Category: Health Communication

Improving Patient-Provider Communication: Meet Crystal Bentley

Last week, Crystal Bentley, RN, second-year Master of Public Health student in the UNC Gillings School, joined our class to share with us her interests and work in health communication.

Crystal is currently a research assistant in the Community Engagement, AHEC, and Outreach Services department of the UNC Health Sciences Library where she is developing provider-facing health literacy training modules. The goal of her work is to improve patient-provider communication and patient knowledge.

This is not a recent interest of hers, however. Crystal spent the past six years working as a registered nurse in the areas of emergency medicine, public health, and collegiate campus health prior to beginning her graduate program. These experiences are what sparked her interest in patient-provider communication, patient advocacy, and shared decision making. In her daily interactions with patients, Crystal would often see a disconnect between the way patients and providers would communicate and interact with each other in the clinical setting. It was not long until she discovered her calling was to help bridge this gap within patient-provider sphere.

Some of the key takeaways from Crystal’s talk were that lack of health literacy can have both important health and financial implications. She also described the important of using plain language and being mindful of cultural sensitivity when developing health communication materials for different audiences.

Crystal Bentley is a second-year Master of Public Health student in the Department of Health Behavior at the Gillings School of Global Public Health at the University of North Carolina at Chapel Hill. She is also an Interdisciplinary Health Communication scholar, and will be completing her certificate next semester along with her degree program.

What are your thoughts on health literacy? What do you feel are important components of good patient-provider interaction and communication? Let us know in the comments below!

FDA Expands HPV Vaccine for People Ages 27 to 45

Earlier last month, the FDA announced it has approved Gardasil 9, a vaccine for Human Papillomavirus (HPV) for people between the ages of 27 and 45. Previously, the FDA approved the HPV vaccine for individuals aged 9 through 26 years.

Gardasil 9 protects against nine types of HPV, a virus that is transmitted sexually and through intimate skin-to-skin contact. HPV is a very common virus and many individuals will get it at some point in their lives. While most HPV infections go away on their own, some may stick around and cause genital warts and cancer. This may be cancer of the cervix, vulva, vagina, penis, or anus, as well as cancer of the back of the throat.

It is recommended that all children aged 11 or 12 receive the HPV vaccine series. The vaccine is most effective at this age, before children are exposed to HPV.

Still, however, individuals up to age 45 years can now get the HPV vaccine. Older individuals can protect themselves against nine types of HPV. And even if one has been exposed to a few types, the vaccine will protect against the other strains they have not been exposed to.

HPV vaccination is cancer prevention. Why not consider protecting yourself?

For more information, check out the following Centers for Disease Control and Prevention resources:

What is HPV? 

HPV and Cancer

HPV Cancer Screening

References

Centers for Disease Control and Prevention. (2018, August 23). Human Papillomavirus: Questions and Answers. Retrieved from https://www.cdc.gov/hpv/parents/questions-answers.html

Centers for Disease Control and Prevention. (2016, December13). What is HPV? https://www.cdc.gov/hpv/parents/whatishpv.html

U.S. Food & Drug Administration. (2018, October 9). FDA approves expanded use of Gardasil 9 to include individuals 27 through 45 years old. Retrieved from

https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/UCM622715.htm?utm_campaign=10052018_PR_FDA%20approves%20expanded%20use%20of%20Gardasil%209%20to%20include%20individuals%2027%20through%2045%20years%20old

Grady, D & Hoffman, J. (2018, October 5). HPV Vaccine Expanded or People Ages 27 to 45. Retrieved from https://www.nytimes.com/2018/10/05/health/hpv-virus-vaccine-cancer.html

October is Health Literacy Month!

Founded in 1999 by Helen Osborne, Health Literacy Month is all about promoting understandable health information. This information is critical in order for individuals to make appropriate health decisions.

Health literacy is the ability to obtain, process, and understand basic health information and services. This includes reading, writing, and numeracy of health information. Sometimes, health information can be difficult to understand and communicate among different audiences. This can make navigating the healthcare system challenging.

According to the U.S. Department of Health and Human Services, 77 million U.S. adults have basic or below basic health literacy. Low health literacy can lead to poor health outcomes, such low uptake of preventive health services and/or greater use of treatment health services. This can lead to high healthcare costs.

