tag:theconversation.com,2011:/global/topics/health-literacy-8952/articlesHealth literacy – The Conversation2023-05-08T20:38:22Ztag:theconversation.com,2011:article/2050062023-05-08T20:38:22Z2023-05-08T20:38:22ZTaking mental wellness education beyond the campus: How universities can help respond to the mental health care crisis<figure><img src="https://images.theconversation.com/files/524952/original/file-20230508-247781-din9x1.jpg?ixlib=rb-1.1.0&rect=286%2C215%2C5322%2C3485&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The growing interest in wellness is an opportunity for universities to provide evidence-based information beyond campuses, in the broader community. </span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>The <a href="https://cmha.ca/fast-facts-about-mental-illness">Canadian Mental Health Association estimates that</a> one in five Canadians will experience a mental health challenge. The full impact of mental health issues is even broader: almost every adult Canadian at some point has either been directly affected, or has a family member, friend or colleague with a mental health issue. </p>
<p>In terms of economic cost, mental health issues cost the Canadian government <a href="https://www.mentalhealthcommission.ca/wp-content/uploads/drupal/2016-06/Investing_in_Mental_Health_FINAL_Version_ENG.pdf">approximately $50 billion annually</a>. </p>
<p>Although these figures are staggering, they are not surprising. The issue is not about delineating the problem but about what to do about it.</p>
<p><a href="https://www.ontariofamilyphysicians.ca/news-features/news/%7E287-More-Than-2-2-Million-Ontarians-Left-Without-a-Family-Doctor">Family doctor shortages</a>, <a href="https://theconversation.com/emergency-department-crowding-has-gone-beyond-hallways-onto-ambulance-ramps-now-theres-nowhere-left-to-wait-200420">emergency rooms over capacity</a> with periodic <a href="https://www.thestar.com/news/canada/2023/02/21/star-analysis-reveals-staggering-number-of-hospital-emergency-department-closures-in-ontario.html#:%7E:text=Hospital%20emergency%20departments%20across%20Ontario,could%20not%20be%20met%20locally.">closures due to low staff numbers</a> and long <a href="https://www.ctvnews.ca/health/canadians-still-waiting-significantly-longer-for-surgeries-than-before-pandemic-report-1.6325176">wait times for surgeries</a>, are just some examples of the overburdened health-care system across Canada. Mental health <a href="https://www.cbc.ca/radio/checkup/mental-health-service-climbs-waitlists-too-1.6798601">care can be even further delayed</a> than physical health care. </p>
<p>Increasing funding for health care may not change the landscape of mental health care.</p>
<h2>Complicating the mental health care issue</h2>
<p>It’s not just about illness, it is also about wellness. The government of Canada defines mental health as, “<a href="https://www.canada.ca/en/public-health/services/about-mental-health.html#:%7E:text=For%20more%20information-,What%20is%20mental%20health%3F,to%20mental%20and%20physical%20illness">the state of your psychological and emotional well-being</a>.” Wellness is multidimensional, often viewed comprising eight elements: <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5508938/#">emotional, physical, occupational, social, spiritual, intellectual, environmental and financial</a>. A reduction in any one of these areas can decrease well-being and quality of life. </p>
<figure class="align-center ">
<img alt="Blocks forming an image of a full batter icon inside the outline of a person's head" src="https://images.theconversation.com/files/524953/original/file-20230508-105550-ibasyb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/524953/original/file-20230508-105550-ibasyb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=289&fit=crop&dpr=1 600w, https://images.theconversation.com/files/524953/original/file-20230508-105550-ibasyb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=289&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/524953/original/file-20230508-105550-ibasyb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=289&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/524953/original/file-20230508-105550-ibasyb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=363&fit=crop&dpr=1 754w, https://images.theconversation.com/files/524953/original/file-20230508-105550-ibasyb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=363&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/524953/original/file-20230508-105550-ibasyb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=363&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Wellness is multidimensional, often viewed comprising eight dimensions: emotional, physical, occupational, social, spiritual, intellectual, environmental and financial.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>It is estimated that the global “wellness market” is <a href="https://www.mckinsey.com/industries/consumer-packaged-goods/our-insights/feeling-good-the-future-of-the-1-5-trillion-wellness-market">more than US$1.5 trillion with an estimated increase of over five per cent per year</a>. There is both an increase in consumer interest and in consumer purchasing of wellness-related products. </p>
<p>From an educational perspective, this interest in wellness can be mobilized to improve people’s quality of life, regardless of an individual’s starting point. However, with misinformation proliferating on media outlets, it is imperative that the information the public receives is evidence-based. </p>
<h2>The education of wellness</h2>
<p>Education is widely recognized as a <a href="https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1">social determinant of health</a>, on par with factors like income, housing and access to health-care services. Researchers have also noted the importance of education as a <a href="https://doi.org/10.1177%2F0020731415585986">crucial aspect of public health action</a>.</p>
<p>Universities are about education and research. Unfortunately access to such can be limited to those who have the pre-requisites and the money to pay for higher education, leaving out a large segment of the population. However, everyone can benefit from wellness research if it is delivered in an accessible format that is affordable. </p>
<p>Universities are ideally positioned to not only create knowledge but to broker knowledge by delivering science-based wellness information to the general public.</p>
<p>The <a href="https://carleton.ca/mental-health/">Mental Health and Well-Being Research and Training Hub (MeWeRTH)</a> at Carleton University, where Joanna Pozzulo is director and Anna Stone is an administrator, was launched in December 2020. Its main mission is mobilizing knowledge to improve daily life. </p>
<figure class="align-center ">
<img alt="A person out of frame in the foreground participating in an online meeting" src="https://images.theconversation.com/files/524695/original/file-20230505-27-7okuda.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/524695/original/file-20230505-27-7okuda.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/524695/original/file-20230505-27-7okuda.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/524695/original/file-20230505-27-7okuda.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/524695/original/file-20230505-27-7okuda.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/524695/original/file-20230505-27-7okuda.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/524695/original/file-20230505-27-7okuda.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Universities are ideally positioned to be not only knowledge creators but knowledge brokers by delivering science-based wellness information to the general public.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>To this end, we offered non-credit wellness courses to the general public and evaluated whether these science-based courses promoted 1) mental health and well-being and 2) engagement with course material outside of class time.</p>
<p>We offered four wellness courses that were advertised to the broader, local community: </p>
<ol>
<li>The Benefits of Nature on our Well-being, </li>
<li>Me, Myself and I: Exploring the Psychology of Solitude, </li>
<li>Maintaining Wellness Amid Chronic Illness and </li>
<li>Parenting your Child/Teen with ADHD. </li>
</ol>
<p>Courses consisted of 12 hours of instruction over six weeks, using a virtual platform in real time, with no pre-requisites. Cost per course was $200 per participant to cover administrative expenses. Course size was limited to 20 people per course to facilitate discussion and engagement with the material. </p>
<p>Instructors were content experts with graduate level degrees. Participants ranged in age from 16 to 75 years old from various backgrounds, and a range of experience with educational institutions (i.e., ranging from some high-school level education to doctoral level degrees).</p>
<p>A small sample of seven participants completed pre- and post- evaluations. Overall, these participants reported an increase in well-being after completing the course. However, they did not report an increase in mental health, which may highlight the difference in these two concepts. It’s also important to note that respondents reported having started their course in “good mental health.” </p>
<p>Respondents indicated that they sometimes engaged with the material outside of class time, but that their behaviour did not change. It is unclear whether respondents took the course with the intention to change their behaviour.</p>
<p>Respondents also indicated that they shared some of the material they learned with friends, suggesting that these courses have the potential to create a community for improved well-being that extends beyond the classroom.</p>
<h2>A path forward</h2>
<p>Universities are well positioned to offer wellness education to a general public in an accessible format. There is interest from community members to take these courses with course content having the ability to improve well-being. Moreover, by students in these courses sharing the knowledge learned, well-being is passed on to others thereby creating a “more well” community. </p>
