HLOL Podcast Transcripts

Health Literacy

Innovative Ideas for Using AI in Health Literacy (HLOL #245)

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. I also produce and host this podcast series, Health Literacy Out Loud.

Today, I’m talking with Aditya Tummala and Beier Nelson. Aditya is an undergrad student at Harvard College, studying biomedical engineering. His primary focus is on socioeconomic disparities that act as barriers to healthcare in rural and marginalized communities.

Beier Nelson is also an undergrad at Harvard, with a dual concentration in molecular and cellular biology and in government. Beier is looking at barriers in the community that prevent people from accessing needed healthcare services.

Beier and Aditya are Co-Founders and Executive Directors of The Health Fluency Project. Their goal for this project is to use innovation as a way to help dismantle those and other barriers to healthcare.

Welcome to Health Literacy Out Loud.

Aditya Tummala: Thank you so much.

Beier Nelson: Thanks for having us, Helen.

Helen Osborne: Let’s take it from the top. I’ve had the treat of already looking over your website and having a few preliminary conversations with you. Tell the world what The Health Fluency Project is.

Aditya Tummala: The Health Fluency Project is essentially a student-led project really honing in on language equity for non-English speakers.

Specifically, our goal for the project is very simple. We want to empower individuals with the skills needed to navigate the healthcare system confidently and effectively.

Helen Osborne: For people who don’t speak English.

Aditya Tummala: Yes. To do this, we’re focusing our efforts into three major areas: literacy, communication and policy.

Specifically, what we’ve done is created pamphlets and infographics really focusing on some of the topics that we as native English speakers, or we as individuals who are comfortable with the American healthcare system, often take for granted. Even simple things like how to navigate pregnancy care, or maybe what kind of over-the-counter medication I should take.

Helen Osborne: Those aren’t always so simple. How to navigate care in the United States can be huge, and you’re trying to communicate this so people understand who are not native speakers.

Aditya Tummala: Exactly.

Helen Osborne: Thank you. That sounds like a big job ahead. Beier, what’s your perspective on this project?

Beier Nelson: Exactly what Aditya said, our mission is to empower non-native English speakers to effectively communicate with their healthcare providers and build confidence in that manner.

Health inequity, specifically language barriers in healthcare, is a major issue in healthcare. As of 2021, there are around 25 million people even in the United States, or over 8% of the American population, who are considered limited in English proficiency, or LEP.

That is basically defined as people who primarily speak, write or read a language other than English at home.

In addition, there have been a lot of studies out there that show that language barriers can negatively impact health outcomes. When you have a gap of communication between the patient and the provider, a lot of bad things can happen, things like increased rates of misdiagnoses, decreased treatment adherence, more medication errors and an overall decrease in satisfaction in the healthcare system.

Aditya and I both see these issues and we want to try to do something about it.

Helen Osborne: It’s wonderful to hear you’re making this initiative. I’m just curious at this point how did the two of you who are undergrads in college get into doing this work? Why do you feel it’s so important to keep going right now?

I kind of want to hear that backstory to this one. Share as much as you’re willing to about why you felt this was so important. Then we’ll move on to what you’re doing about it and what others could be doing about it.

Beier Nelson: What really connects Aditya and I to this project is our shared stories, our shared experiences. I’ll talk a little bit about my backstory, and then hand it off to Aditya.

For me, I am Chinese American. I was born in China, but I came to the United States when I was 4. When we moved to America, it was just my mother and I. The rest of my extended family remained in China.

As for context, my mom was actually a doctor back in China. She was a cardiologist, so she knows a lot about her body. She knows a lot about healthcare.

When I was a kid, she would always be the one taking care of me because she would know how to treat everything that was going on, essentially.

But when she came to the United States, she actually struggled a lot with the healthcare system. I would often hear her talking to me saying things like, “I don’t understand what my doctor is saying,” or, “I feel uncomfortable sharing these things with my doctor.”

Helen Osborne: Really? Your mother is a cardiologist and she was saying, “I don’t understand everything my doctor is saying”? That’s remarkable.

Beier Nelson: Right. Things like that, things like, “I don’t feel comfortable in sharing these things.”

Putting these stories together, thinking about all these events, to me, it is not the lack of knowledge or the lack of health literacy for my mother, because she was a doctor. She knows a lot of these things.

But it was more of the language barrier, more of things like cultural incompetency and gaps in communication with the provider that caused a lot of these issues.

Thinking about that a lot and coming to college, meeting Aditya, taking all these classes and immersing myself in this environment, it dawned on me that this is something that I wanted to do.

Aditya and I talked a lot about this. We had a lot of conversations about things we were interested in, our shared experiences, and we decided that this was something that both of us wanted to do.