There are many factors that can affect health literacy. Some of these factors include: education, age, language, and culture. Culture can play a key role in how one understands and responds to health information. Culture involves certain beliefs, values, communication styles that all can affect how one processes health information. Therefore, it is important that health information is communicated in a way that is culturally appropriate for the individual or audience.

One key setting for health literacy is that of patient and health care providers. Patients may have difficulty understanding complex medical information, while providers may have difficulty communicating complex medical information. It is important for providers and patients to work together in order to ensure that health information is understood and communicated effectively, so that the best health care decisions are made for the patient.

Interested in learning more about health literacy? Check out the following resources from the Centers for Disease Control and Prevention:

Additional resources from the U.S. Department of Health and Human Services:

References:

Kindig, D. A., Panzer, A. M., & Nielsen-Bohlman, L. (Eds.). (2004). Health literacy: a prescription to end confusion. National Academies Press.

National Institutes of Health. (2017, May 31). Health Literacy. Retrieved from https://www.nih.gov/institutes-nih/nih-office-director/office-communications-public-liaison/clear-communication/health-literacy

U.S. Department of Health and Human Services. (2008). America’s Health Literacy: Why We Need Accessible Health Information. Retrieved from https://health.gov/communication/literacy/issuebrief/

U.S. Department of Health and Human Services.  (N.d.). Quick Guide to Health Literacy: Fact Sheet – Health Literacy Basics. Retrieved from https://health.gov/communication/literacy/quickguide/factsbasic.htm

U.S. Department of Health and Human Services.  (N.d.). Quick Guide to Health Literacy: Fact Sheet – Health Literacy and Health Outcomes. Retrieved from https://health.gov/communication/literacy/quickguide/factsbasic.htm
U.S. National Library of Medicine. (N.d.). Health Literacy: Definition. Retrieved from https://nnlm.gov/initiatives/topics/health-literacy

Dr. Leana Wen Selected as New President of Planned Parenthood

Last week, it was announced that Dr. Leana Wen, Baltimore City Health Commissioner, will serve as the new president of Planned Parenthood Federation of America, an organization that provides vital sexual and reproductive health care and education to millions of people around the world. Dr. Wen will be the first physician in almost 50 years to serve in this role. She will succeed Cecile Richards, who has served as president of Planned Parenthood for the past 12 years.

Dr. Wen, an emergency medicine physician, has led the Baltimore City Health Department since January 2015. She is a passionate public health leader and active champion for communities and patients. During her tenure as Baltimore City Health Commissioner, Dr. Wen led a lawsuit against the Trump administration after its abrupt decision to cut funding for teen pregnancy prevention programs, resulting in $5 million of funding being restored to two of these programs in Baltimore. Additionally, Dr. Wen has fought to preserve Title X in Baltimore, which funds a variety of health care services for low-income women.

Dr. Wen is no stranger to Planned Parenthood. After she and her family immigrated to the U.S. from China, they depended on Planned Parenthood for their health care. Dr. Wen also volunteered at a Planned Parenthood health center in St. Louis during medical school.

In a recent statement posted on the Baltimore City Health Department website, Dr. Wen wrote:

“A core principle in public health is to go where the need is. The single biggest public health catastrophe of our time is the threat to women’s health and the health of our most vulnerable communities.”

She continues, in referring to Planned Parenthood, writing:

“I have seen firsthand the lifesaving work it does for our most vulnerable communities. As a doctor, I will ensure we continue to provide high-quality health care, including the full range of reproductive care, and will fight to protect the access of millions of patients who rely on Planned Parenthood.”

Dr. Wen’s last day as Baltimore City Health Commissioner will be Friday, October 12th, where she will then begin her new role as President of Planned Parenthood.

References:

Planned Parenthood. (N.d.). Dr. Leana Wen. Retrieved from  https://www.plannedparenthood.org/about-us/our-leadership/dr-leana-wen

Planned Parenthood. (N.d.). Cecile Richards. Retrieved from  https://www.plannedparenthood.org/about-us/our-leadership/cecile-richards

Zernike, Kate. (2018, September 12). Planned Parenthood Names Leana Wen, a Doctor, Its New President. Retrieved from https://www.nytimes.com/2018/09/12/us/politics/planned-parenthood-president-wen.html?rref=collection%2Fsectioncollection%2Fpolitics