<p>Fees for these non-credit courses can be prohibitive which represents an on-going challenge on how to fund this type of education. As well, more research is needed to understand the relationship between well-being and mental health.</p><img src="https://counter.theconversation.com/content/205006/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Joanna Pozzulo receives funding from Social Sciences and Humanities Research Council. She is director of the Mental Health and Well-Being Research and Training Hub (MeWeRTH) at Carleton University.</span></em></p><p class="fine-print"><em><span>Anna Stone works for the Mental Health and Well-Being Research and Training Hub (MeWeRTH) at Carleton University.</span></em></p>Mental health isn’t just about illness, it is also about wellness. Universities are well positioned to offer accessible, evidence-based wellness education to the general public.Joanna Pozzulo, Chancellor's Professor, Psychology, Carleton UniversityAnna Stone, M.A. student, Psychology, Carleton UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1748982022-02-07T16:01:37Z2022-02-07T16:01:37ZFrom health to the environment, how comics could drive behaviour change<figure><img src="https://images.theconversation.com/files/444568/original/file-20220204-17-109eg1c.jpg?ixlib=rb-1.1.0&rect=1%2C0%2C1235%2C810&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">An image from Plastic Nightmare.</span> <span class="attribution"><span class="source">Jim Lavery</span>, <span class="license">Author provided</span></span></figcaption></figure><p>When we hear the word “comic”, graphic novels oozing with superheroes, villains and other colourful characters are likely to come to mind. It’s true that comics are, traditionally, fictional tales condensed into compelling visual narrative. But since their infancy <a href="https://the-artifice.com/history-of-comics/">in the 1920s</a>, and evolution to superhero fiction in the 1960s, comics have been adapted to various fiction subgenres – and to non-fiction contexts too.</p>
<p>Today, comics are increasingly used to educate and influence attitudes and behaviour in <a href="https://www.sciencedirect.com/science/article/abs/pii/S2214635021001581">various settings</a>. Comics can support our understanding of <a href="https://www.bmj.com/content/340/bmj.c863">health information</a> – an area we call “<a href="https://pubmed.ncbi.nlm.nih.gov/22282425/">graphic medicine</a>”. They can also be used as an educational tool when it comes to <a href="https://www.erudit.org/en/journals/mcr/2013-v77-78-mcr77_78/mcr77_78art01/">environmental issues</a> – these are sometimes called “eco-comics”.</p>
<h2>Graphic medicine</h2>
<p>Comics which visually explain health treatments and complex medical procedures can improve physical and mental <a href="http://repository.tavistockandportman.ac.uk/1230/">health literacy</a> and help people to <a href="https://journals.sagepub.com/doi/abs/10.1177/1757975918798364">keep taking their medications</a>. They can also help <a href="https://journals.sagepub.com/doi/full/10.1177/1054773821994851?casa_token=c6gzqMQGxNAAAAAA%3ATeVm1ObmQg_wpVE-aawa23Z-Z6OFCeFSp4rb7rtr3KiX_ekBjihFvn6BDNWvSvYdSwuO4WW39z8">alleviate anxiety</a> in patients before surgery.</p>
<p>By providing accessible health information and advice, comic novels can also encourage people to engage in <a href="https://link.springer.com/article/10.1007/s13187-017-1241-4">health screening</a>, helping prevent <a href="https://www.sciencedirect.com/science/article/pii/S0749379717302064">chronic conditions</a>.</p>
<figure class="align-left ">
<img alt="The cover page of the first issue of the 'Plastic Nightmare' comic. The illustration depicts a predatory creature above a university campus." src="https://images.theconversation.com/files/444525/original/file-20220204-19-ag7vh2.PNG?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/444525/original/file-20220204-19-ag7vh2.PNG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=808&fit=crop&dpr=1 600w, https://images.theconversation.com/files/444525/original/file-20220204-19-ag7vh2.PNG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=808&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/444525/original/file-20220204-19-ag7vh2.PNG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=808&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/444525/original/file-20220204-19-ag7vh2.PNG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1016&fit=crop&dpr=1 754w, https://images.theconversation.com/files/444525/original/file-20220204-19-ag7vh2.PNG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1016&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/444525/original/file-20220204-19-ag7vh2.PNG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1016&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">One of the comics we have developed, Plastic Nightmare.</span>
<span class="attribution"><span class="source">Jim Lavery</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>During the current pandemic, comics and images extracted from comics have been used to convey how COVID-19 is spread, and how our behaviour can affect its spread.</p>
<p>Health researchers believe that comics not only provide a more <a href="https://www.tandfonline.com/doi/full/10.1080/17453054.2020.1761248">accessible medium</a> for disseminating important public health information, but that readers can relate to and develop empathy for the comic characters. This can influence their perceptions of health risk. In turn, they may be inclined to imitate the behaviour of these characters (a concept called modelling) if the observed behaviour results in a favourable outcome.</p>
<p>There has also been a steady growth of comics used to convey patients’ lived experiences of <a href="https://link.springer.com/article/10.1007/s10912-011-9158-0">chronic physical illness</a> and <a href="https://www.tandfonline.com/doi/full/10.1080/21504857.2020.1773885">mental health conditions</a>.
These comics provide a resource for others who are dealing with similar health challenges, by validating experiences such as fear, uncertainty, and isolation, and presenting <a href="https://muse.jhu.edu/article/748214/pdf?casa_token=rTWPhUd4cgYAAAAA:dazogQ0oHvoqRV8xMi5eCES1uSBl6esaQrEyME2TJif9Z8lRQAyEJfNYRYmpoqZKHnrolrmw">advice and solutions</a> through the narrative.</p>
<p>Comics depicting lived experience of illness may also help healthcare providers <a href="https://journalofethics.ama-assn.org/article/graphic-pathographies-and-ethical-practice-person-centered-medicine/2018-02">empathise</a> with their patients, which can improve the quality of care they provide.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/soap-operas-can-deliver-effective-health-education-to-young-people-new-research-175087">Soap operas can deliver effective health education to young people – new research</a>
</strong>
</em>
</p>
<hr>
<p>I recently developed a comic called “Diabetes Cyberspace” together with a <a href="https://twitter.com/jimlavery1?lang=en-GB">comic artist</a> and a group of young people living with type 1 diabetes from the UK, Ireland and Denmark. The narrative of the comic was informed by themes generated through interviews with these young people (our findings are published as a <a href="https://psyarxiv.com/b5nku">pre-print</a>). The comic tells the story of a young person with type 1 diabetes and the impact that diabetes-related social media content has on their mental wellbeing.</p>
<p>The comic is intended to be used as an educational resource to convey some of the challenges that young people with type 1 diabetes experience. It also provides advice and tips to help young people with the condition deal with unhelpful content online. </p>
<figure class="align-right ">
<img alt="The cover page of the first issue of the 'Diabetes Cyberspace' comic. The illustration depicts three people in a car, including a young person on a smartphone." src="https://images.theconversation.com/files/444555/original/file-20220204-19-g548oi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/444555/original/file-20220204-19-g548oi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=819&fit=crop&dpr=1 600w, https://images.theconversation.com/files/444555/original/file-20220204-19-g548oi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=819&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/444555/original/file-20220204-19-g548oi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=819&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/444555/original/file-20220204-19-g548oi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1029&fit=crop&dpr=1 754w, https://images.theconversation.com/files/444555/original/file-20220204-19-g548oi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1029&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/444555/original/file-20220204-19-g548oi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1029&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Diabetes Cyberspace.</span>
<span class="attribution"><span class="source">Jim Lavery</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Research has demonstrated the potential benefits of comics as communication tools in the areas of <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/hir.12145">physical</a> and <a href="http://repository.tavistockandportman.ac.uk/1230/1/Farthing%20-%20Graphic%20Medicine.pdf">mental health</a>. But most of the existing evidence on comics is speculative, based on <a href="https://mh.bmj.com/content/38/1/21.abstract?casa_token=osxaPORLufUAAAAA:ZNd8hJoOb8Vnnt2VVA9iXiK6gf2CnanwyIUrqdZBG5fi2n98EXWqgR3Tql3pGkk_5FUVxPabnQ">theoretical studies</a> (where researchers observe and analyse the contents of the comic) and small <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/hir.12145">qualitative</a> studies.</p>
<p>With a lack of <a href="https://mh.bmj.com/content/40/1/49.full?casa_token=D1fj2E60YUkAAAAA:dbROr7i2XiBiCUgWbCkiTQt43xRS-Jj59HmjF9OQSr8hqnhU5MYM3MJ6z27AEBxss_o0Ooyv9g">empirical studies</a> examining the effectiveness of comics to influence health-related outcomes such as knowledge and behaviour change, it’s difficult to understand the scale of their impact. </p>
<p>We hope the Diabetes Cyberspace comic can be evaluated to explore its effectiveness as an educational resource and communication tool for young people with type 1 diabetes and their caregivers, and in turn go some way to filling this knowledge gap.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/pow-comics-are-a-way-to-improve-queer-mens-body-image-119582">Pow! Comics are a way to improve queer men's body image</a>
</strong>
</em>
</p>
<hr>
<h2>Eco-comics</h2>
<p>Comics have also been used to enhance learning about <a href="https://www.erudit.org/en/journals/mcr/2013-v77-78-mcr77_78/mcr77_78art01/">environmental issues</a>. As with graphic medicine, the body of evidence exploring the capacity for ecological comics to influence environmental attitudes and behaviour is sparse. </p>
<p>But recently the use of an <a href="https://www.mdpi.com/2071-1050/11/11/3148">eco-comic</a> in primary schools in east Africa demonstrated positive results. Questionnaires indicated the children had enhanced conservation knowledge immediately after and, again, one year after they were exposed to the comic. </p>
<p>In other research, a comic which illustrated more sustainable ways of disposing of waste resulted in significant improvements in <a href="https://www.researchgate.net/profile/Blessing-Ario/publication/344693332_Assessing_the_Effectiveness_of_Comic-Style_Illustrations_for_Promoting_Environmental_Sustainability/links/5f89cce0299bf1b53e2c247d/Assessing-the-Effectiveness-of-Comic-Style-Illustrations-for-Promoting-Environmental-Sustainability.pdf">waste disposal habits</a> among people in Nigeria.</p>
<p>By providing information in a more accessible way, these studies highlight the potential for eco-comics to increase environmental literacy and promote conservation.</p>
<figure class="align-center ">
