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Abstract

  1. Top of page
  2. Abstract
  3. “IT'S NOT YOU; IT'S ME”
  4. “DUMP THE CHUMP”
  5. “THERE ARE TOO MANY LIES BETWEEN US,” AND ITS COROLLARY, “YOU'VE CHANGED”
  6. “TIME HEALS ALL WOUNDS”
  7. “I LOVE YOU, BUT I CAN'T COMMIT”
  8. “WE ARE JUST IN DIFFERENT PLACES”
  9. “MAYBE IT IS YOU”
  10. “BREAKING UP IS HARD TO DO”
  11. REFERENCES

With the recognized need to increase health literacy, some practices have not worked and, therefore, “should be dumped.” Herein we present alternative approaches that may increase health literacy.

Is this the beginning… or is this the end?

According to the U.S. Department of Health and Human Services, low health literacy is associated with poor health, higher hospitalization rates, less use of preventive medicine, and higher health care costs (U.S. Department of Health and Human Services 2009b). Unfortunately, the National Assessment of Adult Literacy suggests that only 12% of U.S. adults have “proficient” health literacy. This low level of literacy indicates that health care professionals need to break away from traditional communication methods that are based on the assumption that consumers are actively and rationally processing information and will fully integrate that information in their future decisions.

The pragmatic directive is to move beyond documenting consumer frailties, and turn to theory-based research designed to create health care systems which maximize consumer health literacy. This agenda must incorporate the communicators (the health care professionals, the insurance providers, the lawyers’ requirements, the government regulators, the Courts, the bench scientists), the receivers of information, and the context in which the information is generated.

To this end, we present observations that use common life experiences as the framework for progress. Perhaps, we erroneously assume that most readers have experience with the romantic break-up, but we will forgo some of our own advice, reasoning that most of us have at least second-hand experience with these clichés. Undoubtedly, clichés become clichés because of the underlying element of truth. These common tales of break-up in life and popular culture provide a basis to explain the value of a new approach.

“IT'S NOT YOU; IT'S ME”

  1. Top of page
  2. Abstract
  3. “IT'S NOT YOU; IT'S ME”
  4. “DUMP THE CHUMP”
  5. “THERE ARE TOO MANY LIES BETWEEN US,” AND ITS COROLLARY, “YOU'VE CHANGED”
  6. “TIME HEALS ALL WOUNDS”
  7. “I LOVE YOU, BUT I CAN'T COMMIT”
  8. “WE ARE JUST IN DIFFERENT PLACES”
  9. “MAYBE IT IS YOU”
  10. “BREAKING UP IS HARD TO DO”
  11. REFERENCES

Plain language is proposed as one important tool for increasing health literacy. Plain language documents are designed so that “people can find what they need, understand what they find and act appropriately on that understanding” (U.S. Department of Health and Human Services 2009b). Yet, this basic tenant of health care communication is often ignored. Indeed, we suggest that much of the low health literacy rate can be attributed more to the communicator than to the consumer.

The U.S. government website on “Preparing for Pandemic Influenza” (U.S. Department of Health and Human Services 2009a) presents an overwhelming amount of information. If the consumer is persistent and links to “Health and Safety,” (the seventh item on the left side of the homepage screen), s/he will see a series of links—one being “families.” This consumer will learn that s/he should do the following:

  • 1)
    Develop preparedness plans as you would for other public health emergencies.
  • 2)
    Participate and promote public health efforts in your state and community.
  • 3)
    Talk with your local public health officials and health care providers; they can supply information about the signs and symptoms of a specific disease outbreak…
  • 4)
    Practice good health habits, including eating a balanced diet, exercising daily, and getting sufficient rest and take these common-sense steps to stop the spread of germs.
  • a.
    Wash hands frequently with soap and water.
  • b.
    Cover coughs and sneezes with tissues.

