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Getting a flu shot, ’tis the season

January 22, 2013

A long number of weeks have passed with various flus and bronchitis and other hits keeping friends and family members out of the flow of work and fun. I was surprised as I asked my undergraduates last week how many had gotten the flu shot. About half have done so. So I asked the students in my graduate seminar. None had. Wow.

Then they asked me, “Why do you do it?”

Easy. Affordable. Protects me. Protects you.

“Why don’t you do it?” I asked them.

I don’t ever get the flu. I got the shot once and it gave me the flu. Takes too much time to go do it.

Ahh. So we talked a bit about the concept of ‘public’ in public health, transmission of the flu virus and so on. And we talked about how they make the flu vaccine to refute the notion that the vaccine could give them the flu. And then we talked about how much time it would take to be sick when they really didn’t need to be.

I guess the challenge remains even with a relatively educated audience to overcome perceived barriers to relatively simple practices to promote the public’s health. No one said they had a needle phobia. No one said they were allergic to eggs. In short, I didn’t really hear any reasons why they weren’t getting the flu shot that I felt couldn’t be addressed with communication relatively easily.  

So I hope if you have gotten the shot, and many of us have, that you encourage others to do so, hopefully making it a shorter flu season for us all.

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.


Guest Post–Learning to React to a Seizure: Things Everyone Should Know

October 31, 2012

Guest Post: Leslie Johnson is an education health writer for She welcomes your comments.

Seizures— in their most common form—are the result of irregular, electrical activity in the brain and often lead to involuntary muscle contractions and convulsions. Although they typically last less than five minutes, they can result in disorientation and potentially worse complications if not handled in the right way.

While it’s rare that they result in any permanent damage seizure episodes are still a very serious matter and should be handled with care. Commonly, they occur because the individual having them has a condition such as epilepsy, although other things have been known to cause them like stress.

For people not very familiar with them, seizures can be a scary, startling event, especially if they don’t know the proper “protocol” of things to do in such a situation. They wonder, should I do this for the person experiencing it, or maybe I should do that, and really, the only way to overcome this uncertainty and proceed confidently is to empower one’s self with knowledge and information.

So, in the event that you are near someone having a seizure, the information in below should help you better understand how to handle the situation. Read on to learn what you SHOULD be doing.

Don’t Move Them

Unless they are in a dangerous, potentially harmful position, it is best to not move or shake the individual in any way. If you can, situate them onto his or her side for breathing purposes, but no sudden, big movements—they can likely lead to more harm and injury than good.

Clear the Area

Since the individual’s muscles are contracting involuntarily, they have no control over their movements or gestures, so you want to ensure there is nothing around them that can cause them harm. Move tables, chairs, stands, anything that could fall or injure them should it be jarred unexpectedly. This will also make room for paramedics, should they need to be called onto the scene.

Clock the Seizure

If you can, it’s a good idea to make note of WHEN the seizure begins. Generally they do not last longer than 2 minutes, so in the event that it does you can relay that to medical professionals.

Stay Alert Until the Seizure Ends

Just because seizures can be a potentially routine part of a person’s life, doesn’t mean that each episode will be routine. There’s always the chance that something could take a different, negative turn, so you want to be sure you are there to provide further assistance if necessary. Also, it is likely that the individual will experience a bit of disorientation once the seizure stops, so you want to be there to reassure them of where they are and what happened.

Alert Medical Professionals If Anything Was Different than Usual

If the person has never had a seizure before, or experienced symptoms unlike their usual episodes, contact medical professionals immediately. They should be checked out as soon as possible to ensure no serious damage has been done.

Overall, knowing how to respond in the event of any emergency is an important skill, because you just never know what might happen. Being on alert and at the ready are invaluable traits everyone should strive for.

Leslie Johnson is an education health writer for She welcomes your comments.




Health communication and IOM paper findings about how to discuss medical evidence

September 26, 2012

I have talked often about the importance of evidence to guide our informed decisions about health. A new paper from the Institute of Medicine discusses how to talk about medical evidence [see].

One of the interesting issues considered addresses ways that language relates to patient confidence about evidence and health care. 1,068 US adults were surveyed to answer this question: 71% were White, 48% male, 46% 55 years of age and older, 55% rated themselves as in ‘very good’ or ‘excellent’ health, 62% were not living with any chronic condition, 88% had health insurance, and 36% usually or always bring a list of questions with them to ask their doctors.   