<img alt="A scene from the comic 'Plastic Nightmare'. It depicts a dinosaur looking in through the window of a science lab." src="https://images.theconversation.com/files/444567/original/file-20220204-13-168civr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/444567/original/file-20220204-13-168civr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=268&fit=crop&dpr=1 600w, https://images.theconversation.com/files/444567/original/file-20220204-13-168civr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=268&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/444567/original/file-20220204-13-168civr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=268&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/444567/original/file-20220204-13-168civr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=337&fit=crop&dpr=1 754w, https://images.theconversation.com/files/444567/original/file-20220204-13-168civr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=337&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/444567/original/file-20220204-13-168civr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=337&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">An image from Plastic Nightmare.</span>
<span class="attribution"><span class="source">Jim Lavery</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>We have also recently developed an <a href="https://www.qub.ac.uk/sites/StaffGateway/staff-blog/SupportingsustainabilitythroughcollectivecreativityCo-designingtheQueensGreenComic.html">ecological comic</a>, called “Tales of Ecological Terror – A Plastic Nightmare.” We hosted face-to-face and online workshops with students and staff from diverse disciplines across Queen’s University Belfast to co-design the comic.</p>
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Read more:
<a href="https://theconversation.com/kapow-zap-splat-how-comics-make-sound-on-the-page-160455">Kapow! Zap! Splat! How comics make sound on the page</a>
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<p>The comic aims to raise awareness of the harmful impact of plastic waste and the importance of waste reduction and recycling through a fun yet emotive narrative. We envisage that the comic will be piloted in different educational settings to measure its potential impact on ecological literacy, attitudes and behaviour.</p><img src="https://counter.theconversation.com/content/174898/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Emma Berry does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>We’ve developed two comics – one which we hope will help young people with diabetes, and another which we hope will raise awareness about the issue of plastic waste.Emma Berry, Lecturer in Health Psychology, Queen's University BelfastLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1736362022-01-13T19:48:45Z2022-01-13T19:48:45ZIn a pandemic, ignoring science affects everyone. Citizenship education can help ensure that doesn’t happen<figure><img src="https://images.theconversation.com/files/439270/original/file-20220104-25-1doptb.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C3443%2C2117&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Disregard for public health, like protests at hospitals challenging vaccine passports, seen at this event in September 2021 in Toronto, show schools need to expand how they teach what it means to be a responsible global citizen. </span> <span class="attribution"><span class="source">THE CANADIAN PRESS/Chris Young </span></span></figcaption></figure><p>Since early 2020, our way of life has changed dramatically. COVID-19 has transformed how we study, learn and work — even how we shop, eat and gather.</p>
<p>Throughout the pandemic, <a href="https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection/health-professionals/public-health-measures-mitigate-covid-19.html">Canada has implemented individual and community-based measures</a> to protect its citizens. While <a href="https://www.environicsinstitute.org/docs/default-source/default-document-library/cot2021-report1-final_corrected-ap-19.pdf?sfvrsn=6f378628_0">most Canadians have trusted and listened to the scientists and public health experts</a>, too many have ignored the science — <a href="https://theconversation.com/covid-19-freedom-rallies-actually-undermine-liberty-heres-why-161863">protesting mask wearing, social distancing and vaccination</a>.</p>
<p>Those who have failed to comply with these protocols have prolonged the pandemic and put their fellow citizens at risk. This troubling issue requires attention and future action, <a href="https://doi.org/10.1007/s11125-021-09594-2">including addressing it through education</a>. </p>
<h2>Responsible citizenship and education</h2>
<p>Responsible citizenship is fundamental in a democratic society — and with it comes the responsibility to not engage in behaviour that endangers the health and well-being of neighbours. </p>
<p>Noted professors of citizenship education, Joel Westheimer and Joseph Kahne, tie <a href="https://doi.org/10.3102%2F00028312041002237">good citizenship</a> to an active democratic citizenry. They stress the importance of teaching about following the law and becoming a personally responsible citizen, engaging in civic affairs and becoming a participatory citizen, and challenging social inequities by becoming a justice-oriented citizen.</p>
<p>In recent years, as a result of growing global challenges — such as <a href="https://globecit.com/global-citizenship-in-a-covid-19-world/">poverty, hunger, public health and climate change</a> — the concept of responsible citizenship has expanded to include <a href="https://journals.sfu.ca/jgcee/index.php/jgcee/article/view/213/443">global belonging and commitment</a>. </p>
<p>Global citizenship seeks to <a href="https://teachingsocialstudies.org/2021/08/05/global-citizenship-education-and-liberal-democracy/">unite people within and across countries in common cause to bridge national divides to address seminal challenges facing the world</a>. Global citizenship in many ways seeks to fulfil the <a href="https://sdgs.un.org/goals">United Nations Sustainable Development Goals</a> designed to confront pressing global issues. </p>
<p>In schools, “<a href="https://en.unesco.org/themes/gced">global citizenship education</a>” aims to provide students with the knowledge, skills and values to become responsible citizens and learn to address a range of generational challenges. Schools in several countries, <a href="https://www.doi.org/10.5038/2577-509X.4.2.1121">including Canada, have started to recognize the importance of these educational goals</a>. Several provinces, such as Alberta, British Columbia, Manitoba, Nova Scotia, Ontario and Québec, have <a href="https://www.unicef.ca/sites/default/files/imce_uploads/UTILITY%20NAV/TEACHERS/DOCS/GC/ChartingGlobalEducationinElementarySchools.pdf">integrated global citizenship education into their social studies curricula</a> in the past few decades. </p>
<p>Canadian intergovernmental bodies representing every provincial ministry of education, including the <a href="https://www.cmec.ca/en/">Council of Ministers of Education, Canada (CMEC)</a>, have emphasized the importance of global citizenship education among other priorities. In its recent <a href="https://static1.squarespace.com/static/5af1e87f5cfd79c163407ead/t/5e20d79f9713f543996da6ad/1579210656022/Pan-Canadian+Systems-Level+Framework+on+Global+Competencies_EN.pdf"><em>Pan-Canadian Systems-Level Framework on Global Competencies</em></a>, CMEC laid out six global competencies for students: global citizenship and sustainability; critical thinking and problem solving; innovation, creativity and entrepreneurship; learning to learn and to be self-aware and self-directed; and collaboration. </p>
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<img alt="A man in a face mask walks past a wall spraypainted with 'covid is a lie' and 'the news is the virus.'" src="https://images.theconversation.com/files/440782/original/file-20220113-19-m8eif3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/440782/original/file-20220113-19-m8eif3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=375&fit=crop&dpr=1 600w, https://images.theconversation.com/files/440782/original/file-20220113-19-m8eif3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=375&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/440782/original/file-20220113-19-m8eif3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=375&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/440782/original/file-20220113-19-m8eif3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=471&fit=crop&dpr=1 754w, https://images.theconversation.com/files/440782/original/file-20220113-19-m8eif3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=471&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/440782/original/file-20220113-19-m8eif3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=471&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">After the COVID-19 pandemic, curriculum should engage students in discussions about how responses to public health messaging interact with being a responsible global citizen.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Graham Hughes</span></span>
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<h2>Contemplating post-pandemic citizenship</h2>
<p>Despite these curricular trends, issues that have come to light in the pandemic have shown that the goals of global citizenship education must adapt. </p>
<p>These include the disregard for public health protocols, the undermining of science, the spread of misinformation and the lack of concern for others (particularly for seniors, <a href="https://www.cdc.gov/aging/covid19/covid19-older-adults.html#:%7E:text=Older%20adults%20are%20more%20likely,60s%2C%2070s%2C%20and%2080s.">who are more likely to get very ill with COVID-19</a>, and for those with underlying health conditions).</p>
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Read more:
<a href="https://theconversation.com/the-urgent-need-for-media-literacy-in-an-age-of-annihilation-117958">The urgent need for media literacy in an age of annihilation</a>
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<p>It is increasingly important that the next generation of Canadian students learn how to navigate the many increased challenges of a post-COVID-19 world. Research from the Center for Global Development noted that “<a href="https://www.cgdev.org/blog/the-next-pandemic-could-come-soon-and-be-deadlier">the next pandemic could be much sooner and more severe than we think</a>.” </p>
<p>In light of the lessons of COVID-19, schools across Canada should consider offering a social studies elective course that emphasizes post-pandemic values, including commitment to public health, empathy and compassion, self-sacrifice and a co-operative spirit. Such a “post-pandemic citizenship” education could help prepare the next generation of Canadians to promote the kind of values sometimes lacking during the pandemic. </p>
<h2>Health literacy, compassion</h2>
