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 my conversations with some really remarkable people hearing what health literacy is, why it matters and ways all of us can help improve health understanding.

Today, I’m talking with Steve Sparks, who is Director of Wisconsin Health Literacy, a division of Wisconsin Literacy, Inc.

There, Steve provides consultation, training and coordination for statewide health literacy programs, communications and interventions.

Before Wisconsin Health Literacy, Steve held marketing and communication positions in hospitals, health systems and taught college-level communication courses.

Steve and I often speak at the same health literacy conferences. When I heard his presentation about the public health campaign “Let’s Talk About the Flu,” I knew this would be a great topic for Health Literacy Out Loud.

Welcome, Steve.

Steve Sparks: Thank you, Helen. I’ve learned so much from other podcasts. I’m really glad for the opportunity to share information that will hopefully help my health literacy colleagues.

Helen Osborne: That’s great.

“Let’s Talk About the Flu” is what you’re focusing on. Flu is maybe not one of those sexy kinds of diseases. It’s something that happens every year. We all get the flu. A lot of people get the flu. We hear about getting the flu shots. Why did you decide to focus so much effort on a public health campaign about flu?

Steve Sparks: In part because of the reasons you just mentioned. It happens every year and it can be so big an issue and so disastrous for those who are affected and who may already have health conditions for which they’re compromised, so it’s really important to get that shot.

We know that people from populations that are most at risk for low health literacy are also the populations least likely to get the flu shot. We wanted to reach out to those groups.

Helen Osborne: Yes, flu can be a very serious, life-threatening disease and getting that shot is something we need to do every year, and whoever wants a shot. Why is this a difficult message to give?

Steve Sparks: It’s difficult to give because for one thing there are many myths out there about the shot.

One of the most common things we heard in regard to our flu workshops was people saying it can make you sick. That is one of the most common myths out there.

There are many reasons people can come up with to not get the shot, so we wanted to focus on why they should get the shot.

Helen Osborne: Do you mean those myths that people just have passed on through their neighbors, their friends and maybe what they see on TV or something? They’re not health facts, but just some longstanding thoughts about the flu. Is that right?

Steve Sparks: That is exactly true. Everybody knows somebody who had a flu shot and felt sick afterwards.

Helen Osborne: We sure do.

Steve Sparks: Everybody has a story about that, so one of the things we really needed to focus on for our program was dispelling some of those myths.

Helen Osborne: What did you do? You talk about your program. I’ve heard you present about it. Share it with everybody. What is this program?

Steve Sparks: This is a program that was done in 2010, 2011 and 2013, three different years, and actually focused on a one-hour workshop with populations that would be considered at risk for low health literacy.

The workshops included a workbook that was done in very plain, simple language using all health literacy principles that focused on the symptoms of the flu, how to avoid getting the flu and why you should get a shot.

Helen Osborne: That’s really that know, do, act information that we often do in health literacy. Know why it’s important, here are ways to make it possible and here are actions you can take. It sounds like it’s framed in that format.

Steve Sparks: Absolutely. We knew that people needed the information before they could be inclined to take action, and then they needed to know how they could take action once they believed that it was important to get the shot.

Helen Osborne: You did this three years in a row?

Steve Sparks: We did this three years, yes. Many of the organizations we worked with were the same and many were different, but obviously since, as you mentioned earlier, it is something that you have to get every year, we all need a bit of a reminder to do this every year.

Helen Osborne: Did you have the same people come every year or just totally different populations with different programs?

Steve Sparks: It was both. It depended. Some of the organizations we worked with over the years were the same, but some of the people were the same and some of them were different.

Helen Osborne: Our listeners are people who are clinicians, public health folks, health educators or people somehow interested in communicating health information. They might also be literacy teachers. What lessons did you learn over doing this three times that others might be able to take and put into place in their setting?

Steve Sparks: I think the most important thing we learned was the best approach to reach these folks. We know that the folks we were targeting for our messages tend to be hard to reach.

Helen Osborne: What do you mean by that term “hard to reach”? I’ve used that term over the years, but what do you mean by it?

Steve Sparks: What I mean is they are groups that perhaps are not using traditional media as much as the rest of us.

There may be some language difficulties that are intervening. There may be refugees where you’ve got populations that may have language and cultural barriers that keep them from getting some of the communications that others might get.

Helen Osborne: Thanks for that. What are these lessons that we can all learn from?

Steve Sparks: The most important thing, I think, is, when we’ve got a program like this where we’re reaching out to groups that are hard to reach, the most successful approach may be reaching out to them where they live, work, pray and play, for example.

Rather than holding a public program and saying, “Hey, everybody, come in,” what we did was we went to homeless shelters, senior centers, refugee programs and neighborhood centers that they were accustomed to coming to. They were trusted places that they knew people.

