HLOL Podcast Transcripts

Health Literacy

Health Literacy and Health Equity (HLOL #203)

Helen Osborne: Welcome to Health Literacy Out Loud. I’m Helen Osborne, President of Health Literacy Consulting, founder of Health Literacy Month and author of the book Health Literacy from A to Z: Practical Ways to Communicate Your Health Message. I also produce and host this podcast series, Health Literacy Out Loud.

Today, I’m talking with Janet Ohene-Frempong, who is a plain language and cross-cultural communications consultant who has decades of experience in patient/provider communications.

Janet’s accomplishments are many. They include leading workshops, keynoting conferences, writing and editing plain language projects and consulting with a wide range of clients on health-related topics.

Janet has deservedly received numerous accolades and awards for her excellent work.

Janet and I have been health literacy colleagues and friends also for decades. Our work and interests overlap and intersect in so many ways. Yet we each bring our own views and life experiences.

Now at this time with issues of race and justice being openly discussed, we thought it fitting to have a candid conversation about health literacy and health equity from Janet’s perspective as a Black woman and mine as a woman who is White.

Welcome to Health Literacy Out Loud, Janet.

Janet Ohene-Frempong: Thank you. Thanks for having me, Helen. Thanks so much.

Helen Osborne: I’m eager for our conversation. So much sometimes goes unsaid than said.

Let’s take it from the beginning. You and I have both been working in health literacy for decades. The definitions of that vary and are in flux, but overall I consider this as communicating about health in ways others can understand. Very broad definition. Are you on board with that too, more or less?

Janet Ohene-Frempong: More and less. I think that’s a major part of it. But I think if we’re trying to promote health literacy among people in general, what we’re trying to do is to give each person the chance to know what he or she has to do to stay alive and as well as possible. I’ve really boiled it down to the basics.

Not only as an individual, but also for their families and their community. We want people to know what it takes to stay alive, first of all, which is a challenge right now with this pandemic. But also to be able to stay as well as possible.

Those are skills. Those are really important skills. That’s what we’re trying to do.

Helen Osborne: They’re skills, they’re actions, and you broadened it from the individual to the family. I’m very comfortable broadening that to communities and public health information as well.

Janet Ohene-Frempong: Definitely.

Helen Osborne: We both respect that mutuality of communication.

Janet Ohene-Frempong: Definitely.

Helen Osborne: That there are two sides to that message. But you use a term, and I’ve been hearing more and more, about health equity. I wonder if you could put that into context for all of us.

Janet Ohene-Frempong: We want to make sure that everyone has the same chance, as much as possible, to stay alive and as well as possible. That’s the equitable part about it.

Some people have a better chance of doing that than others. They may have more money or more education, and they may have a better standing in terms of how the world sees them. If people see you as being one way, they may give you more privileges than if they see you another way. They may think, “We don’t really need to pay as much attention to you.”

Those things really count in terms of equitable access to care and equitable treatment once you get in.

Helen Osborne: When you talk about how the world sees you, does this get down to that very awkward, awkward for me, part of the conversation to discuss about the color of our skin?

I just want to tell you and listeners that as long as you and I have known each other, don’t think we’ve ever overtly talked about our differences in this way. It’s uncomfortable for me, but I think it’s time.

Is that what we are talking about, how we are different and how we look different?

Janet Ohene-Frempong: Absolutely. It’s huge. From a personal point of view, I’ve certainly experienced that in the healthcare system.

In fact, if you’re growing up as an African American, from pretty early on you begin to get a sense that you may need to conduct yourself a little bit differently because people see you and they react to you in a way that you think, “What is this?” Then you think, “Oh, okay. That’s what that is. Let me make an adjustment so that I don’t frighten someone or give somebody the wrong impression.”

Helen Osborne: Really?

Janet Ohene-Frempong: Oh, yes.

Helen Osborne: Janet, I love you. I’ve known you so long. Just the fact you used the word that people would be frightened of you, oh my goodness.

No, I can’t imagine. Isn’t that the core of the problem? I can’t imagine what it is like for you.

Janet Ohene-Frempong: Absolutely. Not only am I African American, but I’m 72. When I was 20, I was at school. I was at Cornell. This was the late ‘60s. There were all kinds of movements going on. I cut off my hair. Not all of it, but I got an Afro. I had been straightening my hair, worrying about my hair going back, as we say.

Helen Osborne: What was the term? I have such straight hair. This is all new to me.

Janet Ohene-Frempong: I had straightened my hair because that was the thing to do. I took the straightener out of my hair, and my hair has been natural ever since.

I know that when people see Afros . . . not so much now. I think people have become a little bit more accustomed to them. But I’ve been all around and I’ve gotten reactions because of my Afro. I don’t think about it until I get that reaction and I think, “Oh, okay.”

Not only am I African American, but I’ve got an Afro, so they probably think I’m this militant person who’s frightening and so forth. People back away on elevators and all of that sort of thing.

You adjust to it. It’s just part of living in this country.

Helen Osborne: Yikes.