<p>First, the course should include issues of public health. It could, for example, use online tools and platforms to teach students <a href="https://www.who.int/activities/improving-health-literacy">health literacy</a>. As noted by the World Health Organization, health literacy implies equipping people to “play an active role in improving their own health, engage successfully with community action for health, and push governments to meet their responsibilities in addressing health and health equity.”</p>
<p>Researchers from the Healthy Schools Lab at the University of Alberta noted that when education went online due to pandemic closures, provincial guidelines for at-home learning <a href="https://hslab.ca/2020/03/24/health-and-physical-education-in-the-midst-of-a-pandemic">did not include a focus on health and physical education</a>.</p>
<p>The course also could examine how other countries handled COVID-19 and prior epidemics or ask students to devise a plan for combating the next pandemic. </p>
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<img alt="Students standing in a hallway in face masks." src="https://images.theconversation.com/files/439747/original/file-20220106-12389-1tsh5k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/439747/original/file-20220106-12389-1tsh5k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/439747/original/file-20220106-12389-1tsh5k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/439747/original/file-20220106-12389-1tsh5k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/439747/original/file-20220106-12389-1tsh5k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/439747/original/file-20220106-12389-1tsh5k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/439747/original/file-20220106-12389-1tsh5k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Students should have the opportunity to devise plans to combat pandemics.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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<p>Second, there should be an emphasis on empathy and compassion, including its impact on positive health outcomes. In Canada, there have been efforts to impart empathy in the classroom and these efforts should continue. For example, Canadian educator Mary Gordon founded <a href="https://rootsofempathy.org/">Roots of Empathy</a> more than two decades ago. This program seeks to <a href="https://www.usnews.com/news/best-countries/articles/2017-12-20/canadian-classroom-program-aims-to-teach-children-compassion">develop students’ emotional and social competencies, resulting in less aggression and bullying</a>. </p>
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Read more:
<a href="https://theconversation.com/strong-relationships-help-kids-catch-up-after-6-months-of-covid-19-school-closures-145085">Strong relationships help kids catch up after 6 months of COVID-19 school closures</a>
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<h2>Self and community interest</h2>
<p>At the same time, the course should stress self-sacrifice. From reviewing case studies on those who disregarded public health recommendations at the expense of others, to debating situations where <a href="https://doi.org/10.22381/KC83202012">collective responsibility should transcend individual self-interest</a>, these lessons can be instructive. </p>
<p>For instance, the Winnipeg School Division recently released an <a href="https://www.winnipegsd.ca/page/8804/education-for-sustainable-development">Education for Sustainable Development Plan</a> to teach students about collective responsibility in such areas as human rights, environmental protection and reducing poverty. </p>
<p>Studies of collective responsibility should include examining issues around equity due to the <a href="https://www.canada.ca/en/public-health/corporate/publications/chief-public-health-officer-reports-state-public-health-canada/from-risk-resilience-equity-approach-covid-19.html">disproportionate impact of the pandemic on marginalized communities in Canada</a>. </p>
<p>Studying documents like the <a href="https://www.canada.ca/en/canadian-heritage/services/how-rights-protected/guide-canadian-charter-rights-freedoms.html">Canadian Charter of Rights and Freedoms</a> also can shed light on the critical role of government mitigation strategies in supporting the collective dignity and rights of citizens. </p>
<h2>Collective good at stake</h2>
<p>By embracing a co-operative spirit, students can appreciate local examples of community involvement, or consider when public and private sector institutions should collaborate for the good of society at home and abroad. </p>
<p>For instance, <a href="https://www.international.gc.ca/world-monde/stories-histoires/2021/education_covid-19.aspx?lang=eng">Toronto’s Bloorview School Authority, which provides school programs to children with special needs who are undergoing intensive therapies, has partnered with UNICEF Canada</a> to raise funds for necessary school equipment for students in Malawi. A Bloorview teacher noted that the project, known as <a href="https://www.unicefusa.org/mission/protect/education/kids-need-desks-kind">Kids in Need of Desks</a>, helps students understand what it means to be global citizens in a pandemic. This is even as they deal with their own learning disruptions due to COVID-19 while managing other challenges.</p>
<p>This is just a starting point. Over time, Canadian schools will need to continue to re-examine and rewrite social studies curricula to groom the next generation of citizens for a post-pandemic world. The collective good and responsible citizenship are at stake.</p><img src="https://counter.theconversation.com/content/173636/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Evan Saperstein does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The failure to observe public health protocols during the pandemic requires attention and action. Revitalizing global citizenship education in schools should be part of addressing the problem.Evan Saperstein, Postdoctoral Fellow, Citizenship Education and History Teaching Research Lab, Université de MontréalLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1738052022-01-11T13:36:27Z2022-01-11T13:36:27ZConfused by what your doctor tells you? A new study discovers how communication gaps between doctors and patients can be cured<figure><img src="https://images.theconversation.com/files/438464/original/file-20211220-13-ivqi91.jpg?ixlib=rb-1.1.0&rect=0%2C512%2C6872%2C4140&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A new study identifies significant language barriers between doctors and their patients. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/just-relax-royalty-free-image/1320931826?adppopup=true">ljubaphoto/E+ via Getty Images</a></span></figcaption></figure><p><em>The <a href="https://theconversation.com/us/topics/research-brief-83231">Research Brief</a> is a short take about interesting academic work.</em> </p>
<h2>The big idea</h2>
<p>Most doctors use language that is too complex for their patients to understand, but some have the unique ability to tailor their language to meet their patients’ communication needs and overcome the confusion that is so common in health care. These are the key findings of <a href="https://doi.org/10.1126/sciadv.abj2836">our new study</a> recently published in Science Advances. </p>
<p>This language-matching strategy – what we call “precision communication” – appears to be especially helpful for the one in three Americans who have low health literacy. Prior studies have shown that individuals with low health literacy have <a href="https://doi.org/10.1016/S0738-3991(03)00107-1">worse comprehension</a> of medical information and instructions and <a href="https://doi.org/10.1001/jama.288.4.475">poorer health outcomes</a> compared with those with adequate health literacy. </p>
<p>To conduct our research, we analyzed hundreds of thousands of secure email messages between doctors and patients with diabetes. Using sophisticated computational linguistics techniques, our research team discovered that only about 40% of patients with low health literacy have a doctor who adapts the complexity of their language to match the language their patient uses. We also found that even fewer patients are cared for by doctors who are consistently attuned to the kind of language that their patients use – whether it be low or high health literacy – and then adapt their communication accordingly. </p>
<p>We found that patients fortunate enough to be under the care of doctors who practice this form of precision communication were better able to understand and act on their doctors’ advice and instructions. Patients whose doctors don’t match their language to their patients’ health literacy are more likely to be confused and may get sicker. The benefit of this approach was so strong as to eliminate the usual gaps in understanding between patients of low and high health literacy.</p>
<h2>Why it matters</h2>
<p>Perhaps no health care experience is more universal than being sick and not understanding one’s doctor. Not only is this a frustratingly common – and often dangerous – experience, it’s also a massive and costly <a href="https://doi.org/10.17226/10883">public health problem</a>. Despite the outsized impact of this problem, few clinical studies have examined the issue, and no study has used artificial intelligence methods or has been large enough to draw firm conclusions. </p>
<p>Doctors and patients are relying more on <a href="https://doi.org/10.1093/jamia/ocaa281">secure messaging</a>, a digital communication innovation that has expanded during the COVID-19 pandemic. Our findings suggest that most doctors can and should adjust how they listen and respond to patients to achieve more effective communication. </p>
<p>Patients who find themselves confused should ask their doctor to restate their explanations and advice in more approachable ways. And our study suggests that health systems should carefully consider the ways that they can best support doctors and patients to achieve shared meaning. This includes how they train clinicians and how they allocate and reimburse for the time, personnel and technologies that can promote communication.</p>
<h2>What still isn’t known</h2>
<p>While <a href="https://doi.org/10.1016/j.pec.2008.11.015">prior research</a> has shown that understanding one’s health condition and its treatment is key to getting healthier, we do not know how beneficial this form of precision communication is to achieving better health outcomes. We also can’t yet determine whether doctors’ written communications reflect how they communicate verbally – in person – although the results of the <a href="https://doi.org/10.1177/2374373518793143">patient survey</a> that we used in this study suggest overlaps between doctors’ written and spoken communication. </p>
<h2>What’s next</h2>