The summary of findings is in Table 1. ‘What is proven to work best’ was found to be the phrase leading to the greatest level of confidence, 79%–in the evidence used for their health care.

I wonder, given that so many come prepared to ask questions, if the participants would ask any questions about the evidence. Things like ‘is the evidence based on someone my age, my biological sex, or my race/ethcnity?’

I wonder, too, about the levels of education for this group. IOM has convened panels to write reports about health illiteracy in this nation. What does ‘evidence’ mean to the large percentage of adults in the US who are health illiterate? What does ‘evidence’ mean to this group of mostly white, mostly insured, and very healthy personal advocates [they ask a lot of questions on their own behalf] participants? 

Hopefully, the responses do not become scripts for medical interview education.

The paper also makes ‘evident’ that US health consumers want their personal goals to take a priority in conversations about their health with health professionals. So, we need to understand what goals the patient has about the ‘evidence’ being used to guide decisions. Is it their goal to understand more about what makes up medical evidence? If so, I am not ‘confident’ that this advances that aim.

Health communication online for supporting fitness–

September 21, 2012

 Today is my daughter-in-law’s birthday. September is filled with birthdays in my family. And we celebrate them. Not so much with cake. More with talk and support. Reminding each other of all the good things from the past year and all that we have to look forward to in the year ahead. That support makes all the difference in the world for living a fulfilled life. That must be part of the idea behind I read about the online site when I was going through a pile of old magazines this summer. I do that now and then, tearing out pages for items I want to follow-up on and throwing the rest of the magazine away or–if it is not too destroyed–donating it for others to read. At any rate, I read about SparkPeople being a site where members find support for reaching fitness goals. So today I visited the site.

My first impression in joining is that the site has a lot of capacity for customization. I could [tho I didn’t] create my own personal page. Even without creating the personal page, I entered some information in a very quick fashion and the screen rolled over to content relating to my interests. The site is filled with color and images and all kinds of links. There are communities to join, friendships to make [the site says], stories of success before and after joining.

I wonder how long members, on average, spend on the site and how many weeks, months, or years they  remain active members. I noticed that the site has a lot of advertising support. As far as I have gone, that apparently supports the site so that it is free to subscribers. So far anyway. I do wonder if the site is doing so much for so many topics that it might prove to be less depth than some would want. I also wonder about the name and how people would find their way to the site if they didn’t read about it in a magazine. Perhaps others have experiences with the site and will let us know more.

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”  []. 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.

Health communication and forest therapy…is this a case of country mouse vs. city mouse?

August 22, 2012

One of my sister’s brought to my attention some research about ‘forest therapy’. I read the article she sent me and was pleased to find that basking in the surroundings of a forest was reported to have positive benefits for human health. I would have to say that I didn’t need any justification for spending time in nature any opportunity that I get, but it was a nice thought to justify my own love of nature.

And then I decided to go on a hunt for the research. Alas, as is too often the case, there was no mention of the actual publication in the news report and so I had to go in search of the research. On PUBMED, I was able to find research on ‘forest therapy’. Sadly, the most recent article–published in the past several months in 2012, is a meta-analysis that examined all previously published articles and concludes that there is no evidence from which to draw conclusions about the effects of forest therapy [see]. The authors conclude that, “Because there was insufficient evidence on forest therapy due to poor methodological and reporting quality and heterogeneity of RCTs, it was not possible to offer any conclusions about the effects of this intervention. However, it was possible to identify problems with current RCTs of forest therapy, and to propose a strategy for strengthening study quality and stressing the importance of study feasibility and original check items based on characteristics of forest therapy as a future research agenda.”

Alas, I remain steadfast in my belief that forest therapy, spending time walking and living and breathing in forest environments, sustains me. But I have at least one very good and close longtime friend who would not agree with me. She basks in the bright lights and fast pace of locations such as New York city in December. That, in fact, was one of the challenges associated with the research. There are unpleasant forest setings that no one would want to spend time in, so not all forests are created equal. And there has to be a great deal of individual variance related to preferences in this regard. Perhaps it is more important to communicate that each of us should take time to identify what environment and setting gives us the most calm and promotes our well-being. And then find time to bask in it.


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: ].

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:  

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.