Talking About Health; Why Health Communication Matters

CESAR–Center for Substance Abuse Research: High school students’ use of nonprescribed prescription drugs

June 24, 3013

You can sign up to receive a weekly fact sheet called CESAR FAX in your email. Go to http://www.cesar.umd.edu/cesar/cesarfax.asp. The May 6th, 2013 issue asked 3,884 U.S. high school students why they use prescription drugs without a prescription. The number one reason given by 18% was ‘to help me relax’ followed by’16% who reported ‘to have fun’. If you add in the 13% who said ‘to help me forget my troubles’ and the 11% who said ‘to deal with pressures and stress of school’–you have 42% using prescription drugs that were NOT prescribed to them to deal with anxiety and stress. We truly need to find creative programs to help high school students deal with their daily lives–programs that do not include prescription drugs that were not prescribed for the students using them.

What is a patent and what did the US Supreme Court decide about human genes and patents?

June 13, 2014

The US Supreme Court ruled that human genes cannot be patented. A patent is the authority to make, use, or sell something. Myriad Genetics Inc. sought patents regarding genes for which some versions have been linked to breast and ovarian cancer–the BRCA gene mutations. The Court decided that identifying and isolating these genes is not worthy of a patent. On the other hand, Myriad also has created a synthetic form of DNA known as cDNA and that was determined to be worthy of a patent.

For patients, testing for BRCA gene mutations may become more accessible. Until now, Myriad has had the only genetic test for BRCA gene mutations. Perhaps others will now develop testing and contribute to cost reductions, since Myriad does not hold exclusive rights to make, use, or sell products associated with these genes.

Soy products and nutrition and cancer: Conflicting messages

June 6, 2013

One of my granddaughters is allergic to cow’s milk. I saw effects of such allergies decades ago when a nephew was born with severe allergies to cow’s milk and used goat’s milk. My granddaughter used goat’s milk for awhile but seemed to develop an allergic reaction to it as well. Not as severe as cow’s milk but not waiting around to make that happen…

What about soy milk, my son asked. I have read some of the research and debate surrounding soy and phytoestrogens and cancer. But I never read anything specifically about infants. So I searched and read a number of pieces written. I want to recommend this one written by a pediatrician: http://www.babycenter.com/404_is-it-safe-to-give-my-toddler-soy-milk-if-she-wont-drink-cow_1200425.bc

In a nutshell, the author notes various deficiencies in soy milk that need to be address, such as its lack of B12, and the importance of buying whole soy milk to obtain the fats necessary for brain development, and the importance of having soy milk that is fortified with vitamins A & D, as well as calcium.

The pediatrician does not address the phytoestrogen controversy directly but observes that there is no research linking adverse outcomes to children.

Another alternative is coconut milk. While I could not find any research or pediatrician discussing this as an alternative, I did find a site with a pretty complete discussion by moms, including moms who used coconut milk for multiple kids who are into adolescence now and still drink it. Coconut milk has they say a lot of good fats in it but lacks calcium and protein.

My son asked specifically about Asian diets rich in soy and the health benefits. I have worked closely with Asian graduate students over the past two decades and have come to understand that how they consume soy is quite different from what we think of. Our grocery stores offer tofu and soy milk as mainstays in soy products. Soy in Asian diets takes on different forms and is often fermented in miso, tempeh and natto. Soy milk and tofu are highly-processed soy products. So it appears that one part of the conflicting messages relates to the form that soy takes. More processed forms, as with so many food products, do not offer the same health benefits as less processed.

The Affordable Care Act and part time employment

June 1, 2013

…thanks to Darci Slaten for this picture…

One of the most gifted undergraduate students I’ve had in a Penn State health communication classroom is crossing her fingers that she will get a job she has interviewed for. I am hopeful for her as well. An odd thing about the job is that it is for less than 30 hours a week. I also have a nephew who recently started a new job at a sandwich shop. He loves the work. And he too is being employed for less than 30 hours a week. Neither was looking for part time work. And it does make me wonder. Could it be the Affordable Care Act’s rule that companies with 50 or more employees be required to provide health insurance to employees–except if they work less than 30 hours a week.

I don’t know the answer to this question. I haven’t talked to my nephew’s employer and the question doesn’t fit into a conversation as a reference for a former student. I do wonder about risk data relating to part time employees and projecting the cost for health care.