McCormack and her colleagues (2009) propose that understanding one's insurance plan is an important component of health literacy. They find that overall understanding of the insurance terminology and Medicaid proficiency is low to moderate among older adults. Given the methods used to communicate insurance information, it is difficult to expect otherwise. Let's look at an example from West Virginia Public Employees Insurance Agency (PEIA). The first page of PEIA's 37-page Shopper's Guide includes a five-paragraph disclaimer that ends with “We have tried to ensure that the information in this booklet is accurate. If, however, a conflict arises between this Guide and any formal plan documents, laws, or rules governing the plans, the latter will necessarily control” (West Virginia Public Employees Insurance Agency, 2). This is followed by a 7 by 62 cell matrix entitled “Benefits at a Glance” comparing the different available plans.

In a good-faith effort to be comprehensive, both of these “communications” are likely to fail to communicate because of simple information overload effects. Consumers have difficulty encoding and using information when too much information is densely presented. This is a widely known problem, well documented over several decades, but which health care communicators tend to ignore. Fortunately, some not-for-profits and governmental units are improving. In 1999, the Food and Drug Administration changed the labeling format for over-the-counter drugs from block paragraphs to a standardized format incorporating section headings and easy to understand language (21 CFR 201.66 et al). Industry has also begun to respond. Consider, for instance the relatively recent changes in the “brief summary” used in direct-to-consumer pharmaceutical advertising. These summaries, intended to provide consumers with important risk information, were originally indistinguishable from the physician labeling sporting technical language in small print and unbroken columns. Now, many sponsors offer a more consumer-friendly format using layman's terms and white space.

What can be done when consumers must deal with considerable information in making a choice, such as when selecting an employer-based insurance plan from one of multiple options? Basic research is needed to develop and test the efficacy of, and consumer reaction to, alternative approaches that move beyond the multipage website or brochure. For instance, are consumers willing to spend 10 to 15 minutes discussing their insurance choice with a counselor trained to identify the consumer's most important needs? Alternatively, given the trend toward electronic health records in the United States, what factors would influence a consumer's willingness to use past medical history, in the form of his/her electronic health records, as input into an electronic algorithm that selects the best (most cost effective coverage of the specific medical needs of the consumer) health care plan for the consumer and his/her family? Or, will consumers be concerned about turning over their medical history to their employer? Would an online decision aid that asks consumers to identify their health-care priorities and concerns and, based on these responses, ranks the various alternatives, prove to be a useful solution? Theories derived in interpersonal dialogue, trust, consumer perceptions of privacy, and resistance to technology would be of use in these contexts.

“DUMP THE CHUMP”

  1. Top of page
  2. Abstract
  3. “IT'S NOT YOU; IT'S ME”
  4. “DUMP THE CHUMP”
  5. “THERE ARE TOO MANY LIES BETWEEN US,” AND ITS COROLLARY, “YOU'VE CHANGED”
  6. “TIME HEALS ALL WOUNDS”
  7. “I LOVE YOU, BUT I CAN'T COMMIT”
  8. “WE ARE JUST IN DIFFERENT PLACES”
  9. “MAYBE IT IS YOU”
  10. “BREAKING UP IS HARD TO DO”
  11. REFERENCES

Basic research has identified several commonly used tactics, which are unlikely to increase health literacy. Above, we mentioned that in a noble attempt to be comprehensive, we provide too much information, and thereby thwarting our goals. The temptation to provide all the relevant information is strong; we have so much we need to share. However, if basic research fails to show efficacy, health care educators and communicators should stop using this tactic.

Behavioral decision researchers (c.f., Eggers and Fischhoff 2004) offer an alternative that has the goal of providing an information environment that enables consumers to make choices in their own best interest—thus maximizing overall consumer welfare. Researchers begin by identifying the most important outcomes to consumers and then examine the effect of a particular piece of information on the consumer's choice. If the information significantly changes consumer choice and behavior in a manner consistent with the consumer's goals, it becomes a focal point of the communication. Alternatively, information that does not influence consumer choice and behavior is omitted when legally possible.

Another commonly used technique in health education, for which there is limited evidence of effectiveness, is the disclosure or disclaimer. These techniques have been suspect for at least a decade. Consider Andrews, Netemeyer, and Burton's (1998) statement, “The history of print ad disclosures in ‘curing’ misleading advertising impression is not good.” More recent, and directly tied to health literacy, are concerns that disclosures used in the dietary supplement and food industries are ineffective (France and Bone 2005; International Food Information Council 2005; Mason, Scammon, and Fang 2007). Qualified health claims arose from the landmark Pearson v. Shalala (1999) ruling where the Court found that manufacturers have a Constitutional right to provide consumers with information from “emerging science” (i.e., science that is preliminary and indicative of a nutrient's positive impact on consumer health). In the Pearson ruling, the Court stated that a qualifying statement could be used to remedy any miscommunication from the health claim.

