Helen Osborne: Welcome to Health Literacy Out Loud. I’m Helen Osborne, President of Health Literacy Consulting, founder of Health Literacy Month and your host of Health Literacy Out Loud.

In these podcasts, you get to listen in on some really amazing conversations with remarkable people, talking about what health literacy is, why it matters and ways all of us can help improve health understanding.

Today, I’m talking with Michele Erikson, who’s been involved with adult literacy for many years. She started as a volunteer literacy tutor and now serves as Executive Director of Wisconsin Literacy, Inc.

One of Michele’s many accomplishments is overseeing Wisconsin Literacy’s Health Literacy Division that not only hosts national health literacy summits but also works closely with adult learners and healthcare professionals to ensure that health information is communicated in ways everyone can understand.

I have known Michele as a colleague for many years and I’m a huge fan of how she brings together the concepts of literacy and health literacy.

Welcome, Michele.

Michele Erikson: Thank you, Helen. I’m really happy to be involved in this.

Helen Osborne: We’re happy to have you on the podcast, too. Your life started in the world of literacy. Put that into context for us. When we say “literacy,” what does that really mean?

Michele Erikson: There are many definitions, but in its simplest form I sometimes call it a decoding skill. It’s really the ability to use printed and written information to function in society, to achieve one’s goals or develop one’s knowledge.

It also goes beyond that. It can really involve a much broader sense of where you are in the context of the world around you.

Helen Osborne: Do you mean being able to use the written word?

Michele Erikson: Exactly. It’s expressing ideas and opinions, making decisions and solving problems as a family member, worker, citizen and lifelong learner.

Helen Osborne: That’s not just a matter of reading. It sounds like that’s broader than just looking at printed words.

Michele Erikson: Certainly. You can put literacy in cultural, political and historical context, so it becomes a very broad skill with the foundational piece being that decoding of printed or written information.

Helen Osborne: Explain what that word decoding is. I’ve heard it so many times. Tell us all who may not be literacy professionals. What does that term mean?

Michele Erikson: Decoding can mean a lot of different things, but learning to read builds confidence and hope, and this leads to independence.

Our brains are hardwired for speaking, but reading is an acquired skill that really must be explicitly taught. It’s identifying separate speech sounds within a word and then learning how these letters represent those sounds.

Helen Osborne: That’s decoding?

Michele Erikson: Correct.

Helen Osborne: Thank you. I know people at various stages of life may have difficulty. One of my heroes I refer to is Archie Willard, who told me that he never learned to read until he was 54 years old. Why do people struggle learning to read?

Michele Erikson: There are so many answers to that question.

Helen Osborne: Give us a few.

Michele Erikson: A lot of times, it starts very young at birth, where that building of those skills is not given to a child. A lot of times, parents don’t realize the importance of oral literacy where we’re just orally communicating.

A lot of studies have been done on early brain development. The synapses and things that occur in a baby’s brain at the earliest of stages are really quite remarkable.

They’re happening constantly all the time, but they are a reaction to stimulation from outside. When a child isn’t spoken to or engaged in oral literacy from the very early years, those circuits and connections aren’t being made quite as frequently as they are with other kids whose parents might be talking to them, singing, reading and engaging them.

Helen Osborne: It’s something a person can be born with, having trouble with this or something from parenting that happens in those early, wonderful learning years.

I remember Archie told me that he has severe dyslexia, but he didn’t know that until later in life. Is that another reason people can struggle?

Michele Erikson: Absolutely. That’s a really prominent reason and those learning disabilities are often undetected.

Imagine a teacher with a roomful of children in a classroom of 25 or 30 and you have a quiet, well-behaved kid that just is not able to decode like that has a learning disability. Those can be undetected for quite a long period of time.

There are certainly skills that learners can use to overcome those barriers, but they have to be taught.

Helen Osborne: People can be at various stages. I know that there is a saying and a video from the American Medical Association about literacy and health literacy and it says, “You can’t always tell by looking.” Is that the same for people who struggle to read?”

Michele Erikson: Absolutely. We use that same phrase a lot.

There are a lot of people that have this secret that they keep with them for a long time. Normally, people learn to read in 1^st, 2^nd, or 3^rd grade. If you’re an adult and don’t have that skill yet, it’s not something you’re really anxious to share with many people at all.

There are a great percentage of nonreaders who don’t share that with some of the people closest to them, so you can be very close to a person and not know that reading and writing is a tremendous challenge for them.

Helen Osborne: Thank you for talking about that secrecy there. I’ve heard the term shame too and that bridges to the health literacy world that I know a whole lot about.

Should we as clinicians find out that reading is a problem or is that something that we shouldn’t deal with right now? We have an acute medical problem we’re dealing with and we have to build relationships.

Michele Erikson: I think that from a person’s perspective the doctor’s office is a difficult place in and of itself in terms of how comfortable someone may feel.

Having a literacy test or some kind of assessment there I think is a great challenge for people who are uncomfortable from the get-go, but you can start conversations.

You can ask people, “How do you learn best? How can I present this information to you in a way that will make it the easiest to understand? Is that if I jot something down? Are you a visual learner? Do you want to talk about it a little bit more?”

