If you care about health literacy, in this episode you’ll learn why busting the myth that literacy is a skill can help you in your work–and what you can do instead.
It’s health literacy month again, so here’s another look at some literacy myths. If you care about health literacy, I’ll tell you why busting the myth that literacy is a skill can help you in your work, and tell you what you can do instead.
Hi everybody, I’m Dr. Anne Marie Liebel and this is “10 Minutes to Better Patient Communication” from Health Communication Partners. Our expertise is in teaching people and organizations how to get better at communication. Our new course teaches all patient-facing employees to identify and manage those cultural mismatches that can show up in communication. Why? Because every interaction with a patient is important, and everyone who interacts with patients deserves high-quality support. So from cafeteria to cardiology, we’ve got you covered, with “Foundations of Equitable Interpersonal Communication in Health.” Learn more at healthcommunicationpartners.com.
Thanks to all the health professionals I work with, people like you, I have an appreciation for how hard you’re working to manage the challenges and stressors of communicating with different people about topics important to their health. Successful communication, we know, can help individuals, groups, and organizations grow, learn, have better health outcomes. Health literacy, again, we know, is part of this.
When people talk about health literacy—or literacy– like it’s a skill, I have that improv comedy response: yes…AND. Because there’s a lot more going on. So that’s where I’m going: to talk about why a skills focus in literacy and health literacy may not be as helpful as it sounds, and what we can focus on instead.
Not only is it health literacy month, it’s the anniversary of this series! We’re five, everybody! We’re 5 this month! This show has been going, we’ve been dropping new, exclusive, original episodes every 2 weeks without fail for 5 years! Hey, not bad, huh? You can visit healthcommunicationpartners.com for the full show archive and episode transcripts.
This episode is a real treat for me also because I get to talk about the topic that drew me into the health sector to begin with, health literacy. And I get to talk about the approach that I use, that’s beneath every episode in this series. And, I get to start by telling you about one of my professors.
I was very fortunate to have studied with Dr. Brian Street, one of the founders of the New Literacy Studies while I was at University of Pennsylvania. Brian Street’s impact on literacy studies is impossible to exaggerate. Go ahead, google him. You may have heard of him.
Now his work, and the New Literacy Studies, and this body of research that he helped kick off has been referenced in health literacy since the start of the health literacy field (here, here and here are some more recent examples). Street himself at times was involved in what would now be called health literacy work.
Street and his colleagues, including Professor Jim Gee who you hear me reference a lot, they used ethnographic tools and orientations to observe and sometimes participate in different social and cultural groups around the world, paying attention to how people use language in specific situations, and what this language use means to them.
In language and literacy studies, it was and still is popular to claim there’s one universal set of rules that governs all human language use. But rather than search for universal rules for language—these rules, by the way, tend to favor Western European ways with words, but that’s another conversation—New Literacy Studies researchers analyzed actual uses of language and what it meant to the people involved.
Street found there’s not a universal thing or a skill called literacy, that if you have it, you can use anywhere and get the same results, no matter who you are. Instead, what Street and his colleagues found was: yeah, there are rules, but different groups of people have different rules. Most of these rules are local. And some of these rules change over time.
Yes, there are skills involved with using language and with literacy. But these skills vary significantly by the situation–and with who’s there.
Overall, they found that language and literacy were not traits that people had, or even skills they used, as much as sets of social activities, or practices, or processes. And that these processes or practices were context-specific.
That was a real game change in literacy studies. Now, there’s thousands of studies that approach literacy as a social process. For instance, researchers will study everyday conversations and what they mean to the people involved. You could analyze discussions among family members or neighbors. Or maybe high stakes conversations like in courtrooms or police stations. It includes analyzing texts and talk in places where there are significant power dynamics, like in classrooms and hospitals. It also includes research on the many social processes involved with everyday uses of writing.
Now what do I mean by social processes, or practices, or activities? Don’t people just read and write? Well, let’s play around with this. We’ll have an imaginary example. Think of all the processes that go into something you do frequently: making up or using a grocery list for your shopping. Let’s unpack this.
While you’re writing things down on this list, you’re doing it in a specific situation that has an impact on what you write. For example, you’ve got a budget, maybe it’s set by you, maybe not. Maybe you’re trying to keep a handle on your feelings about that budget as you make the list. You’re thinking about who’s at home, who’s eating what, how quickly. Whose responsibility it is to take care of meals on different days this week. How good of a cook is this person? If you’re anything like me, all of these and more come into play when you are deliberating over what to write on that list.
Or maybe you didn’t write the list, it’s just your job to do the shopping! When you’re reading that list stood at the store, you’re not just using skills to read the list. You’re also interpreting the meaning of what’s on the list. You may go through similar processes: thinking about money. Also thinking about the person who wrote the list, what they tend to do when choosing what to put on this list, as well as what they tend to forget off the list. How much you do or don’t agree with what’s on the list. The conversations you might have later around what you did and didn’t get from the list. And what all this has to do with who’s got the power to set the budget for the grocery shopping to begin with.
Here’s one of the many reasons I think busting the myth that literacy is a skill could be helpful if you care about health literacy: seeing literacy as social processes helps if you have to get down to specifics.
Here’s what I mean. The universal rules approach, or making kind of broader general claims about language and literacy, is still very popular. It’s far more well-known than social practice views. And Health literacy research often relies on large data sets about groups or patient populations. These studies are important. But these approaches can make it difficult to drill down for meaningful suggestions at the small group or individual level.
And what people have told me they find the most exciting thing about health literacy to begin with is that it’s a focus on people. Real, regular people– patients–and what they think and what they say.
A social processes view, like that from the New Literacy Studies, allows you to deal with actual people’s actual communication in particular scenarios, when you need to. It also allows you to draw distinctions among different social groups’ communication, conversations, even writings. That’s because New Literacy Studies focuses on actual, everyday, spontaneous communication between real people. Not imagined, not hypothetical.
So when you’re looking to understand a specific groups’ health literacy, you can use a social practices view. That lets you account for social contexts, including the things you know make a difference. This is a way of expanding our tool set as health literacy researchers and practitioners.
So if you want to try this, my first step is suggesting that you stay open. Now, you already listen to this show, so you’re used to looking at things a little differently. Go ahead and check out the links and the research I gave. Listen to other episodes in this series, because this is the approach underneath all of them. And if you’d like a hand, contact me. This has been 10 Minutes to Better Patient Communication from Health Communication Partners. Audio engineering and music by Joe Liebel.