State laws covering workmen compensation do cover part time employees. If my nephew is hurt on the job–let’s say, for example, cuts off the tip of his finger with a meat slicer or gets a hand caught under a heavy bread tray and breaks a finger–workmen’s compensation will require his employer to pay the medical costs related to the accident and cover wages for the time he cannot work. So, that is a relief. But what it won’t cover is time off or care for the flu or a bad cold.

Looking at the issue from a public health and public good perspective: Do we unintentionally incentivize ill workers to come to work when we adopt policies that won’t cover their care or give sick leave benefits? Do we pose other risks to the public besides exposure to ill workers when we move toward part time employment, risks associated with the experience one gains from being on a job full time, for example?

Jennifer Ohs talks about how older adults make medical decisions

March 14, 2013

I am using a new text in my undergraduate health communication course. The text is edited by Maria Brann, a professor at West Virginia University. It is called, “Contemporary case studies in health communication” and is published by KendallHunt, 2011. The text has a unique approach that is working well to spark discussion in my diverse undergraduate classroom. Each case in the book leaves out the conclusion to the case, so that the class can speculate on the possible endings. Then, as the instructor, I have access to the conclusions written by the case study authors and can share these with the class. We have lively debates about how a case is resolved versus other ways it might have gone. For example, the case that I will discuss with the class tomorrow was written by Dr. Jennifer Ohs, a professor at Saint Louis University. The case discusses medical decision-making and uses the example of an older woman who is deciding whether to have sinus surgery. It is a case used to illustrate problematic integration theory, which is the theory we are discussing in class this week, a framework for understanding proposed by Professor Austin Babrow who is a faculty member at Ohio University. The theory explains why communication may cause us to form judgments that a good outcome is highly unlikely, while a bad outcome is very likely. Other situations that are problematic to integrate with our experiences include situations in which communication makes two options seem to be equal, both in terms of how likely or unlikely they may be and/or how good or bad we judge outcome linked to the option. The case discusses how an older woman considers what her husband, son, and daughter have to say about the surgery, the role of prayer, a friend’s view, and the conversations that her usual doctor and the specialist who would conduct the surgery have with her. In the end, she decides not to have the surgery. It is a good decision for her as it turns out, because she later learns that she needs dental surgery, and having that surgery resolves the issues she was having with her sinuses as well. Of course, she did not know that when she made the decision. Rather she made her decision because her daughter did not offer to come and be with her, because she really wanted a second opinion and her husband would not like to have to drive to the city to see another specialist, and because her son had a similar surgery that did not improve his health much. These were weighed with the doctor’s advice to have the surgery and led to her choice. It will be interesting to see how the class views this case and the ideas they come up with for possible conclusions.

Clean Your Hands Campaign

February 19, 2013

The World Health Organization — WHO — has long promoted hand-washing as an important way to reduce the risk of spreading infections. While we all can reduce the risk by washing our hands, we may also assume that healthcare workers would be among the people most likely to practice hand-washing. Apparently not. A study designed to increase hand-washing among healthcare works cites evidence that compliance with the practice is just 25-40%. The article appears online in PLOS ONE [ a publication of PLOS [ http://www.plos.org/] an organization designed to make peer-reviewed medical research accessible in less time and with less cost than more traditional approaches to publishing scientific results. The research led by Chrsitopher Fuller, “The Feedback Intervention Trial (FIT) — Improving Hand-Hygiene Compliance in UK Healthcare Workers A stepped Wedge Cluster Randomised Trial”, conducted the study in 60 locations that included 16 acute hospitals and 44 general medical wards or acute elderly care sites. All sites were already participating in the “Clean Your Hands” campaign. This campaign includes placing alcohol hand-rub at patient bedsides, using posters and other educational materials to encourage workers to clean their hands. an audit and feedback on compliance was cinluded at least once every six months, so workers knew that the behavior is expected and would be evaluated. The FIT focused on goal-setting for and rewarding of handwashing behavior as an additional compoment to the national campaign.

A significant increase in hand-washing occurred with the FIT, with more change in the 16 intensive therapy units than in the other sites — achieving 13-18% change versus 10-13% change, ranging about 60% to nearly 80% compliance. The improvement declined over time. There were difficulties associated with implementing the protocol, including that the trial place extra responsibilities on some ward staff, who did not receive additional training beyond the initial introduction to the intervention and were not monitored after the initial observation of their placement of materials bedside. To increase the likelihood that such a campaign would be successful over time, the authors recommend that the tasks be integrated into the role of some employees and audited regularly as part of job performance. As for me, I will be watching to be sure healthcare workers wash their hands. And I will do the same.