Wen, Leana S. (2018, July 6). Trump’s family planning dystopia. Retrieved from http://www.baltimoresun.com/news/opinion/oped/bs-ed-op-0708-wen-dystopia-20180703-story.html

Baltimore City Health Department. (2018, September 12). Statement from Baltimore City Health Commissioner, Dr. Leana Wen. Retrieved from https://health.baltimorecity.gov/news/press-releases/2018-09-12-statement-baltimore-city-health-commissioner-dr-leana-wen

Dr Lisa on the Streets: An approach to improve health literacy

Health literacy has become a buzzword not only in the public health world but in general. As the technologies, treatments and advancements are improving the quality of medicine, the way that these new discoveries are communicated are not. One physician and public health professional has made it her mission to increase the awareness of the health literacy crisis here in the United States by taking it to who it affects the most, Americans. She has launched a “Dr. Lisa on the Streets” campaign to increase awareness and gather support to improve the way health information is communicated. In her TedX talk “Are you confused about health information? You’re not alone” she discusses the economic consequences of low health literacy and how as a nation we can attempt to improve this. She refers to the “grapevine” (casual conversations, internet etc.) as one of the most powerful educators and needing to capitalize on this as a means of sharing health information.

Here are few strategies mentioned in the video about improving health literacy:

  • Manage the grapevine, it’s like ivy if it isn’t maintained it will get out of control
    • Need grapevine to counteract misinformation through verification before spreading information
  • Doctors need to embrace technology
    • Change is inspired by the masses
  • Health literacy is up to you!
    • Avoid gaps in care
    • Find your provider
    • Be persistent

To learn more about this movement and health literacy watch the full TedX talk: https://www.youtube.com/watch?v=-x6DLqtaK2g

Health Orientations for New Patients

Orientations for new patients are one technique for setting the stage for positive patient experiences with a new clinic, especially for those who are unfamiliar with the healthcare system. These orientations have been shown to be successful in reducing stress for cancer patients, preparing patients for beginning psychotherapy, and reducing no-show appointments in a primary care setting, which improves clinic efficiency.

As the Patient Navigator at a Federally-Qualified Health Center (FQHC) from 2016 to 2017, I was tasked with creating this type of program for immigrant and refugee patients, whose cultural differences and unfamiliarity with the American healthcare system often serve as a barrier to successful clinic interactions. From speaking to clinic providers on various levels, as well as patients from refugee communities, I established the following priorities for the orientation curriculum:

  1. Prescription refill process
  2. Calls to our clinic – what to expect, how to request an interpreter, how to speak to a nurse
  3. Difference between preventative and acute care, and emergencies, and benefits of seeing your provider at least once a year
  4. How to make and cancel appointments, and why no-shows reduce our efficiency
  5. Different occupations that clinic staff hold, and how staff can connect patients to other resources they may need
  6. General information about the American healthcare system that may be confusing, such as insurance coverage and social services application processes
  7. Patient rights and responsibilities
  8. Interactions with providers – letting patients know that they can and should ask questions when confused, or when misunderstood by an interpreter or provider

I quickly found that creating a curriculum like this presents several challenges. For example, “refugees and immigrants” is a broad group of people, representing those from wildly different education levels and familiarity with Western healthcare systems. Many times, it was impossible to know patients’ backgrounds before meeting with them to discuss our clinic. I had to be careful to be informational without seeming patronizing, while basing communication strategy on the perceived level of understanding of the patient, which can also be influenced by cultural norms.

Patient orientations have a great potential to reduce patient stress, improve understanding of clinic operations, and give the power back to the patient when it comes to their own health. However, cultural differences must be given weight when developing this type of program. Using community leaders or liaisons for curriculum development and delivery may be a way to bridge that gap.

Sources:

https://onlinelibrary.wiley.com/doi/abs/10.1002/(SICI)1099-1611(199805/06)7:3%3C207::AID-PON304%3E3.0.CO;2-T

https://onlinelibrary.wiley.com/doi/abs/10.1002/1097-4679(198311)39:6%3C872::AID-JCLP2270390610%3E3.0.CO;2-X

https://onlinelibrary.wiley.com/doi/full/10.1046/j.1525-1497.2000.00201.x

https://www.sciencedirect.com/science/article/pii/S0277953610003199

Using Oral History in Public Health

Public health prides itself on being interdisciplinary – but there’s always more to learn. I recently discovered a field of study whose department at UNC was looking to collaborate with public health students. This discipline is called oral history, and the Southern Oral History Program at UNC is a pioneer in its field.

