we’re trying to figure out how to create and disseminate apps successfully, given the channel’s specific constraints. Pharma is learning that those constraints are not trivial. Consider:

• App names need to be short or risk getting truncated in the iTunes App Store, rendering them incomprehensible on the small screen. Manufacturers, then, can’t include both the sponsoring brand and a descriptive name on their custom-built apps. A descriptive name is clearly the better choice if you want people to know what your app does. So, if you can’t put your product name on your app, where will all those brand impressions come from?
• Because apps are found in the open marketplaces (iTunes App Store, Droid Market), anyone can download them. Apps can potentially boost a brand’s competitors just as much as they can help the brand that builds them
• Manhattan Research’s Levy noted that 71% of research respondents aged 35 years or older said they were not interested in mobile apps and programs from pharmaceutical manufacturers. (More on this credibility gap from Siren’s Eileen O’Brien)

Of all the apps described at the conference, Glucose Buddy (presented by Todd Siesky) was the most encouraging. It appears that Roche, Glucose Buddy's partner, has cracked the code on app development for pharma, avoiding the pitfalls by following a cohesive blueprint for doing mobile in the pharma space:

• Find a partner. Rather than build from scratch, Roche piggybacked on an already successful app. Glucose Buddy, according to our own informal research at HealthEd, has garnered some of the best reviews on blogs by diabetes patients and pharma app reviewers. Key here is not only cost savings and distribution economies of scale but also credibility
• Seek to be as useful as possible. Roche’s main addition to Glucose Buddy is educational content related to Accu-Chek. That content includes the Accu-Chek Testing Pairs log tool, which already has a lot of offline credibility among doctors and patients. Providing useful tools lies at the heart of a strong educational framework
• Create a brand-neutral opt-in strategy. Roche invited all diabetes patients, whether or not they use a Roche product, to sign up for Glucose Buddy. The idea is not to pigeonhole mobile as an “acquisition” medium or an “adherence” medium but to employ it as a multiuse channel that can serve patients across their disease journey
• Build first; then message to your list. With a growing list of subscribers, Roche was able to create the foundation for an eRM program that includied push e-mails to patients who have downloaded the app and opted in to the stream
• Learn from the data. Thanks to some heads-up thinking, Roche figured out how to deidentify the patient data streaming in from the app. This rich, usable data source alone is enough to justify the program

As apps go mainstream, it will be interesting to watch how pharma companies approach development and distribution. Partner or solo? Branded or unbranded? One thing is for certain: With more than 300,000 apps currently available for Apple devices alone, mobile marketers have an awful lot of differentiating to do.

Megan Beardsley (iPhone)
Creative Director, Digital
HealthEd

 

 

 

Jeff Greene (Droid)
Director, Digital Strategy
HealthEd

 

Health Literacy Extended

A common definition of health literacy is the ability to read, understand, and act upon health information.

Reading and understanding

Many of us in the pharmaceutical industry build our patient education programs on the idea that consumers or patients will proactively seek information about their condition, or perhaps will receive it from a healthcare provider. This information helps patients ask questions about their condition and learn how to manage it. As an industry, we are becoming more and more aware of the need to match the language and design of patient education materials to the general audience that reads at or below the eighth-grade level. This is good news for all of us.

But it is important for us not to become complacent. While reducing the reading level of our materials is laudable, there is more to supporting health literacy than simplifying copy. In a recent article in the Journal of Communication in Healthcare, author and long-time advocate for health literacy Rima Rudd advocates for a more extended view of health literacy—a view that takes into account the complex demands our healthcare system makes on its patients. It reminds me of work I did before becoming an educator, and I realized there is much I can bring with me from my former therapeutic role.

Supporting “action”

Before I became a health educator, I worked as a certified therapeutic recreation specialist. In that role, I helped link patients to leisure activities that could enhance their physical, cognitive, and emotional functioning. Before a recreation specialist chose a patient's therapeutic activity, we considered his or her preferred leisure pursuits and then conducted a task analysis. This required the specialist to consider every step in an activity and determine whether the patient could complete it or adaptation was required.

For example, I worked with a person with Alzheimer's disease who enjoyed playing bingo. Because of her condition, she had trouble remembering the numbers called and maintaining her concentration to scan a board with 24 numbers listed. She knew how to play but was unable to easily participate. I adapted the game by handing her a visual cue when I called out the number—an index card listing the number that had been called. This helped her remember, scan, and match the number listed on her board. I also called the numbers more slowly and allowed more-than-usual normal time to pass before calling the next number, to give her the extra processing time she needed. These adaptations made use of her remaining strengths. By our supporting her challenges, she was able to return to playing a game that she loved.

A day in the life

In the same way, health literacy researchers are now analyzing health-related tasks to find those that might present challenges for patients with low health literacy skills. For example, many of our industry communications focus on helping patients understand their medication regimens and adhere to treatment plans.