Health Communication, Health Literacy, and the Affordable Care Act

November 8, 2012

If you are like me, you imagine a time when you will be less ‘scheduled’. This has been a time of being over-scheduled in the past half dozen weeks. I have a pile of topics I want to discuss relating to communicating about health. And too little time to do so.

One of the topics that keeps coming through my piles relates to an article written by Stephen A. Sommers and Roopa Mahadevan that was commissioned by The Institute of Medicine–IOM–and published in October 2010. I came across it when preparing to talk about health literacy and health communication with my undergraduates last year. It has been shuffling about on my desk since then. Today is finally the day I will share my thoughts about it.

First, the relationship between health literacy and health communication that I discuss with my undergraduates in a ‘designing health messages’ course is two-fold. On the one hand, low levels of health literacy, meaning the audience is unlikely to understand many health and science terms or be able to use math and statistics to make decisions–suggests that health communicators, whether they are public health program planners or medical doctors, should adapt their communication so that it will be understood, and informed decisions can be made based on an accurate understanding. A great deal of health communication message design research and practices focuses on this effort, working to assure that knowledge gaps do not become wider between more and less educated audiences, for example.

The second issue related to health communication and health literacy relates to efforts to improve health literacy. In other words, how could we communicate to motivate someone with low levels of health literacy to become excited about learning more vocabulary and applying more statistics in making choices about health?

Addressing both health literacy issues in health communication is the ethical thing to do. Knowing that someone does not understand health vocabularies or may be embarrased to ask questions when they do not understand places a responsibility on the health communicator to adapt. Knowing that high levels of health illiteracy uniformly exist in the U.S. suggests that health communicators ought to be involved with improving the situation across the many contexts for talking about health.

Stephen A. Sommers and Roopa Mahadevan open their paper with the statement that the Affordable Health Care Act does not address low health literacy directly. BUT–they assert–the law cannot be successful unless national efforts strive to address low health literacy. Health literacy is mentioned in the ACA in relation to research dissemination, shared decision-making, medication labelings, and workforce development. “All four suggest the need to communicate effectively with consumers, patients, and communities in order to improve the access to and quality of health care” (p. 6).

So there we have it. If we are to achieve the aims associated with the ACA, including improving the population’s health and bringing health care costs under control, we will only achieve these aims through communication that adapts to and accommodates low levels of health literacy while motivating citizens to improve their health literacy.

Health communication, organizations, and health advocacy

September 14, 2012

Today is my daughter’s birthday. What a wonderful way to spend some time… reflecting on her years of growing up and the strong, healthy woman she is today. In the midst of thinking those lovely thoughts, I am clearing some desk clutter. I came across a glossy brochure from my health care organization. It says it is ‘exclusively’ for Health Advocate Members. I didn’t know that I was a member, but I guess I am. I opened it up and found five member wallet cards. A phone number is the highlight of the card, together with information about what HealthAdvocate does: healthcare help, EAP [employment assistance program], find the right doctors, and untangle insurance claims. Interesting. The brochure itself elaborates on each of these topics. For employee assistance, for example, the topics include stress and anxiety, work conflicts, anger and grief, as well as drug and alcohol abuse.

The brochure tells me that the way this all works is, I call the number which is toll free and I will get to talk to a counselor. Or, I can go online and access services. I’m not sure how well this all works. I’m not sure about a counselor communicating about so many health topics. Maybe the information is more general and the goal is to redirect a call to a more specific resource. It is interesting. I’ll check at the online resource and let you know what I think.

Health communication about BONIVA

August 25, 2012

“BONIVA has not been proven to stop and reverse bone loss in 9 out of 10 women and is not a cure for postmenopausal osteoporosis” [http://www.stategazetteftp.com/mags/parade/Pg_07.pdf]. This message has appeared in numerous magazines and newspapers. Have you seen or heard it?

I wonder how Sally Field feels about that. She appeared in ads to endorse the product and she read the script that said the research had shown that BONIVA reversed bone loss… I will track down the research and see if we can find what the published research really found. For now, I am reflecting on how many of us heard Sally’s ad versus how many of us have seen or read about the FDA’s retraction. And I am enjoying having the strength, including my bones, to pick up my 4 year old grandson and wrestle him into my lap for a family gathering at a restaurant after church on a warm Sunday afternoon.