That’s something on my end. I’ll have Aditya talk a little bit more.

Helen Osborne: I welcome hearing your backstory, too, Aditya.

Aditya Tummala: Yes, of course. Thank you so much. Really, the roots behind any sort of initiative are in the stories.

Beier and I are actually very close friends. We’re even roommates, in fact, so we’ve talked about this a lot. We talk about our backgrounds, where we come from and our shared experiences. This issue is something that we both are very passionate about and really wanted to make a difference in, so we teamed up to do so.

A little more specifically, just like Beier’s story, mine is very similar. My family comes from India, and although my parents are in the healthcare field in general, they still have significant trouble communicating with their physicians, communicating with doctors and really making sure that they have control over their own healthcare and their own treatment programs. Even though they’re experienced in healthcare, this exists.

These aren’t stories that are limited to just us. In fact, they’re experiences that countless others, really, face on a daily basis

Helen Osborne: Can I ask you about that? Your family came from India. Do they speak English in India?

Aditya Tummala: Yes.

Helen Osborne: They came from another culture, but even the language was not a concern. It might be more formal English, not the American English, but the words are essentially the same, and even they struggled to understand at times.

Aditya Tummala: Exactly. One of the best examples of why cultural competency is so important in such a field like this and why this is something that we’re very passionate in is, as a little background, I’m from South Dakota originally, a small town in South Dakota.

What we saw within my own community is that often in rural communities, access to health resources is already limited. Understandably so, these already limited resources often go to serving the majority rather than the cultural niches or linguistic enclaves that exist throughout the state.

What we saw is that not only is this a shared experience in my family or families like mine that immigrated to this country, but one of the biggest groups of individuals in my own state that are most disproportionally affected by this are Native American communities.

In fact, one clear example, a very unfortunate example, is the Rosebud Reservation, which is in western South Dakota. What we see is that because of a lack of healthcare resources that have gone to this area historically, because of a lack of targeted care, we see that the Rosebud Reservation today has a life expectancy of around 20 years less than the national average.

Helen Osborne: Oh my goodness.

Aditya Tummala: This is just one example of the hundreds that exist throughout the country, really.

This is field that we’re both very passionate in. We both grew up around experiencing this, and we really wanted to try to make some sort of difference in together.

Helen Osborne: Nice that you two ended up being roommates and having this shared experience. Thank you both for sharing your background stories with the listeners of Health Literacy Out Loud.

Let’s move this forward a little bit. You started this project, and this isn’t just, “Everybody go to this project. Go to The Health Fluency Project.” I mean, that’s good, but I also want to know your recommendations and strategies beyond the resource that you’re creating. What can our listeners be doing?

Let me tell you about our podcast listeners. They might be clinicians, in public health, working at community agencies or people who are just interested in communicating a bit about health.

What have you learned from this? You articulated the problems. What are you thinking about for some solutions to make this a little bit easier for people?

Aditya Tummala: That’s a great question. When it comes to addressing any issue, especially one as complex and multifaceted as language barriers and equity in healthcare, it’s really only through engaging at a very deep level with the community, both future patients in the healthcare setting or other organizations and players in the field, that you can really try to make a meaningful impact.

For us and for many other successful organizations throughout the country, and throughout the world really, it’s trying to stay grounded and understanding and adapting to the real needs of the community constantly, and not just the needs we think need to be addressed and try to impose them on the community.

That’s kind of been our number one priority throughout the project, and that’s what we hope to continue throughout going into future.

Helen Osborne: I just took a note of your words there. You said really the core of this is about understanding and adapting to the very real needs of communities.

But communities can be everywhere. There are multiple communities, infinite numbers of communities. How could one person make a difference in doing that? That seems overwhelming in many ways.

Aditya Tummala: Anyone, no matter how young, no matter how old, no matter what background you really come from, all you need to do is see your own community and try to better it in some way or another.

It doesn’t need to be the world. It doesn’t need to be a huge population of people. All you need to do is really try to better your own community in some way or another, and try to give back to what your community has given to you.

That’s a principle that both of us have tried to hold throughout our life, and I think it’s a very nice thing to hold with us as we go into the future as well.

Helen Osborne: That’s what I’m gathering from you. That’s what both of you are doing individually and collectively, trying to make it a bit better.

Beier, what are your recommendations for everyday folks, whether they be someone who’s ill themselves or caring for someone who is? Wherever they come from, how can people better communicate about health and better understand about health?

Beier Nelson: I’ll say something similar to what Aditya is saying. For us, something that was relevant to our project and our mission to learn more about health literacy, healthcare and health injustices in the community was to engage in conversations with a lot of the stakeholders.

We’ve engaged in conversations with community members themselves, as well as community leaders, people who run libraries, people who run immigrant centers, people who are very engaged in the community. They have taught us so much.