<p>We are designing studies to examine whether language-matching improves health outcomes such as blood sugar or blood pressure control. We have also developed and are testing whether an automated feedback system embedded in the electronic health record can enable precision communication in email exchanges. The system rapidly analyzes patients’ email messages and alerts the physician if the complexity of their email response is too high.</p><img src="https://counter.theconversation.com/content/173805/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dean Schillinger received funding from NIH/National Library of Medicine grant R01LM012355 and NIH/NIDDK grant 2P30-DK092924 </span></em></p><p class="fine-print"><em><span>Nicholas Duran receives funding from the National Science Foundation (NSF 1660894). The current work is funded by the National Institutes of Health (NIH R01 LM012355). </span></em></p>Communication breakdowns between doctors and their patients have real-life consequences and can result in poorer health outcomes and sicker patients.Dean Schillinger, Professor of General Internal Medicine, University of California, San FranciscoNicholas Duran, Associate Professor in Social and Behavioral Sciences, Arizona State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1653072021-07-30T04:42:31Z2021-07-30T04:42:31ZNo wonder people are confused. Most official COVID vaccine advice is way too complex<figure><img src="https://images.theconversation.com/files/413894/original/file-20210730-21-1ip43oh.jpg?ixlib=rb-1.1.0&rect=2%2C0%2C995%2C667&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/beautiful-elderly-woman-looking-smartphone-288866810">from www.shutterstock.com</a></span></figcaption></figure><p>As Sydney’s COVID-19 outbreak continues to grow, the message has shifted to urgently “get the jab”. And people’s motivation to get vaccinated <a href="https://www.abs.gov.au/statistics/people/people-and-communities/household-impacts-covid-19-survey/latest-release">is increasing</a>.</p>
<p>But with ever-changing advice, many people are confused about which vaccine they’re eligible for and where to get an appointment.</p>
<p><a href="https://www.mja.com.au/journal/2021/coronavirus-covid-19-vaccination-information-must-pay-attention-health-literacy">Our recent review</a>, which has been accepted for publication in the Medical Journal of Australia, shows information for the public about COVID vaccines is too complex to read, understand and act upon. It’s even more complex than other COVID public health advice, such as for physical distancing or masks. </p>
<p>Then there’s the results of <a href="https://mfr.au-1.osf.io/render?url=https://osf.io/ehvxm/?direct%26mode=render%26action=download%26mode=render">our recent survey</a>, which has yet to be peer reviewed, of where people from culturally and linguistically diverse (CALD) communities get their COVID information from. This finds a huge diversity of sources, beyond official government websites. So we need to tailor communications to these communities via channels people actually use.</p>
<p>Taken together, our research shows we are still missing clear and consistent communication about COVID vaccines all Australians can understand and act on.</p>
<h2>No wonder people are confused</h2>
<p>We looked at publically available COVID-19 information from government websites from Australia (federal and three states), the United Kingdom, New Zealand, and three international public health agencies (including the World Health Organization).</p>
<p>Most public information was above the recommended reading level for the general population (<a href="https://www.sahealth.sa.gov.au/wps/wcm/connect/6dead9da-d1c2-4cbf-9568-74d2131df162/EngagingwithConsumersCarersandCommunityGuide%26Resources_Apr+2021+%281%29.pdf?MOD=AJPERES&amp;CACHEID=ROOTWORKSPACE-6dead9da-d1c2-4cbf-9568-74d2131df162-nzJQsT1">8th grade</a>). </p>
<p>In Australia, information was commonly written at postgraduate level. This means it is too difficult for people with average reading ability to understand. It’s likely even harder for the <a href="https://www.abs.gov.au/ausstats/abs@.nsf/mf/4233.0">9 million Australians</a> who have lower health literacy.</p>
<p>Vaccination information from the <a href="https://www.health.gov.au/initiatives-and-programs/covid-19-vaccines">federal government website</a> was the only Australian material to adequately outline the action or steps readers needed to take to get vaccinated. Websites from all three states (New South Wales, Queensland, Victoria) we reviewed did not.</p>
<p>This means there has been little progress nationally or internationally in terms of improving the readability of written COVID-19 information <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2769382">since April 2020</a>.</p>
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Read more:
<a href="https://theconversation.com/yes-adult-literacy-should-be-improved-but-governments-can-make-their-messages-easier-to-read-right-now-164621">Yes, adult literacy should be improved. But governments can make their messages easier to read right now</a>
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<h2>Culturally and linguistically diverse Australians</h2>
<p>Our review does not begin to capture the additional limitations of COVID-19 communications for CALD communities. </p>
<p>People from CALD backgrounds form a significant and growing share of Australia’s population. For instance, <a href="https://www.swslhd.health.nsw.gov.au/pdfs/SWS%20Our%20Health%20in%20brief.pdf">43% of the population</a> of southwest Sydney (one of the focuses of the current COVID-19 outbreak) was born overseas; up to 71% in certain local government areas speak a language other than English at home.</p>
<p>Yet, translated information and communications about COVID-19 have been sparse, intermittent and not all has <a href="https://www.abc.net.au/news/2020-11-19/government-used-google-translate-for-nonsensical-covid-19-tweet/12897200">been appropriate</a>. The original source materials in English are too complex, official translators are not used, and/or translations are not reviewed to make sure the information makes sense.</p>
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<h2>There has been some progress</h2>
<p>We’ve had some progress this week. Press briefings, crucially important for keeping up-to-date about new rules and regulations, have only in the past few days been <a href="https://www.sbs.com.au/news/sbs-is-now-interpreting-nsw-covid-19-press-conferences-live-in-languages-other-than-english">made available</a> in any other language than English.</p>
<p>Similarly, the online <a href="https://covid-vaccine.healthdirect.gov.au/?lang=en">vaccination eligibility checker</a> has only just been translated into 15 other languages. However, the online vaccine clinic finder, which you reach at end of the vaccine eligibility checker, remains only in English. </p>
<p>More positively, a <a href="https://www.mhcs.health.nsw.gov.au/glossary/covid-19-glossary">COVID-19 vaccination glossary</a> (with clear descriptions of complex vaccine terms) is now available in 29 languages.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1419493363921788933"}"></div></p>
<h2>But more work is needed</h2>
<p>However, more work is needed to ensure COVID information is “distributed widely” to CALD communities via the most appropriate channels, as recommended in the Australian government’s <a href="https://www.health.gov.au/sites/default/files/documents/2021/02/covid-19-vaccination-program-culturally-and-linguistically-diverse-communities-implementation-plan_0.pdf">own plan</a>.</p>
<p>Our <a href="https://mfr.au-1.osf.io/render?url=https://osf.io/ehvxm/?direct%26mode=render%26action=download%26mode=render">recent survey</a> of over 700 CALD community members in Greater Western Sydney showed just over half (about 54%) of participants used official government sources to find out about COVID-19. However, this varied greatly between language groups, reaching as low as 29% for some. </p>
<p>Social media (52%), family and friends (33%), and community sources (26%) were also common pathways for seeking out information about COVID. Many sought in-language communication from overseas. For some of these groups, official sources appear less accessible or useful. </p>
<p>So work is clearly needed to distribute tailored communications via channels people actually use.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/multilingual-australia-is-missing-out-on-vital-covid-19-information-no-wonder-local-councils-and-businesses-are-stepping-in-141362">Multilingual Australia is missing out on vital COVID-19 information. No wonder local councils and businesses are stepping in</a>
</strong>
</em>
</p>
<hr>
<h2>What actually works?</h2>
<p>We know how to communicate public health messages clearly for <a href="https://www.croakey.org/an-urgent-call-for-governments-to-improve-pandemic-communications-and-address-health-literacy-concerns/">diverse communities</a>. We can:</p>
<ul>
<li><p><a href="https://www.cdc.gov/other/pdf/everydaywordsforpublichealthcommunication.pdf">use</a> everyday words for all public health communication</p></li>
<li><p><a href="http://www.online-utility.org/english/readability_test_and_improve.jsp">test readability levels</a> of written documents</p></li>
<li><p><a href="https://www.ahrq.gov/sites/default/files/publications/files/pemat_guide.pdf">check the “actionability” of instructions</a> (whether there are clear instructions of what to do next)</p></li>
<li><p>use <a href="https://www.sciencedirect.com/science/article/pii/S073839912030197X?dgcid=rss_sd_all">pictures, icons </a>or animations.</p></li>
</ul>
<p>We know it is possible to successfully implement these strategies. Our review identified 12 “easy-to-read” <a href="https://www.health.gov.au/sites/default/files/documents/2021/07/covid-19-vaccination-side-effects-you-might-have-after-your-vaccination-easy-read.pdf">materials</a> written at a lower reading grade that were easier to understand.</p>
<p>However, these were rare, difficult to find on official websites and often poorly signposted. For instance, some were on pages labelled for “<a href="https://www.coronavirus.vic.gov.au/information-people-disability-coronavirus-disease-covid-19">people with disability</a>”. </p>
<p>We need concerted action to ensure materials such as these become the “rule” rather than the exception. Plain language and in-language information simply cannot be an afterthought or “optional extra” if we are to achieve the <a href="https://theconversation.com/australia-shouldnt-open-up-before-we-vaccinate-at-least-80-of-the-population-heres-why-165073">80% or higher</a> vaccination rates needed to end lockdowns and return to some semblance of normal.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/australia-shouldnt-open-up-before-we-vaccinate-at-least-80-of-the-population-heres-why-165073">Australia shouldn't ‘open up’ before we vaccinate at least 80% of the population. Here's why</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/165307/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr Danielle Marie Muscat receives funding from Western Sydney Local Health District through a Westmead Fellowship (Early Career Researcher). </span></em></p><p class="fine-print"><em><span>Julie Ayre, Kirsten McCaffery, and Olivia Mac do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Our research shows we are still missing clear and consistent communication about COVID vaccines all Australians can understand and act on.Danielle Marie Muscat, Post-Doctoral Research Fellow, University of SydneyJulie Ayre, Post Doctoral Research Fellow, University of SydneyKirsten McCaffery, NHMRC Principal Research Fellow, University of SydneyOlivia Mac, Research fellow, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1592192021-04-26T05:10:32Z2021-04-26T05:10:32ZHere are 9 ways we can make it easier for Australians to get the COVID-19 vaccine<p>Between vaccine supply issues, confusion about the role of GPs, and changed advice for AstraZeneca, the Australian COVID-19 vaccine rollout is well <a href="https://www.theage.com.au/national/did-australia-get-its-vaccine-strategy-right-20210415-p57jey.html?utm_medium=Social&utm_source=Twitter#Echobox=1618621648">behind schedule</a>.</p>