When is reading a mammogram like looking for a polar bear in a snowstorm?

August 9, 2012

When you have dense breast tissue… at least, that is what some physicians say [go here, for more: http://www.womentowomen.com/breasthealth/densebreasttissue-mammograms.aspx ].

It has been 15 years since my annual mammogram led to a callback from the doctor for more x-rays and then a needle biopsy and finally ‘the all clear’ — no sign of cancer pronouncement. But it happened again last week. I got my annual mammogram on my way out of town to go to Atlanta for a visit with my daughter and granddaughter and son-in-law. And the day after I had the screening, I got a message on my home machine to call for a return visit…

Things have changed in the last 15 years, of course. Now, digital mammography makes some things more likely to be seen on the x-ray compared to film. Go here for a comparison: http://www.umm.edu/breastcenter/digital_mammography.htm?gclid=CNbCiKu_27ECFUlnOgodsH4A_A

At any rate, I returned to the imagery center for more x-rays. Here is how the communication went. First, it was nearly impossible to understand the message on my answering machine. My husband and I listened to it a half dozen times. We looked up the phone numbers of the imagery center, and none of them matched what we thought we were hearing. Nonetheless, I wrote what we thought they were saying and tried the number. It rang out to a message saying that it was long distance. Not likely then to be what I needed to call. Next, I tried calling the number using the first 3 numbers that all the numbers online for the imagery center used. And the last 4 numbers we thought the caller was saying that appeared nowhere in the online listing. Success. I got a nurse who checked and said, “When can you come in?” And I made an appointment for the day after I would return from my visit, which was a week after the first mammogram.

I went to the imagery center, this time with my husband coming in. The volunteer greeted me with, “Oh. I am so sorry.” Yikes. Not what you want to hear. She remembered me from the week before because we had a long chat about my height. At any rate, I would venture to say–“so sorry” is not quite the right expression in this situation. Perhaps “sorry you have to come in for more tests” if ‘sorry’ is to be used at all. The expression and her empathy were, however, unsettling.

Once I was in the room with the x-ray technician, I encountered the other end of the spectrum. The communication was reactive rather than proactive regarding what she wanted me to do. “Put your arm up and grab the handle? I did. “No. Turn this way. Face the machine.” Her tone was irritated. Wow. It is 9:30 in the morning. Why is she so grumpy? I am the one getting my boob smashed again.

She sighed. Letting out a clear expression of annoyance, she said. “Stick your bum out.” Who talks like that? “No. Look at me– Like this–” she said as though talking to someone she regarded to be extremely stupid. Finally, she was satisfied.

Time for another image. She turns me a bit and I try to enact what I have learned. I stick my bum out. “No.” she says harshly. “Stand up straight.” My arm began to quiver. Unavoidably uncertain about what I was doing wrong. Several more images and abrupt commands later, we were done.

“Will the radiologist come in here to discuss these with me?”

“No. Wait in the waiting room. I will get you when he is ready for you.”

I asked the volunteer if she would get my husband when I got called to the radiologist meeting. She told me to ask the technician to do it. So, when the technician came to get me, I asked her. And she did. No attitude. Wow!

And then there was the radiologist. I don’t think he could have been nicer or clearer. He put two pictures up on a screen and pointed to a small round dark spot about the size of a pellet for a BB gun. “This is what we’re looking at that’s different,” he said. “All this is your muscle and dense breast tissue.” It all looked like a lot of snow to me but I could see the BB…

“We’re going to do an ultrasound to see what we can learn about that spot.”

“What will the ultrasound tell you?”

He launched into a helpful answer that I will summarize as, ‘if the sound waves go through the mass, it’s a cyst. If they don’t it may be something we need to take a look at.’

The sound waves showed no mass. He spent plenty of time making sure that it did not appear in any direction. And then he announced, “I believe it’s a cyst. I will call this ‘normal’ and you won’t need to return for a year. Unless, of course, you see or notice changes that should be checked. Any questions.”

Hip Hip Hooray…. But I wish someone would give me a satisfaction survey to fill out about the volunteer and x-ray technician. I have a few thoughts about how their communication could be improved.