The Froedtert & MCW health network strives to solve key health care problems and improve patient experiences through innovation, including collaborating with innovative companies and individuals to reach our goals. One of the ways we do this is by participating in Reverse Pitch MKE, a pitching competition that connects corporations to entrepreneurs and startups who want to help solve challenges and potentially launch a new product or business. This year, the challenge we submitted tackles an issue that affects our work as a health care organization and the communities we serve.
Health literacy: two seemingly simple words. In reality, it's a complex subject impacted by a number of factors such as social determinants of health, housing and transportation. Like anything else, it takes time to master.
Health literacy has a huge impact on how patients understand information, how patients react to that information and how providers interact with their patients. There are two definitions of health literacy, as defined by Healthy People 2030:
- Personal health literacy is focused on the individual. It’s the degree to which individuals have the ability to find, understand and use information and services to inform health-related decisions and actions for themselves and others.
- Organizational health literacy is the degree to which organizations equitably enable individuals to find, understand and use information and services to inform decisions about health care. Ultimately, these two pieces need to work together.
In our community, nine out of 10 individuals are below a proficient level of health literacy and lack the skills necessary to manage their health and prevent disease. Almost four out of 10 individuals have either a basic or below basic level of health literacy. To put this into context, they may not able to read or comprehend the instructions on a prescription label.
Monique Graham, director of community engagement for Froedtert Health, often encounters situations like this when she’s working out in the community. Once, a man from Laos who didn’t speak English came to a flu clinic. An interpreter was onsite and helped translate the form the man needed to sign to get his flu shot. “Because of that service, that person went back and got his wife and invited other members of his family to come out and get their flu shots as well,” she said. Bridging that gap in health literacy helped multiple people get the care they needed.
The health consequences of a low level of health literacy are profound. We want the community to be good stewards of their own health. How do we help them do that?
The Importance of Trust for Health Literacy
Because everyone has a different level of health literacy, meeting people where they are and understanding how they learn can help them feel engaged in their health.
To get to that point, health literacy ultimately starts with one thing: trust.
“You can have a really good, accurate message, but if it's not received in a way that someone trusts it, action won't be taken,” said Greg Stadter, program director of Milwaukee Healthcare Partnership. “You also need to provide information that someone can understand and that they feel motivated to take action with.”
Community Education nurses provide preventive health care services and resources in Milwaukee week through the Care-A-Van program. “Our nurses are building the trust because they are there the same time every week,” Graham said. In one encounter, a nurse took an elderly woman’s blood pressure. After, the nurse asked if she needed help with anything else. The woman replied that “the thing that she used to take her blood sugar” wasn’t working.
“Through more dialogue and questions, we were able to determine that her glucometer was very much outdated,” Graham said. “But what we also determined was that this elderly person did not know where to start. She knew that this device that she was supposed to take, and she’d been compliant up until the point that it stopped working, but she didn’t know what to do.”
The woman may not have known “glucometer” was the technical term for the device she used, but once she was able to explain her situation to a health care provider she trusted, she was able to get the care she needed, specifically a prescription for a new glucometer.
Trust has to be built over time through frequency. That’s difficult to achieve when you only engage with your provider at an annual physical or through office visits once or twice a year. As a result, patients may not perceive recommendations from providers in the way that the providers intend. They may not be delivered in the way that makes sense or seems sincere.
A lack of trust can also lead to delays in care, uncertainty and increased anxiety. For example, someone may not understand why they should have a colonoscopy. They could have a colon polyp, which can be removed, and not know it. If they wait to have the colonoscopy, that polyp wouldn’t be found. It could grow into a colon cancer and become much harder to treat, leading to more significant health problems down the line.
“Health care has been disrupted due to the COVID-19 pandemic,” said Karen Fickel, MD, medical director of the virtual care team at Inception Health. “As we all move forward, we want to build systems that increase trust and efficiently create trusting relationships so people can be confident in the care they're getting.”
Our challenge for Reverse Pitch MKE 2021 is finding a health literacy solution: a way to proactively engage individuals and communities that builds trust, resulting in high rates of health literacy. This requires dreaming and thinking big.
We're looking for a solution that focuses on adults. However, it’s important to recognize that education for adults can also affect their family’s health literacy, as well as their children's. The solution should be culturally competent and is accessible, not requiring a high level of tech-savvy or tech equipment to use. It should leverage technology to drive engagement and be scalable beyond a specific community to the larger population. Health care is a human service-based business, and that human element should be reflected in the outcome.
We are not looking for a solution that creates new educational content or a new social media platform around health care. Both are very competitive areas. It also shouldn’t add a burden to the provider’s experience. We want to offer an opportunity that makes it easier for them, if possible.
What we are looking for is a creative way for patients to engage with educational content or a way for providers to understand what patients are looking for and to help deliver that information.
“If we were to find the solution to this problem, I think we'd have better health outcomes in our community, we'd have a lower total cost of care and we'd have an empowered population that really knows how to manage their own health conditions,” Stadter said.
There are a few different directions to consider when building a solution. It could be patient-centered, one that empowers people to have an increased health literacy rate within themselves. There's the opportunity to deliver a solution that supports organizations and improving health literacy as it relates to how they engage with their patients and deliver information. The solution could also be a tool that bridges the gap between an organization and patients that help improve that health literacy and trust.
Health care providers must have a keen understanding of their patients’ health literacy to care for them effectively and compassionately. One of Dr. Fickle’s patients was an elderly Chinese woman who had a new metastatic cancer. An interpreter accompanied the woman to her appointments. Dr. Fickel felt it was important that the patient acknowledge the severity of her health situation. The interpreter told her, “Dr. Fickle, in her belief system, she doesn’t want to know. She doesn’t want this information, and it’s probably most respectful if you don’t give her all of these details.”
“That was so helpful for me as a clinician to have that knowledge and understanding of where she was coming from culturally,” Dr. Fickel said. “It allowed us to move forward and give her the care she needed in a way that she appreciated and made her feel respected and valued.”
For patients, improved health literacy would mean that they feel understood and empowered in their ability to be an active member of their health and wellness journey. They would be able to proactively access health care services, including preventive care resources and support to live healthy lives.
“When we've accomplished our goal, we're not going to see people when they're in their worst state,” Graham said. “Success is that folks are able to access us when they need us and not when they have no other choice.”
Learn more about our 2021 Reverse Pitch MKE challenge and submit your own pitch.