<p>How can we make it easier for the <a href="https://www.thelancet.com/pdfs/journals/laninf/PIIS1473-3099(20)30559-4.pdf">majority</a> of Australians who want to be vaccinated? Especially given <a href="https://www.abc.net.au/news/2021-04-22/national-cabinet-over-50-vaccination-mass-hub-astrazeneca/100087334">all Australians over 50 years of age</a> are eligible to be vaccinated from May 3 next week. </p>
<p>There are tangible things we can do now to help people understand the benefits and possible risks of COVID-19 vaccination, and get the vaccine quickly as soon as they’re eligible.</p>
<h2>Improve understanding</h2>
<p>We know communication about COVID-19 hasn’t met the needs of people with low <a href="https://www.phrp.com.au/issues/december-2020-volume-30-issue-4/health-literacy-and-disparities-in-covid-19-related-knowledge-attitudes-beliefs-and-behaviours-in-australia/">health literacy</a> or those who speak different <a href="https://theconversation.com/multilingual-australia-is-missing-out-on-vital-covid-19-information-no-wonder-local-councils-and-businesses-are-stepping-in-141362">languages</a>. These groups are also more susceptible to <a href="https://www.jmir.org/2021/1/e23805/">misinformation</a> so it’s vital we communicate well to them. </p>
<p>Here are some practical things we can do:</p>
<ol>
<li><p><strong>use standard terms</strong>: governments need to develop a national glossary for COVID-19 vaccination terms. This would standardise and <a href="https://theconversation.com/how-can-governments-communicate-with-multicultural-australians-about-covid-vaccines-its-not-as-simple-as-having-a-poster-in-their-language-156097">simplify information</a> for diverse communities. For example, the Department of Health provides a <a href="https://www1.health.gov.au/internet/publications/publishing.nsf/Content/mental-pubs-n-wkstd13-toc%7Emental-pubs-n-wkstd13-glo">glossary for mental health</a> terms, which can ensure patient information and translations for words like “care plan” are consistent</p></li>
<li><p><strong>write for year 8 reading level</strong>: one study of COVID-19 information found government information in Australia, the US and UK was too <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/1753-6405.13066">complex</a> for many people to understand; and it was worst for Australia. Online “readability” calculators can be used to check health information is at the recommended year 8 reading level. Real-time editing <a href="https://hdl.handle.net/2123/24642">tools</a> help writers avoid acronyms and uncommon words, and use shorter, simpler sentences</p></li>
<li><p><strong>use supporting images</strong>: we can make sure text is supported by helpful images such as the vaccination timeline, rather than negative <a href="https://theconversation.com/pictures-of-covid-injections-can-scare-the-pants-off-people-with-needle-phobias-use-these-instead-157963">images</a> like pictures of needles that may scare people.</p></li>
</ol>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/pictures-of-covid-injections-can-scare-the-pants-off-people-with-needle-phobias-use-these-instead-157963">Pictures of COVID injections can scare the pants off people with needle phobias. Use these instead</a>
</strong>
</em>
</p>
<hr>
<h2>Improve access</h2>
<p>We know vaccine supply is a <a href="https://www.theage.com.au/national/did-australia-get-its-vaccine-strategy-right-20210415-p57jey.html?utm_medium=Social&utm_source=Twitter#Echobox=1618621648">challenge</a> but we can still make sure every available vaccine dose is used as soon as possible.</p>
<p>Strategies to do this could include:</p>
<ol>
<li><p><strong>local vaccination</strong>: our COVID-19 testing model has been successful including pop up <a href="https://theconversation.com/morrison-government-funds-pop-up-testing-clinics-and-tele-consultations-in-2-4-billion-covid-19-health-package-133368">clinics</a> in places where there have been localised outbreaks. But our vaccine distribution logistics are falling <a href="https://theconversation.com/australia-urgently-needs-mass-covid-vaccination-hubs-but-we-need-more-vaccines-first-158416">behind</a>. The <a href="https://www.abc.net.au/news/health/2021-04-14/covid-19-anthony-fauci-what-australia-can-learn-from-us/100068256">US</a> has used community clinics, pharmacies and mobile field officers to vaccinate millions of people a day. While some testing clinics now offer vaccinations, we could be doing more to provide vaccines for free as locally as possible</p></li>
<li><p><strong>national registry</strong>: registries can keep track of vaccine doses and notify people as soon as they’re eligible. This is done in childhood vaccination, and notification systems are used effectively for cancer screening programs. We could use the existing <a href="https://www.servicesaustralia.gov.au/individuals/services/medicare/australian-immunisation-register">Australian Immunisation Register</a> to track and promote COVID-19 vaccination </p></li>
<li><p><strong>automated appointments</strong>: people could sign up for “opt out” appointments with their local GP or vaccination clinic. This means they would be automatically booked into an appointment as soon as they’re eligible and supply is available, or moved to an earlier appointment if there’s a cancellation. This <a href="https://theconversation.com/how-to-really-fix-covid-19-vaccine-appointment-scheduling-155438">pre-registration</a> approach will reduce wasted vaccine doses when several doses must be used from the same vial in the same day.</p></li>
</ol>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-to-really-fix-covid-19-vaccine-appointment-scheduling-155438">How to really fix COVID-19 vaccine appointment scheduling</a>
</strong>
</em>
</p>
<hr>
<h2>Improve motivation</h2>
<p><a href="https://www.medrxiv.org/content/10.1101/2021.02.04.21251165v1">Our research</a>, published as a pre-print in February, shows motivation is a particular challenge for Australia. Many people perceive their individual risk of contracting COVID-19 to be lower given case numbers are so low, and many people therefore haven’t been as strict with distancing behaviours.</p>
<p>Even before the new risk of <a href="https://theconversation.com/what-is-thrombocytopenia-the-rare-blood-condition-possibly-linked-to-the-astrazeneca-vaccine-158522">serious clots</a> was identified with the AstraZeneca vaccine, the <a href="https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30926-9/fulltext">top barriers</a> for getting the vaccine in 2020 were safety concerns and side effects, which may outweigh the individual risk of COVID-19 for some people.</p>
<p>But most Australians have high intentions to get vaccinated, and there are things we can do to maintain motivation:</p>
<ol>
<li><p><strong>explain benefits AND risks</strong>: rather than focusing on single cases of serious side effects, we need to balance information in the media. We can use simple <a href="https://www.health.gov.au/sites/default/files/documents/2021/04/covid-19-vaccination-weighing-up-the-potential-benefits-against-risk-of-harm-from-covid-19-vaccine-astrazeneca_0.pdf">graphics</a> to help people consider how the rare risk of serious side effects weighs up against the serious complications of COVID-19 for their age group during a local outbreak — which <a href="https://theconversation.com/whats-the-risk-if-australia-opens-its-international-borders-an-epidemiologist-explains-159208">could still happen any time</a></p></li>
<li><p><strong>emphasise community benefits</strong>: since COVID-19 is well controlled in Australia, we can focus on emphasising the benefits to the community of getting vaccinated. This might help people understand why they should get vaccinated even though their individual risk might be low. Our research in 2020 found the top motivators were “<a href="https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30926-9/fulltext">to protect myself and others</a>” and “belief in vaccination and science”. Even if a 25-year-old views their individual risk of COVID-19 complications as low, protecting family, friends, and wider society may be important to them</p></li>
<li><p><strong>provide incentives</strong>: getting vaccinated as soon as someone’s eligible could be linked to financial incentives. This has been used for <a href="https://julieleask.wordpress.com/2015/11/23/no-jab-no-pay-a-questionable-main-course-with-some-excellent-side-dishes/">childhood vaccination</a> where access to childcare rebates is easier with up-to-date vaccination, and health professionals are incentivised to address vaccination gaps. However, this needs to be done carefully to avoid the concerns of coercive policies.</p></li>
</ol>
<p>More coercive options include: mandatory vaccination, such as for certain jobs; financial sanctions like fines; and movement restrictions, including requiring a “vaccine passport” for travel.</p>
<p>These may increase vaccination uptake, but there are <a href="https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30766-0/fulltext">ethical concerns</a> because such approaches could undermine trust and increase inequalities. </p>
<p>Australian vaccination communication experts have argued against a <a href="https://theconversation.com/5-ways-we-can-prepare-the-public-to-accept-a-covid-19-vaccine-saying-it-will-be-mandatory-isnt-one-144730">mandatory</a> approach, in response to a suggestion Prime Minister Scott Morrison <a href="https://www.sbs.com.au/news/scott-morrison-says-a-coronavirus-vaccine-would-be-as-mandatory-as-you-can-possibly-make-it">made in August last year</a> that a COVID-19 vaccine would be “as mandatory as you can possibly make it”, which he later retracted.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/5-ways-we-can-prepare-the-public-to-accept-a-covid-19-vaccine-saying-it-will-be-mandatory-isnt-one-144730">5 ways we can prepare the public to accept a COVID-19 vaccine (saying it will be 'mandatory' isn't one)</a>
</strong>
</em>
</p>
<hr>
