HLOL Podcast Transcripts

Health Literacy

Start by Assuming Your Audience is Smart and Savvy (HLOL #247)

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’s guest is Rohini Khillan, who has been working in the field of public health policy for over a decade with experience in both federal agencies and large nonprofit organizations.

While her focus is primarily on issues of aging and disability, Rohini has worked on a variety of topics that include access to care and socioeconomic disparities.

Much of Rohini’s work is centered on making complex health topics accessible to a variety of lay audiences through written materials and in-person communication.

I met Rohini when she was giving a presentation at a virtual health literacy conference. I was very impressed with what she had to say, especially about the importance to start by assuming that your readers are smart and savvy. I thought that this message was an important one for others to hear.

Rohini, welcome to Health Literacy Out Loud.

Rohini Khillan: Hi, Helen. Thank you so much for having me.

Helen Osborne: I am intrigued. You are dealing with positive attributes of your audience, what they can do, not what they are struggling with. Start from the beginning. Why is it important to start by assuming that your audience is smart and savvy?

Rohini Khillan: In a nutshell, I think a lot of health communication and public health communication over time has tended to be a little bit paternalistic. There is an expert speaking down to you.

I think times have changed a lot, and I think that the greatest change that’s happened is that it is so much easier now to access information for yourself. It’s out there, and it’s almost an inundation. There’s a large, raging river of information.

I think we do our audiences a disservice if we assume that old paternalistic model.

Helen Osborne: By paternalistic, just explain that a bit more. What was that old set of assumptions?

Rohini Khillan: Paternalistic is maybe too simplified a way of putting it, but you have the expert doctor or expert public health person who is the only one who is the arbiter of health information and is providing that information to you.

It used to be you would get information from someone in a white lab coat, or you would get a pamphlet at the doctor’s office. I think we don’t live in that sort of a vacuum anymore. It’s much more widely available.

I think we do messaging a disservice if we assume that it’s happening still in that vacuum and that people are not able to find information from other places and also to understand that information on their own terms and in their own way.

You have to sort of assume that when you’re talking to them, they already come with some level of knowledge, and maybe they’re coming to you for a clarification of that knowledge or a better understanding of the knowledge that they have, which is a different way of looking at it.

Helen Osborne: My background is in healthcare, not public health, but I think we’re all dealing with comparable issues. In healthcare, there are a lot of chronic diseases, so a person has been living with this condition for a long time and they probably have a lot of lived experience and lived knowledge.

Sometimes diagnoses come out of the blue, like, “What? I never heard of that.” Do you use that same assumption to assume that your audience is smart and savvy even if it’s perhaps something they’ve never heard about before?

Rohini Khillan: No. I would say those of us who are trained in health have the most knowledge about it.

To your point about, say, someone living with a chronic condition, I think it is best to assume that the person with the chronic condition or any person knows themselves best. They understand the experience that they’re having best.

How they respond to that experience is going to be different for every person, but it’s not wrong how they respond to their experience.

I’ll just go back to the river metaphor, if I can. Say you’ve been diagnosed with something new and now you can go on Google and you can find all sorts of things: some true, some false, some all over the place. I think our responsibility is not only to guide people across that river of information, but also to teach them how to do that for themselves.

It is understanding, “This is the correct path across this river, and if you find yourself having to cross a river by yourself without me, here is what you should be looking for. Here’s how to understand your condition better.”

Helen Osborne: Then you also said something that was pretty interesting. Even when someone is facing something brand new, they know themselves best. You as the communicator bring in tremendous, it sounds like, respect and appreciation for that lived experience of that person.

Though perhaps they didn’t know the exact thing that you’re talking about, they already know a lot and they know themselves best.

Rohini Khillan: It’s almost helping them sort through what they know and combining it with the science that you know. It’s to help them sort of merge their experience with your experience, but not to assume that they don’t have any experience.

When you’re crafting a message, start backward almost. Start with the person receiving the message. What would they want to hear, as opposed to what you think they should hear?

Helen Osborne: Tell us how that would really happen. Give an example. You’ve worked in public health. Give an example of what that may be like.

Rohini Khillan: Sure. In a lot of places I’ve worked, say you want to do some sort of public health initiative. I’m making this up, but you want to increase exercise. You want people to do more exercise.

Helen Osborne: That’s a pretty common message.

Rohini Khillan: What we found was more effective was to ask people first, to do these really informal surveys about, “When you exercise, what do you do? What motivates you to exercise? What is a challenge you face when you’re trying to do exercise?”