For example, since April 2003 the antioxidant vitamins C and E have been allowed to make the following statement on package labels, “Antioxidant vitamins may reduce the risk of some cancers,” as long as it is accompanied by the following qualifier: “Some scientific evidence suggests that consumption of antioxidant vitamins may reduce the risk of certain forms of cancer. However, FDA does not endorse this claim because this evidence is limited and not conclusive” (U.S. Food and Drug Administration 2003). As the above research shows, the use of disclaimers leads to increased consumer confusion and has not had the effect that the Court anticipated (i.e., remedying miscommunication).

This area is ripe for intellectual contributions. What alternatives can we offer that, in both theory and practice, will remedy miscommunications from a health claim or other promotional communication that needs clarification? Icons are an option, but they may operate at a more global than attribute specific level. For example, Pepsico's “smart spot” symbol is used by consumer to choose an “overall” healthier product based on guidelines by the USFDA and National Academy of Sciences (Pepsico 2008). Can icons be designed that effectively convey specific clarification information? Unfortunately, our literature currently offers few solutions to this persistent problem.

“THERE ARE TOO MANY LIES BETWEEN US,” AND ITS COROLLARY, “YOU'VE CHANGED”

  1. Top of page
  2. Abstract
  3. “IT'S NOT YOU; IT'S ME”
  4. “DUMP THE CHUMP”
  5. “THERE ARE TOO MANY LIES BETWEEN US,” AND ITS COROLLARY, “YOU'VE CHANGED”
  6. “TIME HEALS ALL WOUNDS”
  7. “I LOVE YOU, BUT I CAN'T COMMIT”
  8. “WE ARE JUST IN DIFFERENT PLACES”
  9. “MAYBE IT IS YOU”
  10. “BREAKING UP IS HARD TO DO”
  11. REFERENCES

The market is rife with inaccurate information. Consider for example, consumers’ persistent belief that autism is caused by childhood immunizations (evidenced by recent law suits) despite a lack of scientific evidence and lucid arguments provided by the National Institutes of Health (2006). Consumers fret about the safety of consuming foods developed using biotechnology; over 30% of respondents in a U.S. nationally representative sample classified as “Risk Avoiders,” were very worried about genetically modified food risks (Radas, Teisl and Roe 2008). Yet, there is no scientific evidence that foods developed using biotechnology pose any risk greater than that posed by those developed using traditional cross-breeding techniques (Society of Toxicology 2003).

Confound these misconceptions with the fact that health science changes over time and bigger health literacy issues evolve. Recall that in 2003, FDA concluded that there was at least preliminary evidence that antioxidant vitamins reduced cancer risk. Yet, 2008 and 2009 have been bleak for the supplement industry as numerous randomized clinical trials have shown no positive impact of these vitamins in reducing cancer risk (Roan 2008; for examples of clinical trials see Gaziono 2009 and Lin et al. 2009). Consumers are wasting their money if they are using vitamins C and E as insurance against cancer.

The same holds for fats. The 1980s might be considered the Dark Ages of fat nutrition knowledge, in which the low-fat diet was promoted and all fats were treated equally—they were to be avoided. Today, nutritionists identify bad fats, such as trans fats which increase the risk of heart disease, and better or good fats, such as monounsaturated fats which reduce the risk of heart disease.

In order to maximize health literacy, we must negate erroneous beliefs and design methods which can be used to change consumer beliefs and actions when health science changes. One of the most pervasive and well-documented biases in our literature is confirmatory bias, or the consumer's motivation to expose him/herself to information consistent with current beliefs and to interpret information to be in line with such beliefs (c.f., Nisbett and Ross 1980). Consider a comment on Roan's 2008Los Angeles Times article calling into question the efficacy of vitamins in preventing cancer. One apparent disbeliever states, “What I would like to know is if the supplements used in the study are created in a lab or are they gotten from nature?” Perhaps, if the supplements were natural, the outcome of these trials would have been different—a significant counter argument provided by what appears to be a true believer in vitamins.