Helen Osborne: You went to trusted places. Did these trusted places trust you enough to come in to do this program?

Steve Sparks: Most of these programs were organizations that we already had some kind of a relationship with. That’s often how we identified them, by looking at where we go to reach these populations.

Seniors being one of the big ones, for example, we have relationships with a number of senior centers or senior organizations, so we reached out to them.

They knew us, they knew our name, they knew the kind of work that we did and they knew that we would bring a message that would be of importance to them in a way that people would understand.

Helen Osborne: You had that behind-the-scenes relationship and then you did it at a place that was comfortable for the people you were trying to reach. Did those facilities help do the promotion and the recruitment to get people to attend?

Steve Sparks: They actually did most of the promotion. We gave them some materials, posters, for example, or news releases that they could use, but they really focused on it.

One of the major successes of this program I think was that we typically did the program in conjunction with some other kind of event or activity.

Helen Osborne: Like what?

Steve Sparks: For example, we did a couple of them at churches after the church services. Some of them were done adjacent to a support group. Many of them were done at senior meal sites, for example, where people were coming for a meal and they were just asked to come an hour early for this program.

We really leveraged that opportunity that they were already coming for something, so here’s some additional education that they could get on the topic of flu.

Helen Osborne: It sounds like it was done at a convenient time. However, it could be framed for this particular group and by a trusted organization.

I guess the next step is people actually show up. Tell us what happens there and lessons others can learn from that.

Steve Sparks: When they show up, one of the most important things is for the facilitator to build relationships when people first show up. Because of the fact that these folks are coming to a familiar location, they know people there, but they don’t necessarily know the facilitator for this program because we provided the facilitators.

Helen Osborne: Facilitator is the fancy word of the person teaching this program?

Steve Sparks: That’s right. It’s the leader who was teaching the program. It was very important that they all be extremely interactive.

Much of the program involves asking people, “Have you ever had the flu? What did you do? Do you know anybody that had the flu? Have you gotten a shot? What was your experience?” It was very interactive.

We found that there was definitely a power of the group, in a sense, where one person would open up about their story and that would encourage other people to tell their situation.

Helen Osborne: You got them engaged in it. Was it an hour-long presentation? Was it kind of formal? I know you said it was interactive. What’s the tone like in that room?

Steve Sparks: It’s pretty informal. Behind the scenes, it was very structured. We had a script that we didn’t read but we used. We had a workbook that we used and we had some activities in the workbook, such as little questionnaires where they would answer questions about things and then we’d discuss the answers.

It would feel very informal, but behind the scenes it was very structured because we started with a pre-test and ended with a post-test.

Helen Osborne: What kinds of questions are on a pre- and post-test?

Steve Sparks: In that case, the questions were really exploring some of the information about the flu, for example, myths about the flu to see what they knew.

Then the post-test was pretty much the same questions and asking them to see if we could gauge the change in knowledge.

We also then asked them some attitude questions, such as “How do you feel? Do you plan to get a flu shot this year?”

Then we could measure how many people said they were going to get a flu shot at the beginning compared to how many actually said they were going to get a flu shot at the end of the workshop.

Helen Osborne: Did you use that as one of your measures of success, the difference between the pre- and post-test?

Steve Sparks: We did use that as a measure of success. We had a significantly larger number of people saying that they planned to get the vaccine afterwards compared to before. It was roughly 25% more of the people.

I think the most important measure though was the number of people reporting that they actually did get the shot.

For all the programs we did, we worked with the sponsor organizations to do follow-up contacts with these folks and then ask them after a period of time, “Did you get the flu shot?” We were really pleased to find that 55% of the people actually did get a flu shot.

I’ve had some people say, “Fifty-five percent is just a little over half. That’s not very good.” My response to that is, “In Wisconsin, we had roughly a percentage of 32% of all adults getting flu shots, so to have 55% of this group, which was the group which was probably least likely to get the shots in the first place, compared to 32% of all adults, we felt pretty good about that.”

Helen Osborne: That’s good. Thank you for making it clear what your program is all about. It really sounds effective.

I’ve seen your workbook. It’s terrific. It’s simple, it’s clear and it has pictures of what looks like real people and real questions. That looks great.

What does it take behind the scenes to make all this happen? You talked about how your workshop might appear informal, but it’s really structured. You talked about facilitators. You talked about doing this three different years. Tell us the behind-the-scenes administrative part we need to be aware of.

Steve Sparks: From the very beginning, it was very structured in terms of gathering the research.

We did a lot of work before the program started in gathering input from some of the stakeholders about what they knew about the flu and looked at the literature to find out what was out there about at-risk populations, getting flu shots and even testing the lesson plan with some people with lower health literacy.