 

Think about the tasks associated with managing a medicine regimen. Picture Ray, a 70-year-old man who takes oral medications to control blood pressure and arthritis pain. He also takes basal and mealtime insulin to control blood sugar. Ray has to:

• Read prescription labels and additional stickers on the pill bottles to determine the number and frequency of doses and to learn about warnings and other important information
• Use a clock or other reminder to plan the time of each dose
• Calculate insulin doses according to the meal he will be eating
• Measure insulin doses before injecting
• Correctly use his device to inject insulin
• Remember to carry his medication and diabetes supplies with him if he is having a meal out
• Use a calendar or other reminder item to plan for refills
• Call or visit the pharmacy to reorder his medication

Each of the tasks listed above has more than one step and is therefore even more complex than implied here. This regimen requires:

 

• Reading skills to understand labels and medication information
• Numeracy skills to calculate time, dosing, and blood glucose levels
• Writing skills to track blood sugar levels and noted reminders 
• Visual-spatial skills to follow the instructions for using an injection device
• Manual dexterity to manipulate the pill bottles and device
• Planning and communication skills to reorder medications, whether by phone or in person

 

Seeing our patients in context

This type of regimen—not an uncommon one—requires much more of patients than our simpler health literacy definition of reading, understanding, and acting on health information. It is time to move from theory to practice and consider ways in which health literacy is applied in daily life. Our challenge is to find ways to more comprehensively assess our patients’ health education needs. Our planning efforts can be much more successful if we develop solutions that help them overcome the types of challenges that can exist at each step of their treatment plan.

Laura Wilson, M.Ed.
SVP, Health Education
HealthEd

 



 

Is your marketing direct and relevant?

According to organizers, nearly 10,000 people attended the DMA 2010 conference in San Francisco. Direct marketing (DM) titans such as Howard Draft (of Draftfcb) and Rance Crain (of Ad Age) were inducted into the DMA Hall of Fame for their pioneering work. None other than Lester Wunderman (widely regarded as the inventor of modern-day direct marketing) introduced Draft and Crain to the audience.

The conference reinforced the association’s relevance in a changing marketing paradigm. Direct marketing started at a time when mass advertising was king. To this day, most big-brand marketers continue to regard DM as a “below-the-line” marketing expense. However, it is more widely used than most people realize. Apart from e-mail and paper mail campaigns, there is a proliferation of marketing strategies that continue to employ the foundations of direct marketing. Marketers always strive to locate the coordinates of the 4-D marketing axes—audience, message, time, and place. DM definitely brings marketers closer to pinpointing those coordinates. Here are a few tactics that can be classified as DM:

Web personalization—The World Wide Web was founded on the belief that a global information system could be home based. Web personalization enables marketers to communicate with an individual on the customer’s terms. DMA 2010 attracted a few vendors working on the innovative front in this realm. I met with the founder of Optini (a provider of Web personalization marketing), who works with clients to create customized browser add-ons that can revolutionize the Web experience. Optini’s solution tailors the brand experience for customers via targeted display and search placements not just on the company.com but across every major Web property launched from that particular computer and browser.

 
Mobile marketing—While smart phones and apps have generated a lot of buzz since the mid-2000s, only 1 of 4 mobile users has a smart phone today. So, apps and mobile sites cannot be accessed by the remainder of the mobile audience. Text/SMS marketing continues to be the mobile marketer’s best friend. Peter Johnson from MMA (Mobile Marketing Association) presented a SMS marketing campaign case study by Jiffy Lube that increased new-to-brand opt-in leads by 50% and produced larger-than-previous conversion rates.

Search marketing—Keyword searches and content overload provide the direct marketer with a rich insight into the customer’s educational needs, product wants, and decision triggers. Companies such as Google and Amazon have pioneered the personalization approach and make recommendations on content and product based on usage and consumption patterns.

Social media—Unlike the digital tactics described above, social media marketing is where customers prefer to converse about the brand with other customers, and not the sellers. Approximately 160 million unique visitors in the United States spend much of their time (more than 5 hours per unique visitor) on social media, according to Nielsen. Ad Age predicts that by 2013, social media marketing allocation will grow over 4-fold, to about $5 billion. Many marketers in the pharma/healthcare spaces are still unsure of how to use this medium to converse with patients and physicians. At the very least, the social media happen to be the ideal place to listen to what your customers think about you.

The proliferation in new marketing techniques has multiplied advertisers’ choices, and advertisers will have to make tough decisions because of increased marketing accountability. From DM’s earliest days, measurement has been the driver of its methodology, and success or failure could easily be demonstrated with the correct accountability plan. With digital being a highly measurable medium, media buying decisions can now be made on an engagement basis (cost per click/conversion/download), as opposed to the classic reach-and-frequency model. It’s no surprise, then, that digital marketing would be direct.

As an advertiser once said, “I know half my advertising dollars are wasted; I just don’t know which half.” Which half will your marketing activity be part of when that tough decision is made? 

Abel Rajan, MS
Director of Strategy and Analytics, Strategic Services
HealthEd