Then taking that and using that to build up, going from the person who’s going to receive the message and using that to craft our message.

Our message ended up being not the typical, “You need to walk 10,000 steps a day,” or, “You have to do 30 minutes a day.”

But as you mentioned, I worked with older audiences, so older people. “Did you get up and wash the dishes today? That was exercise. That counts. You did something. You moved.”

Make it feel like a doable habit.

Helen Osborne: A doable habit. I like that term.

Rohini Khillan: And less like someone is holding you to it. Did your watch measure that you got 10,000 steps? No, but you moved, and that means you engaged. You were physically active in some way.

Did you take a little walk today while listening to this podcast? Could you walk? Could you listen to an audiobook and take a walk?

Just really make it something that feels doable. There’s no punishment aspect of it. If you didn’t do it today, that’s fine. Do it tomorrow, or do it later. Do a smaller bit.

Helen Osborne: I’ve got a few questions. It sounds like, listening to you, it’s really affirming the other person.

Rohini Khillan: Yes.

Helen Osborne: Affirming their life, their routines, their habits and their values. That’s wonderful. I love that by the affirmation model, that positive one, I’m getting it about assuming that they are smart and savvy.

But what you’re talking about is very individualized, and that is very important, but that’s important in a one-to-one conversation. Those of us giving health messages, and I’m sure you do that a lot, too, might give health messages in other ways, whether we do it in writing, in group presentations or virtually.

How do we start with this affirmation model really, but do it for a larger scale, especially when we’re not having that personal conversation?

Rohini Khillan: Often you have to be very broad in your messaging. Again, back to what we were talking about at the beginning, these terms that we use in health and public health no longer exist in a vacuum.

When we say exercise, people are hearing what exercise means from all sorts of sources. They’re seeing a fitness magazine with someone super muscular who works out. Exercise has become a term of art almost.

When we do the messaging, you have to be so broad about it. That’s why I said when we would talk about it to people, it would be really inclusive about what exercise means. Exercise can mean all sorts of things to all sorts of people. You just have to do something that makes you move.

To somebody, maybe it is lifting weights in the gym, and that’s wonderful. That is exercise. For someone else who does not feel like they are at that level, maybe it is just washing dishes or taking a walk or something like that, and you build up from there.

Helen Osborne: I’ve got a couple of questions. Is exercise one of those generic words that we as the communicator have in our mind what it might mean, where the other person might think, “That means going to a gym and there’s no way in the world I’m going to be doing that”?

Is that one of those words? Not only because it’s an odd word, exercise. It’s not spelled the way that it sounds. But it might feel intimidating.

Is that one of those jargon words that we should be watching out for? Should we use “move”? Should we use “activity” or “be active”? What’s your advice about that?

Rohini Khillan: I would advise that you do use the word exercise, but you define it while you are using it. “When I say exercise, what I mean is just move,” or whatever it is.

Of course, that will change also depending on your audience. If you’re talking to very active and excited kids, exercise is not just going to mean “move.” Maybe it means jump around. It could be all sorts of things.

I think it’s hard to get away from jargon because if you don’t use the word exercise, the first question will be, “Do you just mean exercise?”

I think we have to be really smart and savvy ourselves about taking the words that people, our consumers, know. Exercise is a word that everyone knows, however they define it.

Then when we do our message, make sure we define it to them by what we mean and what we are encouraging.

Again, make it sound like it’s something doable, something that they wouldn’t mind doing and they’re not being held to some standard.

Helen Osborne: Learning about your background, your work often has focused on older adults, and even that word is questionable right now. Older than what? But also disability, which is also a questionable word. Is it ability or disability?

How do you tailor this message for someone whose abilities and ages are not the same as yours?

Rohini Khillan: First, I would say I always err on the side of inclusivity and not exclusivity. Always assume the same thing about everyone in your audience.

I don’t want to say lowest common denominator. I don’t mean that at all. But your messaging should always be at the 30,000-foot level, if that makes sense, and not down too specifically, meaning it should be as inclusive to the audience that you perceive, however you perceive them, as possible without making too many assumptions.

I would only just push back on this a little bit because especially in the aging and disability spaces, and I don’t wish to speak for either community in too much detail, but I have learned through my interactions with them that often, especially in the aging one, there is a resentment toward having made those assumptions when you come in.