What does our discipline have to offer to address this issue? How do we suggest changing beliefs and attitudes? So far, our advice seems to be to identify compelling information, repeat it frequently and make use of appropriate sources. We need to do more. We know that these biases occur despite compelling information. We also know that, when consumers strongly hold beliefs, such as the MMR vaccine and autism connection, counterarguments arise. We need to use what we already know to develop theories that specifically address these types of problems and go beyond the current advice.

“TIME HEALS ALL WOUNDS”

  1. Top of page
  2. Abstract
  3. “IT'S NOT YOU; IT'S ME”
  4. “DUMP THE CHUMP”
  5. “THERE ARE TOO MANY LIES BETWEEN US,” AND ITS COROLLARY, “YOU'VE CHANGED”
  6. “TIME HEALS ALL WOUNDS”
  7. “I LOVE YOU, BUT I CAN'T COMMIT”
  8. “WE ARE JUST IN DIFFERENT PLACES”
  9. “MAYBE IT IS YOU”
  10. “BREAKING UP IS HARD TO DO”
  11. REFERENCES

Research shows that, over time and with practice, health literacy improves. Let's return to our discussion of fats. In January 2006, trans fat information was added to the nutrition facts panel of package labels. Learning has occurred. Research shows that from 2006 to 2007 knowledge regarding the fact that trans fats increase the risk of heart disease increased by 10% (from 63% to 73%; Eckel et al. 2009). Given time, consumers do learn information.

Kozup, Burton, and Creyer (2006) bring us to the next step, showing experimentally that when consumers were knowledgeable (i.e., read a 317-word excerpt drawn from Consumer Reports regarding the harmful effects of trans fats on the circulatory system), they were able to use the trans fats labels and determine that regularly consuming a specific product labeled as high in trans fat would increase the risk of heart disease.

What can we do to speed up learning? Fats are an interesting problem because there are many types of fats (e.g., polyunsaturated, monounsaturated, omega-3 fatty acids, saturated fats, trans fats) some of which have positive health effects and others negative. The consumer must be able to recall which fats have which effects in order to choose appropriately. Thus information must be accessible via long term memory in order to be useful. The American Heart Association's current fats education goes beyond providing the important information, by also providing a mnemonic devise based on duel-coding theory. Its campaign, “Meet the Fats” (American Heart Association 2008) uses the “Bad Fat Brothers,” named Sat and Trans, portrayed as cartoon characters with wide mouths, large heads, and very short legs. The “Better Fats Sisters” have less exaggerated features, yet are still cartoon characterizations named Poly and Mon.

This example brings forth several lines of research in various domains. First, do icons and other mnemonic devices work better in the immediate time period than using only words? Dual-coding predicts that these devices will be helpful by creating two pathways for encoding information in memory. A much more interesting question, for which we have little research, is examining the consumer at the time a decision is made. When choosing a product in the store, does the consumer correctly recognize the health implications of monounsaturated or trans fat content? How salient is that information? Do icons and other mnemonics increase salience as well as knowledge? Does knowledge translate into appropriate health choices and behaviors? What factors may moderate the effectiveness of these icons? Indeed, some nonverbal representations which, at face value, seem certain to strongly influence consumer choice at the point of purchase in the direction which is best for his/her health, end up instead backfiring. Consider, for instance, the fact that a graphic warning label on cigarettes (i.e., pictures of a person's mouth suffering from gum disease, oral cancer or tooth loss, as used in Canada), increased smoking intent among U.S. high school students (Sabbane, Lowrey, and Chebat 2009). Such a boomerang effect reminds us that a theoretical foundation, as well as empirical research, is necessary to implement successful literacy campaigns.