Oral history works to preserve narratives by interviewing, recording, and archiving life stories. The narrator is often from a part of society whose voices have been silenced, and wants to contribute his or her life story to historical archives. For this reason, unlike with traditional qualitative interviews in public health, the narrator’s identifying information is often attached to his or her story. When oral historians use life stories in their research, the narrators play an important role in ensuring that their stories are portrayed accurately. They also receive a copy of their interview, preserved in a written format, for themselves and future generations.

Oral history would be especially useful in conducting public health needs assessments, seeking community expertise for solving a local health problem, finding more robust quotes for supporting policy movements, or discovering the experiences of living through a particular outbreak or natural disaster. Public health research already uses qualitative interviewing techniques, but could greatly benefit from more collaboration with oral historians. We traditionally go into interviews with pre-established questions about specific health topics. We may get some background of the participant’s life, but hearing this as a narrative rather than a response could help us build a deeper understanding of the person sitting across from us.

Sources:

http://www.oralhistory.org/

www.sohp.org

App Grindr under scrutiny over privacy concerns

In an article published yesterday by BuzzFeed News, it was released that Gay Dating App Grindr has been sharing its users’ HIV status with two outside companies, a move which many consider dangerous to the queer community that the app claims to serve.

The sites, Apptimize and Localytics, work with Grindr to optimize the app and user experience. While it has been noted that these companies do not share information with third parties, there are still concerns with the sharing of sensitive information of a historically vulnerable population. This could raise flags for users sharing their HIV status on the app, which could negatively impact public health interventions that work to reduce HIV transmission and stigma.

Grindr recently announced that they would remind users to get tested for HIV every three to six months, offering a cue to action for users to be more aware of their HIV status. Knowing ones status is a crucial component for reducing the number of new HIV infections, such as by offering the opportunity to those who are living with HIV to be connected to care and achieve viral suppression.

 

Sources:

BuzzFeed News: Grindr Is Sharing The HIV Status Of Its Users With Other Companies –https://www.buzzfeed.com/azeenghorayshi/grindr-hiv-status-privacy?bfsplash&utm_term=.eu9v16ZaQ#.akvOQgNJj

Stethoscopes and Smartphones? How Doctors are Using mHealth Apps for Patient Care

By Elizabeth Adams, MA

There was a time when doctors circulated the hallways of hospitals with nothing but a beeper pinned to the waistline of their scrubs.

But today, you might notice your doctor enter the exam room clutching a more advanced communication device – a Smartphone or tablet. A 2014 survey reported that 85% of medical faculty, 90% of medical residents, and 85% of medical students used a Smartphone in a clinical setting1. Modern doctors are increasingly replacing laptops or desktops with Smartphones and tablets2.

Doctors are constantly on their feet, moving throughout hospitals, emergency rooms, or clinics.  They use these devices for variety of job-related tasks, including remote patient monitoring, electronic health record access, e-prescribing, drug reference calculations, reading medical news, and decision-making support3. Now there is a marketplace for health professionals to locate apps designed specifically for clinical practice. In 2011, the iPhone App Store introduced the “Apps for Health Care Professionals” section, which has expanded to include more than 80 app options4.

Here are a few ways doctors are using apps to improve patient care:

 Retrieving Information. Doctors increasingly rely on mhealth to inform complex clinical assessments and decisions. One survey indicated that two-thirds of doctors use medication-interaction assistance apps to aid in the prescription decision-making process5. In addition, medical residents rely on mobile phones in clinical consultation to look up drug information, perform clinical calculations, take notes, or look up clinical guidelines4. Instantaneous access to information can help doctors and trainees make more accurate decisions regarding treatment.

 Communicating with Patients. Electronic health record software, such as Epic (link to: https://www.inova.org/for-physicians/epiccare-apps) – the program used by UNC HealthCare – incorporate apps Haiku and Canto, which facilitate direct correspondence between patients and health care teams. Other third-party apps, such as OhMD (link to: https://www.ohmd.com), TigerText (link to: https://www.tigertext.com/), and Hale (link to: http://hale.co/), are compatible with electronic health record programs and connect patients to doctors through text messaging platforms.