“I see this audience of people with generally white and gray hair. Therefore, I should assume that they cannot do X.” That becomes a problem in messaging as well, because again in the aging space especially, people feel like, “Why are you talking to me like I’m a child? I do exercise. In fact, I lift more weights than you do.” Most of them do.

Helen Osborne: What I’ gather by listening to this is I, as a communicator, should not make assumptions about you as my audience. You as my audience, in turn, should probably not make assumptions about me.

The assumptions could be, “What does she know? I’ve lived decades longer. I have all this life experience.” It sounds like it’s really that foundation of mutual respect.

The other part of this has to do with appreciating what we do with our acknowledged differences.

Rohini Khillan: The way I have learned through my various experiences is when you are crafting a message, you should think about it as if you are meeting your friend for lunch, and they know what you do for a living, you know what they do for a living and it’s not the same thing.

They say, “Hey, Rohini. I just heard this story on NPR,” or, “I saw this tweet that said X, and it’s about health. You’re a health person. Can you explain it to me?” It should be that level of communication. You respect your friend, you know where your friend is and you’re talking to them like a friend.

Again, that sounds like you’ve boiled it down, but you should speak to everyone at that level as if you are meeting someone you are close to at lunch. You have a healthy respect for their intelligence, they have a healthy respect for yours, but this is a topic you know and that’s why they’ve asked you about it.

Helen Osborne: Thank you. It sounds like it’s really that core of respect, which gets back to assuming they are smart and savvy. You just have expertise in whatever that subject matter is. They have expertise in their lived experience.

Just a few more tips for our listening audience. I’m assuming they want to know more, too. What else can we be doing when we craft these messages?

Rohini Khillan: I’ve touched on it a little bit, but you want to avoid this deficit perspective. We’ve sort of talked about this in a lot of ways.

Whoever you’re communicating with, you don’t want to talk to them like they lack something. You want to talk about how you can positively build upon what they already have.

It’s not saying, “You don’t have this, and therefore you must do this to achieve this level, to achieve this condition or improve this condition.” It should be, “Based on where you are, you could do this, you could do this and then we can build on what you’ve already got.”

On the exercise thing, like I said, it’s not, “You haven’t gotten out of your chair in six months. It doesn’t look good for you.” It’s not like that.

It’s, “Start by listening to music and tapping your feet a lot,” meaning work with a person from where they are and build them up. Give them options that help them get to where they need to go at their own pace in a way that doesn’t seem onerous.

Helen Osborne: And it sounds doable, too.

These are health literacy principles here. I’m appreciating that you’re articulating them.

As people who care about communicating health information, be it in clinical settings, public health or community organizations, we want to help people get better. We know about the basics of health literacy and plain language, but it sounds like what you’re offering is building on what we already know.

My overall take from what you’re talking about is to just assume they are smart and savvy, and that this is going to be doable at their own pace.

Rohini Khillan: Absolutely. So much of it is just about your tone. So much of it is just about what you can give them that they may not be able to get elsewhere.

They have access to information, but you’re there to help them understand it better. You’re there to help walk them through it maybe, not to assume that they’ve never heard of this, that they have no idea what’s going on or that they don’t experience it themselves.

That very friendly tone is really what’s key because often, especially in public health messaging, I think there’s a struggle a little bit sometimes to achieve that right tone so it doesn’t sound so much like you’re putting down some sort of proverb on people or mandating some sort of behavior.

When you meet them where they are, they’re able to adjust. They feel like the adjustment is not as onerous as it might be otherwise.

Helen Osborne: Thank you. I think that’s a good place to put a pause in this conversation about meeting people where they are.

This podcast is for health communicators. We already know a lot, we already care a lot, but we can always make it better. What you’re adding is the importance of tone or a reminder about the tone.

Also, not dealing with that deficit model of, “They don’t know much. They don’t know this topic. Maybe they’re not strong in this area, and we know better about what’s good for them.” It’s building in this respectful tone regardless of how we communicate.

Rohini, thank you, thank you, thank you. You make my day listening to you. You’ve reinforced important messages and added new information. That’s what health literacy is all about. Thank you so much for being a guest on Health Literacy Out Loud.

Rohini Khillan: Thank you, Helen. It was a pleasure.

Helen Osborne: As we just heard from Rohini Khillan, it’s important to start by assuming that our audience is smart and savvy, and build in a tone of respect and inclusivity. But doing all of this is not always easy.

For help clearly communicating your health message, please 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 wide 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