You and I are contemporaries. We’ve been through similar experiences, about the same age and everything else. But I certainly get it, that our differences are surface level right here.

People just look at you and make a judgment. They might look at me and see another white, short woman with straight hair, like, “Okay. She wears glasses or she doesn’t.” Yours are more pervasive and you say make people sometimes back away, be frightened.

Janet Ohene-Frempong: Absolutely. It does include how you wear your hair. In fact, we know for a fact that if you’re going for a job interview, how you look and the hairstyle you have can affect whether or not you get a job.

All of those things count, so many people have had to readjust everything about their outward appearance to be able to just function and get through a basic day.

I decided to keep my hair natural. It wasn’t really a political statement, but it was just a matter of how I see myself. I thought, “Why would I redo myself in that way?”

That doesn’t mean that African Americans who straighten their hair that there’s a wrong thing about that. People have to do what they want to do. But this was my choice, and I know it happens sometimes when people may see me.

Helen Osborne: It’s also people who decide, as they’re going gray, “Am I going to go gray or do I want to keep looking however it was before?”

Obviously, we have our surface-level differences. We have inside, deep differences, and that gets to the issues of life experiences and when I so genuinely said, “Oh my goodness, I can’t imagine what it’s like when people react to you in different ways that I do.”

I wonder if we can reframe this in terms of health literacy and health communication, because that’s what the listeners are interested in.

How can each of us and all our listeners better communicate health messages regardless of our personal experiences?

You’re a pro at this, Janet. What tips and strategies would you recommend for communicating health messages in health equitable ways?

Janet Ohene-Frempong: That’s a really good question, and it’s probably the most important question that we can ask and answer for ourselves.

One of the things that we all agreed on is that when we’re communicating, whether it’s in writing or whether it’s even face-to-face or by phone verbally, the first thing we want is for people to be able to read and understand the information that we are exchanging.

Literacy, of course, is a major issue. It wasn’t that long ago, it was in another century, but there were laws in many southern states that prohibited African Americans from reading. It was actually against the law. Anyone caught teaching someone to read could be punished, and someone caught actually reading could be severely punished.

We have some inter-generational literacy issues, not to mention the fact that we had to fight for the right to actually go to decent schools. Education has been a real problem for us for quite a very long time.

When we think about just fundamental literacy skills and the ability to read, write and then compute, so quantitative literacy, we’ve been able to address that pretty well as a health literacy community.

Helen Osborne: Read, write and compute, yes. That’s the kind of work I’ve been doing for a long time, too. Refashioning our messages in clearer ways.

Janet Ohene-Frempong: Exactly. The question that you asked goes beyond clear. We can be clear, but the question is “Can we be effective?” That is something that I think I really stress with people.

Let’s just take written information. We can craft information in such a way that it’s actually easy to read, and we can craft it in a way that it probably is pretty easy to understand.

Although with a general lack of science literacy in this country, I might add, trying to communicate health information when people don’t have basic not only fundamental literacy skills but science literacy skills . . . And that can be across the board.

Helen Osborne: That’s everyone, yes.

Janet Ohene-Frempong: Yes, that can be across the board, so it’s something I think I’d like to address in the not too distant future, just science literacy. In the midst of this pandemic, it’s clear that some people just don’t understand some very basic things about infection and all of that sort of thing.

Helen Osborne: You were talking about the effectiveness of it. I go back to our lived experiences are so different. You also talked now about inter-generational experiences and what we have learned through the years, too.

What can we do as health communicators? We all want to communicate better today than we did yesterday. What can we do, Janet?

Janet Ohene-Frempong: If we go beyond clarity and we talk about effectiveness, then that means we need to make information easy to relate to. Actually, it was Len and Cecilia Doak who made this apparent way back. These are the people upon whose shoulders we really stand.

Helen Osborne: I will have a link to a podcast I did with them on your Health Literacy Out Loud web page. They’re really the grandparents of health literacy.

You want information easy for everyone to relate to. How do we go about doing that?

Janet Ohene-Frempong: What we have to do, then, is ask good questions, listen and learn. This is basic. I’ve heard you speak about this many times. Some people just give lip service to it. But really, the most important thing we can do is get a sense of the people that we are speaking to, whomever the audience is, if it’s individuals, a group of people and so forth.

We want information to be perceived as being practical, respectful, useful and interested, and if there’s something visual, we want it to be perceived as being attractive.

The way you can get a sense of whether or not that has been the case is if you’ve gone and produced something, you can ask people. The right person has to ask the right people the right questions in the right way in the right place, and they will begin to tell you the truth.

If you’re really smart, you’ll do that before you even start printing or saying things. You’ll get a sense of who you’re speaking with and then craft your messages accordingly, because many people have many different experiences.

Helen Osborne: You talked about being clear, clear in our words, sentences, images and numbers, and you talked about being effective. That includes being respectful and finding out what the audience needs, wants and can relate to.

Are there other big issues that we need to consider as we craft our health messages?