We’ve also met with doctors, with researchers, as well as people engaged in advocacy and policy.

What we really learned from that is just getting a bunch of different voices and having our project be grounded in the suggestions and the advice from all these different stakeholders. It’s something that we take to heart ourselves.

Something I would recommend for those who are looking to create a project, or for those who are not and just living their everyday life, is it is good to seek resources from different perspectives.

Helen Osborne: I want to take it into the near future and into the bigger future beyond that.

The near-term future, you two collectively have created this project. Is this available to everybody, your Health Fluency Project? Can people just go to your website?

Can you tell them the website now, and they can just go there and see a little bit of what you’re doing? What is the URL?

Aditya Tummala: Yes. The URL is www.HealthFluencyProject.org.

Helen Osborne: We’ll have that on your Health Literacy Out Loud web page, too.

People can go, and what will they see there that they might use? Everyone is different. Everyone is special. How can they make use of your information or your style, even if it doesn’t exactly meet their needs? Or will it exactly meet their needs?

Beier Nelson: On our website, we try to make all the resources we have open access. As Aditya mentioned in the beginning of the podcast, one of our core pillars is information dissemination. We aim to create pamphlets, translate them and share them with the broader community free of charge, open access.

If you go on our website, under the Our Resources section, you can find the pamphlets that we’ve created so far.

There are pamphlets such as an appointment navigator, which allows you to write down all the questions you have before visiting your doctor, writing down things like parts of your lifestyle, where you work and the notes from the visit just so you can go into the doctor and not forget anything.

An appointment is not that long. You have around 10, 15 or 20 minutes, not a lot of time to talk to your provider.

We also have pamphlets on what to bring to your first appointment. If you’re seeing a new doctor and you’re unfamiliar with the healthcare system, it is daunting to bring all these resources. What should I bring? Should I bring my insurance card? Should I bring my medications list? Things like that, we have that on our website.

These resources are, again, open access and we want them to be available to everyone.

We currently have them in four languages. We have them in Mandarin, Spanish, Haitian Creole and Ukrainian. We are continuing to work with our partners to develop more languages as well, because there are a lot of languages that people both in Boston and in the larger US speak.

Helen Osborne: It’s a wonderful start. I looked at some of your materials. They are really about how to use the system, a structure for someone using the system, and that’s great.

They don’t seem to be specific on any specific diagnoses or treatment, which makes sense. It’s more about the greater picture of healthcare.

You have four languages, which is wonderful, but our world is filled with hundreds and hundreds of languages. How do you scale this up? What do you see in the bigger picture for making health information and healthcare easier in a sustaining way?

Dream big. You’re both in your early stages. What are your big dreams for this?

Aditya Tummala: Beier and I both have really thought deeply about this, and are really thinking about, “We’re a very brand-new initiative. We’re two young undergraduate students in an ocean of people who have been tackling this issue for decades.”

Something that we really hope to try to bring in is a fresh perspective. Some of the fresh perspective we can really try to bring in is in AI.

Helen Osborne: Artificial intelligence.

Aditya Tummala: Exactly.

Helen Osborne: Some of my people, including me, are thinking, “Artificial intelligence? Egad, what’s that about?” You’re speaking so positively about it. Where do you see artificial intelligence coming in as a solver of some of these issues?

Aditya Tummala: Really, the beauty of artificial intelligence comes in the versatility it has. Artificial intelligence right now has kind of turned our perspective on how to approach problems upside down.

What we see is that this technology has developed so fast that instead of conventionally how we create technology to address a problem, we’re really trying to find problems that we can use AI for.

Helen Osborne: That’s interesting. Flipping it. I like that.

Aditya Tummala: Exactly. Simply put, its versatility, individuality, which is most important here, and overall ease of implementation make a huge opportunity for anyone to at least keep it in the back of their mind as a possible Swiss Army knife, I guess, so to speak.

Especially in a field like health literacy, it’s absolutely crucial to get individualized information and try to get each and every person in the entire country, really, on the same page about health.

Using brand-new, cutting-edge technology like AI serves us this potential. Maybe we can actually have total individuality with any sort of education, any sort of workshops that we really do have.

Helen Osborne: That’s amazing. I think you see the future more clearly than I do. Can either one of you tell a story about what that might be like in real life?

Beier Nelson: Just like Aditya said, we are pretty optimistic about this new technology, and we’ve been working to try to integrate some of this AI technology into our project as well.

AI is very broad. It sounds like this very mystical thing, and it is pretty confusing. But at the end of the day, they’re computer systems that can simulate human intelligence. They can do things like hold a conversation and basically perform tasks that you ask it to do.

A subset of AI is called large language models, or LLMs. An example of an LLM is ChatGPT, something that all of us have heard about.