“I LOVE YOU, BUT I CAN'T COMMIT”

  1. Top of page
  2. Abstract
  3. “IT'S NOT YOU; IT'S ME”
  4. “DUMP THE CHUMP”
  5. “THERE ARE TOO MANY LIES BETWEEN US,” AND ITS COROLLARY, “YOU'VE CHANGED”
  6. “TIME HEALS ALL WOUNDS”
  7. “I LOVE YOU, BUT I CAN'T COMMIT”
  8. “WE ARE JUST IN DIFFERENT PLACES”
  9. “MAYBE IT IS YOU”
  10. “BREAKING UP IS HARD TO DO”
  11. REFERENCES

Smoking is among the most preventable causes of death in the United States and despite great optimism that young adults will be able to quit smoking prior to graduation, few are successful (see Wolburg 2009). According to the American Heart Association, more than four in five smokers want to quit (American Heart Association 2009). Those who are successful have commonly attempted to quit as many as eleven times. The desire is there, but the consumer has problems with a long-term behavior consistent with that desire.

Fifty-six percent of Americans want to lose weight (Moore 2006). There are only three ways to lose weight: eat less, exercise more, or both. But exercise takes time and is sometimes unpleasant, and eating less or choosing healthier foods means sacrificing now.

In both these cases, it is likely that the consumer knows the facts—smoking is unhealthy, and that regular exercise and/or dieting is needed to lose weight. The knowledge is there. The desire, for most, is also likely there. Yet, the behavior, the long-term commitment does not occur. Perhaps, in these instances, health literacy should concentrate on action-oriented goals as opposed to information-oriented goals. Here, researchers and practitioners may find more impact by focusing on incentives that encourage behavior for which the person has already cognitively bought into. Economists have long thought that the key to behavior is understanding incentives; behavioral economists concentrate on changing environments which make it easier for consumers to engage in activities consistent with their own goals (see Thaler and Sunstein 2008).

Let's turn to smoking. If over 80% of smokers wish to quit, what incentives can be created to increase the probability of success? Research shows that for every 10% increase in price, tobacco consumption is reduced by 4% (Adkins 2009). The West Virginia State Legislature is currently debating a tax increase from 55c¢ to $1.20 per pack. Assuming a pack of cigarettes costs approximately $5.00, this 65c¢ increase represents approximately 10% of the current cost, resulting in approximately eight million fewer packages of cigarettes consumed in the state. Could it be that putting the extra effort into lobbying for additional tobacco taxes would positively influence more smokers to quit than an additional quit-smoking help session?

Consider healthy eating. What if company and school cafeterias charged a nominal price, or even no price, for fruits (along the lines of Nestle Corporation's current practices in company cafeterias) and increased the cost of fried foods? This too would be a system of incentives (or disincentives) helping the consumer to make a behavioral commitment. Perhaps, employees or students could opt into (or out of) a program that allows them to purchase items low on the food pyramid at significant cost savings, but items higher on the pyramid at a premium price; thus, creating a self-control strategy for future behaviors by increasing incentives for healthy eating (Thaler and Sunstein 2008). The idea is to create programs in which the consumer freely agrees to participate knowing that these strategies are designed to help maintain consumer motivation over time.

Controversial? Of course. Deserving exploration and testing? Definitely. A direct examination of the efficacy of changing incentives versus more traditional information-based methods of encouraging and supporting changes in health behaviors, examination of consumer reactions to these incentives and theoretical guidance for designing incentive programs could prove both intellectually rewarding and result in better health among consumers.

“WE ARE JUST IN DIFFERENT PLACES”

  1. Top of page
  2. Abstract
  3. “IT'S NOT YOU; IT'S ME”
  4. “DUMP THE CHUMP”
  5. “THERE ARE TOO MANY LIES BETWEEN US,” AND ITS COROLLARY, “YOU'VE CHANGED”
  6. “TIME HEALS ALL WOUNDS”
  7. “I LOVE YOU, BUT I CAN'T COMMIT”
  8. “WE ARE JUST IN DIFFERENT PLACES”
  9. “MAYBE IT IS YOU”
  10. “BREAKING UP IS HARD TO DO”
  11. REFERENCES

A great deal of research in the food science literature suggests that the context in which a decision is made impacts that decision (e.g., Ahlgren, Gustafsson, and Hall 2005; Cardello et al. 2000). Research reveals that not only do the situation and other social factors impact decisions but also the context in which information is presented impacts how that information is perceived and used. For example, Hwang and Lorenzen (2008) show that presenting nutritional information regarding restaurant menu items increases the chance of healthier selections. However, this effect is impacted by the format in which the menu item's nutrition information is presented (Burton and Creyer 2004).