Janet Ohene-Frempong: Absolutely. In terms of how effective a piece is, the messaging, we need to take into consideration people’s situational realities. That includes where people live, what kind of housing. What kind of transportation? Do you have a nice big refrigerator that works, or is that a problem? Are people traveling on buses, having to wait for hours for a bus that comes, or can you just jump in a car and zip along?

What about the kind of income they have? How much money do they have in order to work with? What sort of situation are they living in? It’s all of those kinds of things.

Then when you’re giving people advice, instead of just saying, “Do this. Do that,” you may say, “Try this. It may not be easy, but here’s something you can consider.”

Helen Osborne: Issues of access to fresh food or plenty of produce, that’s an example that comes up a lot in materials that I write.

Janet Ohene-Frempong: Exactly.

Helen Osborne: Not everyone has equal access to abundant fruits and vegetables.

Janet Ohene-Frempong: Exactly. You may live in a neighborhood where there are McDonald’s. Let’s put it this way. Not just McDonald’s but all kinds of fast food restaurants all around. In some neighborhoods, you don’t really have much of that. But in other neighborhoods, you do. That’s what’s there.

Say you’re dealing with somebody with weight issues. If you’re dealing with diabetes, high blood pressure or cardiovascular disease, weight becomes a problem and a real issue.

If you’re judgmental about someone who comes in and is deemed to be over the ideal body weight, you have to ask yourself, “What’s happened here?”

You can make all sorts of judgments about people’s inability to control themselves and so forth, but if you have a sense of where someone is living, what somebody is having to do, how many jobs they have to take on in order to make a living, how many kids they have to manage and all of those kinds of things, it sort of brings you down off of your high horse and onto the ground with regular people who are doing the best that they can very often to stay alive and as well as possible.

Helen Osborne: That’s what I’m hearing as a thread in there. There’s so much more to consider. You covered some high spots about clarity, structural realities and how to make it effective. But what you talked about, I think, at the core of this is to work with the audience you’re intending to reach.

I think in ways that gets back to what you and I are talking about: how we are alike and also how we are different, and respecting those and taking those into consideration as we communicate our messages.

We only have a few moments left. I keep wanting to hear more and more from you, but we don’t have time in this podcast. I want to respect listeners who only have a little while to listen to each one.

What would you recommend for ways people can keep learning more about communicating messages with health equity in mind?

Janet Ohene-Frempong: As you said, we are different from each other. We have some common ground. But it’s to reach out and be open to otherness and other people’s humanity.

If it’s foundational and you’re really open . . . and not just about race, but also about religion, sexuality, how people look and all of those kinds of things.

When you see someone else who doesn’t look and seem to be just like you, then rather than judgment, just interest. Isn’t it interesting that this is how somebody is?

I think if we can maintain some level of openness, and certainly in terms of how we do business. Focus groups, individual interviews, you hear those voices. I hear those voices from 20 and 30 years ago. I hear them as I write. Not in a spooky way, but they inform the way you craft your messages because people will tell you how they see things, how they feel about things and how they reacted to things that they have received.

If you care about that and you actually want to reach people, then you remember those voices. You remember the things that they’ve told you. Then you write, speak or craft your messages accordingly, and you do that because you care.

Helen Osborne: Janet, you always say things so well. I think most of us doing this kind of work feel that we come into this with a sense of caring. But a reminder about respecting the other person’s humanity. I love your phrase “being open to the otherness.”

Janet, thank you so much for all you do and inspiring so many people in the many ways you’re communicating this message, and for being a guest on Health Literacy Out Loud.

Janet Ohene-Frempong: Helen, thanks again for having me. It’s just been a pleasure. It’s always a pleasure speaking with you. I’m just so happy for all the work that you have done for this community over the years. Thank you, and I’m glad to be a part of that.

Helen Osborne: As we just heard from Janet Ohene-Frempong, it’s important not only to communicate messages clearly and effectively, but also with humanity. But doing so is not always easy.

For help clearly communicating your health message, please look at my book, Health Literacy from A to Z. You might be especially interested in Chapter 41 called “You: Empathy and Humanity.”

Feel free to also explore my website, www.HealthLiteracy.com, or contact me directly at helen@healthliteracy.com.

Health Literacy Out Loud podcasts come out every few weeks. You can get all the episodes for free automatically by subscribing at www.HealthLiteracyOutLoud.com, or find us in Apple Podcasts, Google Play, Spotify, iHeartRadio, RadioPublic, Stitcher and probably all the other places you find your podcasts.

Please help spread the word about health literacy and Health Literacy Out Loud. Together, let’s tell the whole world why health literacy matters.

Until next time, I’m Helen Osborne.

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"As an instructional designer in the Biotech industry, I find Health Literacy Out Loud podcasts extremely valuable! With such a conversational flow, I feel involved in the conversation of each episode. My favorites are about education, education technology, and instruction design as they connect to health literacy. The other episodes, however, do not disappoint. Each presents engaging and new material, diverse perspectives, and relatable stories to the life and work of health professionals.“

James Aird, M.Ed.
Instructional Designer