Continuing Education. Mobile continuing education curricula promises to supply doctors and trainees with current medical information and impart recent standards of practice without the time-consuming requirement of sitting at a desktop or in a classroom. In addition, top-tier medical journals, including the New England Journal of Medicine’s This Week app (link to: http://www.nejm.org/doi/full/10.1056/NEJMe1201837) and the American Medical Association’s CPT QuickRef app (link to: https://www.ama-assn.org/practice-management/applying-cpt-codes), deliver scientific articles and guidelines.

 More research is necessary to understand the relationship between mhealth app adoption and improved clinical care outcomes. Smartphones could be considered impediments to patient care, so they must be used with some discretion. But next time your doctor walks in with a tablet or glances at a Smartphone, remember that he or she might be using an app to make better decisions for your health.

References

  1. Ventola, C. Lee. “Mobile Devices and Apps for Health Care Professionals: Uses and Benefits.” Pharmacy and Therapeutics5 (2014): 356–364.
  2. Murfin, M. Know your apps: an evidence-based approach to evaluation of mobile clinical applications. Journal of Physician Assist Education. 2013; 24(3):38-40.
  3. Kaufman, Michele B,PharmD., R.Ph. “Mobile Health Increases as Physicians Seek New Ways to Manage Patients.”Formulary, vol. 47, no. 4, 2012, pp. 161-162, ProQuest, http://libproxy.lib.unc.edu/login?url=https://search-proquest-com.libproxy.lib.unc.edu/docview/1145903653?accountid=14244.
  4. Dolan, B. Apple’s Top 80 Apps for Doctors, Nurses, and Patients. [Online] November 27, 2012. http://www.mobihealthnews.com/19206/apples-top-80-apps-for-doctors-nurses-patients/
  5. Boruff, J. T. M., & Storie, D. M. M. A. Mobile devices in medicine: a survey of how medical students, residents, and faculty use smartphones and other mobile devices to find information. Journal of the Medical Library Association, (2014): 102(1), 22-30.

What’s going on with the HPV vaccine?

HPV is the most common STI, and 9 of every 10 people will have an infection at some point in their lives (1).  This virus can cause cancers in the cervix, penis, mouth, and oropharynx (2), and it also causes genital warts (3).  Even though a vaccine exists against HPV, less than half of teens are up to date on all of their doses of these shots (2).

Part of the reason behind these low vaccination rates are due to parents concerns regarding vaccine safety and fear that vaccination will encourage sexual activity (4).  Though all vaccines, including this one, have potential side effects, the HPV vaccine is considered safe (4). Additionally, studies have shown that the HPV vaccine does not make teens more likely to start having sex (4).

The way providers approach talking about the HPV has also influenced vaccine rates, and strong provider endorsement seems to improve vaccinations (5).  On Monday, March 19, Chris Noronha spoke with the Interdisciplinary Health Communications Class about the work he is doing with Noel Brewer on provider communication regarding the HPV vaccine.  They have found that when providers mention the HPV vaccine in the same list as other vaccines that are due at age 11, vaccination rates increase.

If you’re interested in the HPV vaccine, it may not be too late.  You can receive the series through age 26 (1).  Contact your provider if you’re interested.

 

Works Cited
  1. Centers for Disease Control and Prevention. Human Papillomavirus (HPV) Vaccine Safety. Centers for Disease Control and Prevention. [Online] January 30, 2018. https://www.cdc.gov/vaccinesafety/vaccines/hpv-vaccine.html.
  2. Aubrey, Allison. This Vaccine Can Prevent Cancer, But Many Teenagers Still Don’t Get It. National Public Radio. [Online] February 19, 2018. https://www.npr.org/sections/health-shots/2018/02/19/586494027/this-vaccine-can-prevent-cancer-but-many-teenagers-still-dont-get-it.
  3. Centers for Disease Control and Prevention. What is HPV. Centers for Disease Control and Prevention. [Online] December 20, 2016. https://www.cdc.gov/hpv/parents/whatishpv.html.
  4. —. Talking to Parents About HPV vaccine. Centers for Disease Control and Prevention. [Online] December 2016. https://www.cdc.gov/hpv/hcp/for-hcp-tipsheet-hpv.pdf.
  5. Narula, Tara. HPV vaccine: Why aren’t children getting it? CBS News. [Online] July 23, 2017. https://www.cbsnews.com/news/hpv-vaccination-cancer-prevention-dr-tara-narula/.