Additional research has demonstrated that the individual differences (e.g., knowledge, emotion, relevance) one brings into the situation also impact how one processes information and makes decisions. For instance, Kemp et al. 2007 show that processing of nutrition information is moderated by motivation level (possibly due to a health related condition, weight loss desires, etc.) such that increased motivation increases processing. The individual's emotional state also impacts his/her ability to process information. Research in the area of risk communication demonstrates that heightened emotional states negatively impact one's ability to process information (Finucane 2008). Specifically a positive emotional state increases optimism whereas a negative state increases pessimism with respect to information processing (Walters 2008). Indeed, this effect is discussed in Blink, by Malcolm Gladwell 2005—heightened emotion decreases our ability to accurately process information. Moreover, cancer patients are frequently instructed to have someone at the doctor's office with them when treatment options are presented—physicians know that the patient's heightened emotional state will impact their ability to comprehend the information that is being presented.

“MAYBE IT IS YOU”

  1. Top of page
  2. Abstract
  3. “IT'S NOT YOU; IT'S ME”
  4. “DUMP THE CHUMP”
  5. “THERE ARE TOO MANY LIES BETWEEN US,” AND ITS COROLLARY, “YOU'VE CHANGED”
  6. “TIME HEALS ALL WOUNDS”
  7. “I LOVE YOU, BUT I CAN'T COMMIT”
  8. “WE ARE JUST IN DIFFERENT PLACES”
  9. “MAYBE IT IS YOU”
  10. “BREAKING UP IS HARD TO DO”
  11. REFERENCES

As in most relationships, it is difficult to place 100% of the blame for the break-up on one party… so consumer, maybe, it is you, at least a little bit. We must face the fact that consumers are human; they are prone to take the path of least resistance; they have limitations in abilities and resources; and, sometimes, simply do not have the need or the motivation. In some of these cases, health care researchers and practitioners are able to meet the consumer more than half way once they are aware of the shortcomings. In other cases, the consumer learns to compensate, and still in others, the consumer must “man-up,” to use current terminology, and take responsibility for actions.

Many health-based prevention behaviors require effort and are often unpleasant. The path of least resistance is tempting in these situations. Yet, once the consumer has overcome the initial resistance, it would seem that the positive, preventive behavior would continue. Kahn and Luce (2006) suggest that this is often not the case. Consumers tend to “fall off the wagon” regarding preventive behaviors because they are a hassle. These researchers offer a “Repeated-Adherence Protection Model” which assumes that the consumer understands the benefits of a particular preventive practice, but fails to consistently engage in the practice. The focus of this model is motivating repeated behaviors among the consumers who have, at least on occasion, engaged in the prevention technique. They provide a number of possible strategies which examine the impact of negative feedback (e.g., blood test was negative, so why bother to do it again), emotional reactions (i.e., relief that one is well when a skin test is negative) and behavioral strategies (encourage on-time mammograms yearly).

Think about how this approach could be applied to current issues. For instance, behavioral strategies, as opposed to education strategies, could become the focus of HPV vaccine campaigns, as their effectiveness depends on completing the three shot series spaced at two and then four months. HPV vaccines could be offered at local high schools in September, again in November, and then finally in March to increase the chances of young women completing the series. Rewards (such as drawings for pedicures) could be offered. The relative effectiveness, in terms of the number of completed vaccination series, and costs associated with a completed series, of this behavior approach could be directly measured. Repeated-Adherence Protection Model provides fresh thinking, yet is untested empirically. It offers opportunities for creative thinking and study for researchers as well as practitioners. It also leads us to examine other questions of import, such as willingness of corporate sponsorship to participate in behavioral as opposed to informational campaigns and the differential impact of targeting those with a basic understanding of the benefits of prevention versus those without such knowledge.

