As a confirmed health literacy fan, I’m glad for health professionals’ high level of awareness around health literacy. I am often asked some version of the question: what can we do better as a field to support patients in growing their health literacy?
My goal in this short essay is to challenge the way you think about health literacy and your patients. I’ll introduce you to someone you might not know, and some of his ideas you might not have heard of.
As usual, I’ll give you specific tools you can use to help expand your patients’ health literacy.
It’s my fan letter to Gunther Kress.
Gunther Kress died recently. He was Professor of Semiotics and Education at the Institute of Education, University of London. He was a leading contemporary voice in language studies, and I learned about his work from my professor Brian Street. Here’s some tributes to him from social media:
— The News on Sunday (@TheNewsonSunday) July 3, 2019
Fitting tribute 'In Memory of Gunther Kress (1940-2019)’ highlighting his significant contribution to linguistics & graphic design. He helped us see the design world a little bit differently thanks to his co-authored book: ‘Reading Images’ @IOE_London https://t.co/FMEQHcX3Rw
— Teal Triggs (@tealtweets) June 28, 2019
Kress is well known for his work in multimodality, and I believe some aspects of his work may be helpful in health literacy. So I’ll give a quick summary (with references so you can geek out).
Generally speaking, a mode, in language and literacy terms, is a way meaning is communicated. Examples of modes include speech, written text, graphics, signs, etc. (Here’s video of Kress answering the question, What’s a mode?)
Any work that combines more than one mode is called ‘multimodal.’ For instance, think of how videos combine images and sound. Those are two different modes. Videos are, by nature, multimodal, whereas a photograph is monomodal.
Here’s another way to think about it. It might be easier to understand multimodality if we consider what it’s not. Kress & van Leeuven open Multimodal Discourse with this:
For some time now, there has been, in Western culture, a distinct preference for monomodality. The most highly valued genres of writing (literary novels, academic treatises, official documents and reports, etc.) came entirely without illustration, and had graphically uniform, dense pages of print. Painting nearly all used the same support (canvas) and the same medium (oils), whatever their style or subject. (p.1)
Hmm…“graphically uniform, dense pages of print,” that are “entirely without illustration?” This makes me think of some discharge instructions I saw once. Anyhow…moving on to the good news.
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Why multimodality is good news for health literacy and your patients
I’ll turn again to Kress & van Leeuven to give some good news.
They describe how, as monomodality gave way to multimodality, it was still a monomodal scene for a while.
This is because complex works, though increasingly multimodal, were made by a group of people–each responsible for one mode. That is, each person was a specialist in a mode. For a newspaper, it might be the writer, the designer, the data visualizer, etc. They acted in ensemble to make the newspaper.
Such works “were produced in this way, with different, hierarchically organized specialists in charge of the different modes, and an editing process bringing their work together.” (p. 2) And certainly, this still happens.
But now with digital media, the different modes “can be operated by one multi-skilled person, using one interface…so that he or she can ask at every point: ‘Shall I express this with sound or music?’ ‘Shall I say this visually or verbally?’ and so on.” (p.2. Read more from this chapter here.)
That is to say, because of digital communication, we can all do multimodal work.
Simply because we’re alive in the 21st century, we all consume– and often produce–complex multimodal texts. (That’s any work with more than one mode, more than one way of making meaning.) If you’ve ever shot a video or added images to text, you’ve produced a multimodal work.
The same is true for your patients.
Because of the rapid pace of technology, the expensive design suites that were once only owned and operated by specialists, are now available to all of us. On our cell phones, no less!
Think about all the multimodal work you can consume and produce with a cellphone:
- emojis are added to text messages
- images are modified with color and shape
- videos are created, viewed, and shared
- social media is scanned and updated
For more examples, ask the nearest 12-year old.
Multimodal communication is true of all of us. Including your patients.
Why is this good news? Because it invites us to reconsider what assumption we are making about the interpretational resources and practices of our audiences.
What you are assuming your patient knows and can do? How is this shaping the way you are interacting with them?
You’ve heard me say before: start with what people already do. Your patients are likely making and interpreting multimodal work (maybe on their cell phone).
Rather than worrying about a patient’s educational level or low score on a literacy assessment, focus on the ways they are producers and consumers of multimodal works.
Why multimodality is good news for health literacy and you
Multimodality is good news for you in your practice. This is because it helps you focus on the parts of health literacy you can actually do something about:
- the in person conversations you have with patients
- any digital patient communication
- any materials shared with patients
In short, any way words and images are used before, during and after the patient encounter.
How can you bring this awareness into the ways you communicate with them? In the ways they communicate with you? Here’s some ideas to get your started:
- As I’ve said before, one of the most powerful ways you can help patients learn is through mixing your modes.
This can be simple and unfussy. For example, take a written text you use frequently. Read it aloud–the voice recorder on your phone works just fine–to turn into an audio file. Maybe try reading with a little expression. Post the audio file on your website. You only have to do this once, to help many patients.
- How long has it been since you looked at the written materials you give to patients?
Make sure written materials are accompanied by images, and broken up into small paragraphs. Everyone finds this more manageable and memorable.
- Apps are nearly always multimodal.
They are also interactive. Both of these traits are beneficial for learning. Apps can also be less intimidating than pages of solid prose.
- Think carefully about any forms patients fill out
This applies to any materials you have patients create. See how you can offer different ways these can be completed.
All communication as multimodal
Kress and van Leeuven warn us that pretending “that language is the central means of representing and communicating…is simply no longer tenable, that it never really was, and certainly is not now.” (p. 111)
You and I are both trying to reach people, and I invite you to join me in using multiple modes. Part of my job, as I see it, is to get you thinking in slightly different ways about your own practice, including some things you might take for granted about language. This is so that you can begin to see opportunities and possibilities that maybe you hadn’t noticed before, in order to make the impact you seek. If you’d like more support, contact me through the form below.