Asking people how they learn best is one way that communication can happen.

Helen Osborne: Thank you so much for giving us an alternative. I’m fully with you in that those assessment tools may be needed for research, but as a practitioner myself and someone who used to be in practice, I can’t see that the clinic is the place to start that very difficult conversation.

I very much like what you offered by asking, “How can we best teach this? What would you want me to do, talk about it with you, show you or go over the materials together?” and making it real in that person’s world. Thanks for helping us figure out about that.

A lot of our listeners are clinicians, public health people, health educators, writers or people somehow on the communicating end of health. What are strategies you would like us to know and do to make it better so health information is really understood by everyone?

Michele Erikson: There are a lot of different strategies, and your podcasts have gone over many of those.

Teachback is the first one, of course, that comes to mind. That is an expansion of what I just mentioned about asking people about the best way that they learn.

That strategy certainly allows for the provider and the patient to make sure they both understood each other if the patient can reiterate back what the provider has told them.

Helen Osborne: You really are a fan of teach-back. That is such a consistent recommendation. I hear that over and over, so thank you for reinforcing it.

What else can we be doing? So much of health information is either written or spoken.

Michele Erikson: Certainly assessing what it looks like in oral communication and written communication to patients and making sure that health materials are written at a very basic level.

There are really good examples of things that can be written at a level where everybody can understand. I think that even people that read at higher levels appreciate the ease in which that material is delivered.

Helen Osborne: Can I do a little detour? I want to ask you about that level because over and over again I hear people say, “It needs to be at X grade level.” Honestly, I’m not a fan of that, but are you?

Michele Erikson: I think there are just certain benchmarks that people can keep in mind. More important than the grade level are those things like the font and how much white space there is. Is it pleasing to the eye, are there a lot of multi-syllable words that are used and those kinds of things.

I think paying attention to those details in particular can help you get it to a level that makes it much easier to read for everybody involved.

When it’s health information and complicated, it’s all that much more important, I think, to keep it at a fairly simple level.

Helen Osborne: Thanks for that. What else can we do?

Michele Erikson: I think, again, it’s making sure that the patient feels comfortable having those conversations and approaching the encounter as a team approach and shared decision making sure that it’s not a one-way conversation and the patient feels they’re part of working on a health solution.

Helen Osborne: The principles you’re talking about, the team, collaboration, communicating clearly and the teach-back, are all what I know of as health literacy principles. I know your world started in a large part in the literacy principles.

Sometimes I see those two concepts getting tangled up together. Are they the same or are there important distinctions between literacy and health literacy?

Michele Erikson: They’re very similar. Health literacy, also like literacy, is the use of a wide range of skills that allows people to act on the information that they’ve just heard. In health, of course, it’s focused on that information to be used in order to live a healthier life.

Just like we talked about the literacy definition earlier, those skills are used to express ideas and opinions, make decisions and solve problems. In that way, they’re very similar.

I see literacy as a much broader skill because it’s used within everyday context where health literacy is really focused more in a health context.

Helen Osborne: Thank you. I just hope for listeners, and this is my bias, that we make clear that distinction that health literacy might be literacy or good communication in a health context where literacy is a broader array of skills, and they’re not the same thing.

Michele Erikson: They’re not the same thing, but very similar. Things like listening, speaking, numeracy and critical analysis are all really important communication and interaction skills and they’re needed both within the health setting as well as within our everyday life.

Helen Osborne: Thank you for making sense about how these interlocking and overlapping pieces come together.

As far as learning more for our listeners, I know that Wisconsin Literacy does wonderful work with your Health Literacy Summits. How can people find you?

Michele Erikson: You can find us as www.WisconsinLiteracy.org. There, you’ll find our website actually can veer off into the health literacy division. Up at the right-hand corner there will be a health literacy link.

All of our former summits are available through our website, so you’ll get to hear wonderful presentations, a lot of the PowerPoints and also a lot of the plenary speakers are webcasted.

Helen Osborne: Thank you. You’re actually embodying the principles you’re talking about, about communicating in all those ways when you have the videos, the PowerPoint, the words and the links.

Thank you, Michele, for all you are doing to be such a leader and champion of literacy and health literacy.

Michele Erikson: It’s my pleasure. It’s very rewarding to be in this field. Thank you for what you’re doing.

Helen Osborne: Thanks, Michele.

Michele Erikson: Take care.

Helen Osborne: As we just heard from Michele Erikson, it is so important to communicate all information and specifically health information in ways everyone can understand. But doing so isn’t always easy.

For help clearly communicating your health message, please visit my health literacy consulting website at www.HealthLiteracy.com. While you are there, feel free to sign up for the free monthly e-newsletter, What’s New in Health Literacy Consulting.

New Health Literacy Out Loud podcasts come out every few weeks. Subscribe for free to hear them all. You can find us on iTunes, Stitcher Radio and the Health Literacy Out Loud website at www.HealthLiteracyOutLoud.org.

Did you like this podcast? Even more, did you learn something new? If so, tell your colleagues and tell your friends. Together, let’s tell the whole world why health literacy matters.

Until next time, I’m Helen Osborne.