Many consumers are also operating under resource and ability constraints. About forty-five million Americans do not have health insurance (U.S. Census 2008), a situation which may influence the consumer's consideration of the costs versus benefits of certain expensive preventative health care procedures. Almost 20% of Americans perform at the lowest levels of health literacy with very limited skill and significant difficulty in performing simple tasks such as determining how often a medication should be taken (Educational Testing Service 2004). While low functional health literacy scores are often identified as a problem to be “fixed,”Adkins and Corus (2009) offer a broader examination of health literacy that includes the consumers’ ability to use other personal and social resources to improve their health. Adkins and Corus propose that health care providers should optimize a match between low-literate consumers’ strategies for improving health and the health care providers’ options to give assistance to the consumers on the basis of the power relationship, as defined by the consumers, between consumers and providers. They offer a theoretical advance which leads to actionable ideas for improving health.

Finally, we turn to the issue of motivation and consumer responsibilities. Bates et al. 2009 empirically show that motivation matters, as it increases the effectiveness of health information. Unfortunately, we must also realize that the consumers often lack motivation or fail to see the need to use information or engage in health-enhancing behaviors. The same as in other areas of consumer self-protection, some people are simply not interested in looking for information they are fully capable of understanding (e.g., see Rotfeld 2008).

For example, West Virginia has recently implemented a wellness-based option for the state Medicaid program which covers smoking cessation and nutrition counseling, and encourages annual checkups with a primary care physician. The take-up rate has been disappointing to many consumer advocacy groups; yet, it is likely that a nonsmoking young male with an average BMI would see little need to join such a program—he perceives he does not need the services.

What if the services were promoted as preventive, rather than curative? If science shows improved health outcomes for engaging in a practice (i.e., cardiovascular workout at a gym three times a week) or refraining from a behavior (i.e., no smoking) and the consumer fails to take actions to promote his/her health, perhaps the consequences of these actions should be placed more on the consumer.

Many health insurers provide a nonsmoking discount; perhaps insurance rates could be cut for consumers who regularly receive preventive procedures (such as annual blood tests) or who participate in exercise or diet programs. Alternatively, insurance premiums could be increased when consumers fail to participate in prevention activities known to reduce overall health care costs. Specifically, tobacco users could be charged a tobacco-user fee, rather than nonsmokers given a discount. While the goal is the same (reducing smoking rates and improving health), in the first instance the cost difference is framed as a loss, while in the latter it is framed as a gain. Theory suggests that losses are more heavily weighted than gains and thus, are more likely to influence behavior. While perhaps controversial, such a program would more clearly place the responsibility for an individual's health on the individual. It also provides numerous research questions regarding consumer perceptions of direct consequences of healthy or unhealthy practices, examining a system of explicit loss and gain scenarios to determine which are most palatable as well as most effective, and examining the potentially synergistic effects of enhancing responsibility, providing feedback with regard to the consumer's progress, and creating ties between corporate wellness programs and health outcomes.

“BREAKING UP IS HARD TO DO”

  1. Top of page
  2. Abstract
  3. “IT'S NOT YOU; IT'S ME”
  4. “DUMP THE CHUMP”
  5. “THERE ARE TOO MANY LIES BETWEEN US,” AND ITS COROLLARY, “YOU'VE CHANGED”
  6. “TIME HEALS ALL WOUNDS”
  7. “I LOVE YOU, BUT I CAN'T COMMIT”
  8. “WE ARE JUST IN DIFFERENT PLACES”
  9. “MAYBE IT IS YOU”
  10. “BREAKING UP IS HARD TO DO”
  11. REFERENCES

Through diligence, health care professionals and researchers can make the path toward greater health literacy easier to travel and therefore, more likely to be traveled. Only through a better understanding of the obstacles to health literacy and an acknowledgment that many of our current practices are not working as intended can we move forward. Fresh ideas and alternatives need to be explored in order to increase literacy and subsequently impact behavior.

REFERENCES

  1. Top of page
  2. Abstract
  3. “IT'S NOT YOU; IT'S ME”
  4. “DUMP THE CHUMP”
  5. “THERE ARE TOO MANY LIES BETWEEN US,” AND ITS COROLLARY, “YOU'VE CHANGED”
  6. “TIME HEALS ALL WOUNDS”
  7. “I LOVE YOU, BUT I CAN'T COMMIT”
  8. “WE ARE JUST IN DIFFERENT PLACES”
  9. “MAYBE IT IS YOU”
  10. “BREAKING UP IS HARD TO DO”
  11. REFERENCES