<p>We could be doing much more to improve understanding, access and motivation among Australians right now. We need to ensure everyone has the information they need to get a COVID-19 vaccine as soon as they’re eligible.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/396995/original/file-20210426-15-1wlylft.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/396995/original/file-20210426-15-1wlylft.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=1235&fit=crop&dpr=1 600w, https://images.theconversation.com/files/396995/original/file-20210426-15-1wlylft.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=1235&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/396995/original/file-20210426-15-1wlylft.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=1235&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/396995/original/file-20210426-15-1wlylft.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1553&fit=crop&dpr=1 754w, https://images.theconversation.com/files/396995/original/file-20210426-15-1wlylft.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1553&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/396995/original/file-20210426-15-1wlylft.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1553&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><span class="source">Department of Health/The Conversation</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure><img src="https://counter.theconversation.com/content/159219/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Carissa Bonner receives funding from the NHMRC for a project investigating barriers to vaccination; and from the Marie Bashir Institute to investigate barriers to COVID-19 testing.</span></em></p><p class="fine-print"><em><span>Rachael Dodd receives funding from the Marie Bashir Institute to investigate barriers to COVID-19 testing. </span></em></p>There are tangible things we can do now to help people understand the benefits and possible risks of COVID-19 vaccination.Carissa Bonner, Research Fellow, University of SydneyRachael Dodd, Research Fellow, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1555672021-03-01T19:09:49Z2021-03-01T19:09:49ZWe asked children around the world what they knew about COVID. This is what they said<figure><img src="https://images.theconversation.com/files/386340/original/file-20210225-15-d97ldc.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1000%2C667&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/little-cute-girl-playing-playground-child-1814357357">from www.shutterstock.com</a></span></figcaption></figure><p>During the pandemic, children have been separated from family and friends, schools have been closed and there have been limitations on important activities, such as play.</p>
<p>We know a good deal about the <a href="https://theconversation.com/worried-about-your-child-getting-coronavirus-heres-what-you-need-to-know-131909">physical effects</a> COVID-19 <a href="https://theconversation.com/why-do-kids-tend-to-have-milder-covid-this-new-study-gives-us-a-clue-155555">has on children</a>. But the impact on their mental and emotional well-being is less well understood – particularly from the perspective of children themselves.</p>
<p>Our <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0246405">recently published research</a> highlights the importance of listening to children, about what they have to say and the information they want about COVID-19.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-do-kids-tend-to-have-milder-covid-this-new-study-gives-us-a-clue-155555">Why do kids tend to have milder COVID? This new study gives us a clue</a>
</strong>
</em>
</p>
<hr>
<h2>Here’s what we did</h2>
<p>We took part in an international study with children from six countries – the UK, Spain, Canada, Sweden, Brazil and Australia.</p>
<p>We recruited children through our professional and social networks, for example sporting groups and community groups. </p>
<p>We asked children aged seven to 12 years about how they accessed information about COVID-19, about their understandings of the virus and why they were asked to stay at home.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/386333/original/file-20210225-15-1le7okg.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Child's drawing of two coronaviruses." src="https://images.theconversation.com/files/386333/original/file-20210225-15-1le7okg.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/386333/original/file-20210225-15-1le7okg.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=466&fit=crop&dpr=1 600w, https://images.theconversation.com/files/386333/original/file-20210225-15-1le7okg.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=466&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/386333/original/file-20210225-15-1le7okg.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=466&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/386333/original/file-20210225-15-1le7okg.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=585&fit=crop&dpr=1 754w, https://images.theconversation.com/files/386333/original/file-20210225-15-1le7okg.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=585&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/386333/original/file-20210225-15-1le7okg.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=585&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">This drawing from Ben, aged 7, Tasmania, shows children express what they know about the coronavirus in many ways.</span>
<span class="attribution"><span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>The survey was open when the highest level restrictions were in place across Tasmania, where the Australian arm of the study was based. In total, 49 children from Tasmania took part in the survey and 390 children internationally.</p>
<p>There were important differences across the countries when we conducted the survey, including the numbers of reported cases and deaths from COVID-19, as well as government responses and levels of restrictions. </p>
<p>For example, the reported deaths and cases were much higher in countries such as the UK and Brazil compared to Australia and children in Sweden continued to attend school, whereas most children in other countries were learning from home.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/is-it-time-for-australia-to-implement-kids-only-covid-19-briefings-144878">Is it time for Australia to implement kids-only COVID-19 briefings?</a>
</strong>
</em>
</p>
<hr>
<h2>Here’s what we found</h2>
<p>There were many similarities across the different countries in the things important to children, what they had to say and what they wanted to know. But there were also differences across countries and between children.</p>
<p>More than half the children said they knew a lot or quite a bit about COVID-19. Their comments included:</p>
<blockquote>
<p>It is a stupid virus.</p>
<p>It spreads really quickly.</p>
<p>People play it down and tell me it can’t kill people, but I know people are dying each day.</p>
</blockquote>
<p>But they also had questions:</p>
<blockquote>
<p>How and where did it start?</p>
<p>What does the coronavirus actually look like?</p>
<p>How does it make you poorly?</p>
</blockquote>
<p>Some said they did not want to know any more about the virus:</p>
<blockquote>
<p>It is boring.</p>
<p>I don’t want to know about it because it’s killing people and that makes me sad.</p>
</blockquote>
<p>Children expressed different emotions about COVID-19. They said they felt “worried”, “scared”, “angry” and “confused”. </p>
<p>Children knew the virus was particularly dangerous for vulnerable people: </p>
<blockquote>
<p>It can possibly kill old and unhealthy people. </p>
</blockquote>
<p>And they missed their friends and family:</p>
<blockquote>
<p>When can we go back to school?</p>
</blockquote>
<p>Children obtained information about COVID-19 from different sources, mostly from parents and teachers. Children also sought information from friends, TV shows and the internet, including social media.</p>
<p>Children understood what the community was being asked to do and they had learnt the meanings of new words and terms. So they knew what social distancing meant and that they needed to stay 1.5m apart. </p>
<p>Children also knew key public health messages about washing your hands, not touching your face and needing to stay at home “to save lives”.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/stupid-coronavirus-in-uncertain-times-we-can-help-children-through-mindfulness-and-play-135317">'Stupid coronavirus!' In uncertain times, we can help children through mindfulness and play</a>
</strong>
</em>
</p>
<hr>
<h2>Why does this matter?</h2>
<p>Children have had an important role in society’s response to COVID-19. Their significant contributions to limiting the spread of the virus have included being separated from family and friends, and limitations on important activities that are part of their “normal” lives. </p>
<p>However, the impacts on children’s lives and well-being are largely unacknowledged. Their contributions should be acknowledged and they should be thanked for their part.</p>
<p>Children have a right to be provided with information in a form that is appropriate for their safety and well-being. Children need to have the opportunity to ask questions and learn about what COVID-19 means for them with adults they trust, including parents and teachers.</p>
<p>Children have questions about COVID-19. Questions are different for each child and not all children want the same amount of information.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/8-tips-on-what-to-tell-your-kids-about-coronavirus-133346">8 tips on what to tell your kids about coronavirus</a>
</strong>
</em>
</p>
<hr>
<h2>What can adults do?</h2>
<p>Adults should make the time and space to have conversations with children. They can ask:</p>
<ul>
<li><p>what would you like to know?</p></li>
<li><p>what would you like to ask? </p></li>
</ul>
<p>This approach means children are empowered to identify their needs and concerns, and the information they are provided is relevant and meets their needs.</p>
<hr>
<p><em>Andrea Chelkowski, from the Centre for Education and Research — Nursing and Midwifery, Tasmanian Health Service South and University of Tasmania, Hobart, was part of the Australian research team. The lead author of the research mentioned in this article is Lucy Bray, professor in child health literacy, Edge Hill University, UK.</em></p><img src="https://counter.theconversation.com/content/155567/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Karen Ford is affiliated with the Centre for Education and Research — Nursing and Midwifery, Tasmanian Health Service South.</span></em></p><p class="fine-print"><em><span>Andrea Middleton is affiliated with the Centre for Education and Research — Nursing and Midwifery, Tasmanian Health Service South.</span></em></p><p class="fine-print"><em><span>Steven Campbell does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>What does the coronavirus look like? What kids want to know about the pandemic isn’t always what we tell them.Karen Ford, Adjunct Associate Professor, School of Nursing, University of TasmaniaAndrea Middleton, Lecturer, University of TasmaniaSteven Campbell, Professor of Clinical Redesign – Nursing, University of TasmaniaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1444942020-09-13T19:51:31Z2020-09-13T19:51:31ZNow everyone’s a statistician. Here’s what armchair COVID experts are getting wrong<figure><img src="https://images.theconversation.com/files/355980/original/file-20200902-16-1gtx7vk.jpg?ixlib=rb-1.1.0&rect=1%2C5%2C997%2C678&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/concentrated-bearded-man-browsing-laptop-looking-1746168092">Shutterstock</a></span></figcaption></figure><p>If we don’t analyse statistics for a living, it’s easy to be taken in by misinformation about COVID-19 statistics on social media, especially if we don’t have the right context. </p>