They made some suggestions and we were able to make some improvements on the lesson plan and the workbook that helped the program for future workshops.

Helen Osborne: It sounds like this took a lot of time beyond just the flu season.

Steve Sparks: It did. The way that this worked out was a little unusual because it started in 2010, which was the year of H1N1.

Helen Osborne: That was the really nasty flu.

Steve Sparks: Yes, it was.

Helen Osborne: It had a miserable name, H1N1.

Steve Sparks: Exactly.

The first program that we did was put together pretty quickly because there was some money that came through a CDC grant through our Wisconsin Department of Health services that funded the first workshops in 2010.

Those had to be done pretty quickly because of the concerns about this and getting people vaccinated quickly.

We had a little bit more time for the subsequent workshops to build on that and to build a little bit better and strong evaluation process to really focus more on those cultural myths that we knew we needed to address.

Helen Osborne: You had the evaluation. This can’t be done on a shoestring. You need some funding behind it. Is this all grant funding or is this line item funding? How does all that get paid for?

Steve Sparks: This was made possible through grants. As I said, the first one was through our Health Services Department, but following that in 2011 and 2013, we were able to receive grants from Anthem Blue Cross and Blue Shield that made this possible, so tying that in with a lot of in-kind support from our organization is what made this possible.

Helen Osborne: It was a lot of behind-the-scene work.

It’s happened three times now. What do you see ahead for flu campaigns, and what would you like to see in the bigger picture, nationwide and not just statewide?

Steve Sparks: We’ve learned a lot through this process. Because it happens every year, I think we’d like to continue the program. We are looking for potential sources of funding to do another program.

Helen Osborne: You’re like everybody else, always looking for funding.

Steve Sparks: Exactly. We are.

The timing, of course, is more critical on this because there’s a specific flu season. Even though we remind people that you can get the flu any time of the year, if we’re going to do a flu campaign like this, it really needs to be done in the fall moving through the winter, so the timing is very important on that.

We really do hope to do this again. We feel like we’ve got a strong model that we can use and some good materials. We can build on what we know.

The future ones may be a little bit challenging because of our experience with the flu vaccine last year and its relatively low effectiveness rate.

Helen Osborne: What was that experience last year?

Steve Sparks: The flu vaccine that was created had a pretty low effectiveness rate.

Helen Osborne: That was in 2014.

Steve Sparks: That’s right. In the 2015 flu season, I think a lot of people are going to be pretty skeptical about getting the flu shot because they would be afraid it wasn’t going to work anyway.

Helen Osborne: Boy, Steve, listening to you, you really are embodying all these health literacy principles. You’re engaging your audience, doing your planning and doing it in words people can understand, in terms they can understand, at places that have meaning and putting it in context of reality.

One year was H1N1 that was getting a lot of attention. Last year, in 2014, it might have been a flu shot that wasn’t so effective.

It looks like you’re tying up all those pieces together in one program that outwardly looks pretty easy, but, boy, when we hear the inside parts there’s a lot going on.

What words of wisdom do you want to pass on to our health literacy colleagues across the country and around the world about this?

Steve Sparks: I think it is the value of using health literacy principles in communication.

Just as one example, during one of the sessions the question was asked, “Why wouldn’t you get the flu shot?” Somebody raised their hand and said, “I don’t want to get the flu shot because I heard you can get immunity from the shot.” They didn’t understand what the word immunity meant.

In another case, we found out that among some Latino population there’s a myth going around that the flu shot can cause sterility.

Those are the important kinds of things or barriers to getting the flu shot that we needed to know about and, through the learnings, were able to subsequently address.

Helen Osborne: Wow, you must have learned so much in three years of doing this. Thank you so much for passing on these words of wisdom and lessons learned to all the listeners of Health Literacy Out Loud.

If people want to learn more, can they contact you? Would you be willing to share that? Is there a website they can go to? Certainly we’ll have information on your Health Literacy Out Loud web page.

Steve Sparks: That would be fine. We do have some information on the program on our www.WisconsinHealthLiteracy.org website, and we’ll certainly post that contact information on your website.

Helen Osborne: Steve, thank you for being a guest on Health Literacy Out Loud and even more for doing all you do and helping us hopefully not get the flu. Thank you, Steve.

Steve Sparks: Thank you.

Helen Osborne: As we just heard from Steve Sparks, it is so important to remember health literacy principles and use them in all our communications, even for an everyday issue like the flu. But health literacy isn’t always so easy to do.

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 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, www.HealthLiteracyOutLoud.org.

Did you like this podcast? Even more, did you learn something new? I sure hope so. 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.