LLMs are AI programs that can recognize and generate text. You can tell ChatGPT to do something and it’ll do it. You can say, “Hey, ChatGPT. Write a five-paragraph essay on the moon landing,” or, “Create a list of 10 countries that I should visit next year.”

LLMs have a lot of potential, we see, in healthcare specifically, health literacy and health communication.

One of the projects we’ve been working on is a collaboration with a startup at Harvard Medical School, an AI startup called AuxHealth. AuxHealth has a product called MD & Me, and this product is a conversational symptoms checker, a large language model, an LLM.

This product allows a patient to essentially have a conversation with a chatbot. In that conversation, a patient can describe their symptoms, describe their pain and what is going on.

They’re being prompted by this chatbot. The chatbot will ask questions like, “Can you tell me the pain you’re feeling? Can you tell me about your symptoms? When did this start? On a scale of 1 to 10, with 1 being no pain and 10 being the worst pain, how do you feel?” They’re questions that a provider would ask.

We saw this as a great opportunity to collaborate, because in our educational workshops that we host within the community, we are asking the same questions to practice.

A lot of our workshops have been targeted on how to communicate to your doctor and how to describe your symptoms accurately. We are essentially having the students practice answering the same questions that this chatbot is asking.

We are currently integrating this tool essentially to have students continue to practice.

Something very nice about this tool is that there’s a voice feature as well, so you’re not just typing on a computer. You can actually practice English as if you’re communicating to an actual doctor.

Helen Osborne: I can hear your potential that you’re seeing in this. As someone on a different end of the age spectrum from both of you who are excited and see all the possibilities, I also like the role of tradition.

I don’t know where a real live person and patient come in that. Are we just going to be treated by robots? Robots are pretty smart, but is that the future that you see for healthcare, or will there still be the people part of this?

Aditya Tummala: Maybe I’m being overly optimistic here, but I really think there’s a sort of magic in human communication that just can never be replaced by a robot.

Helen Osborne: I’m cheering you on. That’s what I think, too.

Aditya Tummala: Hopefully we’re right on this. I really think that any tools like AI serve to be a sort of Swiss Army knife where you can use it in many instances, and really try to make the lives of so many around the world better. But again, you can’t use a Swiss Army knife without a person using it.

I think especially in settings such as healthcare, there will always be the human element to it that just simply cannot be replaced. The communication, the openness of a physician talking to a patient, that essence of healthcare is something that has been crucial for the success of healthcare as a field for centuries, and even millennia, really.

Helen Osborne: I’m excited by your enthusiasm. I’m wowed by your commitment to making this happen, and the possibilities you’re seeing in what the world can be looking like and trying to fix this tough problem of how you communicate about health.

I want to bring this to a close and go back to your origin stories. It sounds like your families’ experiences are what inspired you. What do your families say about the work you’re doing now?

Aditya Tummala: They’re very proud, very happy. Definitely having to keep them up on what’s going on. Everything has been moving so fast. But they’re very happy for us, both Beier and I, and definitely encouraging us on.

Helen Osborne: Beier?

Beier Nelson: I’d say more or less the same thing. It’s very nice to be able to take the stories that we’ve had and use them and try to give back to the community.

Aditya Tummala: I’ll give one nice example, I guess.

Helen Osborne: Sure.

Aditya Tummala: Just during winter break, I visited my grandparents in India and I showed them actually this AI chatbot that Beier just told us about. Really, they were kind of mesmerized.

They didn’t understand exactly what was going on, but it really shows us that there’s a huge potential for things that we can’t even conceive that could be a reality right now, but in 10 years, this could be our everyday world.

Definitely glad to have the family behind us and really encouraging us through the process.

Helen Osborne: Thank you. I’m encouraging you, too. You see the possibilities, you know the technology and you’re making a commitment to make it happen. That’s part of health literacy. That’s health literacy in action.

Thank you both for doing what you’re doing and telling the whole world about it. Thank you for being guests on Health Literacy Out Loud.

Aditya Tummala: Thank you so much for having us, Helen.

Beier Nelson: Thanks for having us, Helen.

Helen Osborne: As you just heard from Aditya Tummala and Beier Nelson, it’s important to communicate about health in all the ways that everyone can understand, regardless of language, culture, background and even confidence in our healthcare system. But doing this is not always easy.

For help clearly communicating your health message, take a look at my book, Health Literacy from A to Z. Feel free to also explore my website, www.HealthLiteracy.com, or contact me directly at helen@healthliteracy.com.

New Health Literacy Out Loud interviews come out the first of every month. Get them all for free by subscribing at www.HealthLiteracyOutLoud.com, or wherever you get your podcasts.

Please help spread the word about 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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