<p>For instance, we may cherry pick statistics supporting our viewpoint and ignore statistics showing we are wrong. We also still need to correctly interpret these statistics.</p>
<p>It’s easy for us to share this misinformation. Many of these statistics are also interrelated, so misunderstandings can quickly multiply.</p>
<p>Here’s how we can avoid five common errors, and impress friends and family by getting the statistics right.</p>
<h2>1. It’s the infection rate that’s scary, not the death rate</h2>
<p><a href="https://twitter.com/EthicalSkeptic/status/1263660512102973441">Social media posts</a> comparing COVID-19 to other causes of death, such as <a href="https://www.facebook.com/deon.coetzee.77770/posts/10158515376871941">the flu</a>, imply COVID-19 <a href="https://fee.org/articles/npr-mounting-evidence-suggests-covid-not-as-deadly-as-thought-did-the-experts-fail-again/">isn’t really that deadly</a>.</p>
<p>But these posts miss COVID-19’s infectiousness. For that, we need to look at the infection fatality rate (IFR) — the number of COVID-19 deaths divided by all those infected (a number we can only estimate at this stage, see also point 3 below).</p>
<p>While the <a href="https://theconversation.com/how-deadly-is-the-coronavirus-the-true-fatality-rate-is-tricky-to-find-but-researchers-are-getting-closer-141426">jury is still out</a>, COVID-19 has a <a href="https://www.medrxiv.org/content/10.1101/2020.05.03.20089854v4">higher IFR</a> than the flu. <a href="https://www.facebook.com/sharontay.huff/posts/3037891612946957">Posts implying</a> a low IFR for COVID-19 most certainly underestimate it. They also miss two other points.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1233765212030996482"}"></div></p>
<p>First, if we compare the <a href="https://www.bloomberg.com/opinion/articles/2020-08-06/revisiting-how-covid-19-ranks-with-seasonal-flu-and-1918-pandemic">typical flu IFR</a> of <a href="https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200306-sitrep-46-covid-19.pdf?sfvrsn=96b04adf_4">0.1%</a> with the <a href="https://www.medrxiv.org/content/10.1101/2020.05.13.20101253v2.full.pdf">most optimistic COVID-19 estimate</a> of 0.25%, then COVID-19 remains more than twice as deadly as the flu.</p>
<p>Second, and more importantly, we need to look at the basic reproduction number (R₀) for each virus. This is the number of extra people one infected person is estimated to infect.</p>
<p>Flu’s R₀ <a href="https://bmcinfectdis.biomedcentral.com/articles/10.1186/1471-2334-14-480">is about 1.3</a>. Although COVID-19 estimates vary, its R₀ sits around a <a href="https://academic.oup.com/jtm/article/27/2/taaa021/5735319">median of 2.8</a>. Because of the way infections grow exponentially (see below), the jump from 1.3 to 2.8 means COVID-19 is vastly more infectious than flu.</p>
<p>When you combine all these statistics, you can see the motivation behind our public health measures to “limit the spread”. It’s not only that COVID-19 is so deadly, it’s deadly <em>and</em> highly infectious.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-deadly-is-the-coronavirus-the-true-fatality-rate-is-tricky-to-find-but-researchers-are-getting-closer-141426">How deadly is the coronavirus? The true fatality rate is tricky to find, but researchers are getting closer</a>
</strong>
</em>
</p>
<hr>
<h2>2. Exponential growth and misleading graphs</h2>
<p>A simple graph might plot the number of new COVID cases over time. But as new cases might be reported erratically, statisticians are more interested in the rate of growth of total cases over time. The steeper the upwards slope on the graph, the more we should be worried.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/coronavirus-is-growing-exponentially-heres-what-that-really-means-134591">Coronavirus is growing exponentially – here’s what that really means</a>
</strong>
</em>
</p>
<hr>
<p>For COVID-19, statisticians look to track <a href="https://www.forbes.com/sites/startswithabang/2020/03/17/why-exponential-growth-is-so-scary-for-the-covid-19-coronavirus/#65115f274e9b">exponential growth</a> in cases. Put simply, unrestrained COVID cases can lead to a continuously growing number of more cases. This gives us a graph that tracks slowly at the start, but then sharply curves upwards with time. This is the curve we want to flatten, as shown below.</p>
<figure>
<img src="https://cdn.theconversation.com/static_files/files/890/Flatten_the_curve1.gif?1583941324">
<figcaption><span class="caption">“Flattening the curve” is another way of saying “slowing the spread”. The epidemic is lengthened, but we reduce the number of severe cases, causing less burden on public health systems. The Conversation/CC BY ND</span></figcaption>
</figure>
<p>However, social media posts routinely compare COVID-19 figures with those of other causes of death that show:</p>
<ul>
<li><p>more <a href="https://www.facebook.com/SimonCLord/photos/a.451887838292858/1556333767848254">linear patterns</a> (figures increase with time but at a steady rate)</p></li>
<li><p>much slower-growing <a href="https://twitter.com/realdonaldtrump/status/1237027356314869761">flu deaths</a> or </p></li>
<li><p><a href="https://www.facebook.com/mydocfrank/posts/2132408190237845">low numbers from early stages of the outbreak</a> and so miss the <a href="https://mycovidjourney.com/2020/03/30/what-is-exponential-growth/">impact of exponential growth</a>.</p></li>
</ul>
<p>Even when researchers talk of exponential growth, they can still mislead.</p>
<p>An Israeli professor’s <a href="https://www.timesofisrael.com/the-end-of-exponential-growth-the-decline-in-the-spread-of-coronavirus/">widely-shared</a> analysis claimed COVID-19’s exponential growth “fades after eight weeks”. Well, he was clearly wrong. But why?</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1252671468128866308"}"></div></p>
<p>His model assumed COVID-19 cases grow exponentially over a number of days, instead of over a succession of transmissions, each of which may take several days. This led him to plot only the erratic growth of the outbreak’s early phase.</p>
<p>Better visualisations truncate those erratic first cases, for instance by starting from the 100th case. Or they use estimates of the number of days it takes for the number of cases <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30260-9/fulltext">to double</a> (about six to seven days).</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-bar-necessities-5-ways-to-understand-coronavirus-graphs-135537">The bar necessities: 5 ways to understand coronavirus graphs</a>
</strong>
</em>
</p>
<hr>
<h2>3. Not all infections are cases</h2>
<p>Then there’s the confusion about COVID-19 infections versus cases. In epidemiological terms, a “case” is a person who is diagnosed with COVID-19, mostly by a positive test result. </p>
<p>But there are many more infections than cases. Some infections don’t show symptoms, some symptoms are so minor people think it’s just a cold, testing is not always available to everyone who needs it, and testing <a href="https://www.bmj.com/content/369/bmj.m1808">does not pick up all infections</a>.</p>
<p>Infections “cause” cases, testing discovers cases. US President Donald Trump was close to the truth <a href="https://twitter.com/realDonaldTrump/status/1293163704188645385">when he said</a> the number of cases in the US was high because of the high rate of testing. But he <a href="https://twitter.com/realistgeo/status/1295701536979525633">and others</a> still got it totally wrong.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1293163704188645385"}"></div></p>
<p>More testing does not <em>result</em> in more cases, it allows for a <em>more accurate estimate</em> of the true number of cases.</p>
<p>The best strategy, epidemiologically, is not to test less, but to test as widely as possible, minimising the discrepancy between cases and overall infections. </p>
<h2>4. We can’t compare deaths with cases from the same date</h2>
<p><a href="https://wwwnc.cdc.gov/eid/article/26/7/20-0282_article">Estimates vary</a>, but the time between infection and death could be as much as <a href="https://www.nationalgeographic.com/science/2020/07/coronavirus-deadlier-than-many-believed-infection-fatality-rate-cvd/">a month</a>. And the variation in <a href="https://edition.cnn.com/2020/04/04/health/recovery-coronavirus-tracking-data-explainer/index.html">time to recovery</a> is even greater. Some people get really ill and take a long time to recover, some show no symptoms. </p>
<p>So deaths recorded on a given date reflect deaths from cases recorded several weeks prior, when the case count may have been <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30260-9/fulltext">less than half</a> the number of current cases.</p>
<p>The rapid case-doubling time and protracted recovery time also create a large discrepancy between counts of <a href="https://twitter.com/Nutty_Lulu/status/1239817225860775937">active and recovered cases</a>. We’ll only know the true numbers in retrospect.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1239817225860775937"}"></div></p>
<h2>5. Yes, the data are messy, incomplete and may change</h2>
<p>Some social media users <a href="https://twitter.com/CAdamMartin/status/1293642172324077570">get angry</a> when the <a href="https://www.bbc.com/news/health-53722711">statistics are adjusted</a>, <a href="https://archive.is/WX4RO">fuelling</a> <a href="https://www.facebook.com/photo.php?fbid=10156807927231394&set=a.85311241393&type=3&theater">conspiracy theories</a>.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1293642172324077570"}"></div></p>
<p>But few realise how <a href="https://www.usnews.com/news/health-news/articles/2020-04-02/why-are-us-coronavirus-recovery-numbers-so-low">mammoth, chaotic</a> and <a href="https://www.nationalgeographic.com/science/2020/07/coronavirus-deadlier-than-many-believed-infection-fatality-rate-cvd/">complex</a> the task is of tracking statistics on a disease like this. </p>
<p>Countries and even states may count cases and deaths differently. It also takes time to gather the data, meaning retrospective adjustments are made.</p>
<p>We’ll only know the true figures for this pandemic in retrospect. Equally so, early models were not necessarily wrong because the modellers were deceitful, but because they had insufficient data to work from. </p>
<p>Welcome to the world of data management, data cleaning and data modelling, which many armchair statisticians don’t always appreciate. Until now.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/when-a-virus-goes-viral-pros-and-cons-to-the-coronavirus-spread-on-social-media-133525">When a virus goes viral: pros and cons to the coronavirus spread on social media</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/144494/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jacques Raubenheimer does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The pandemic has exposed many of us to new statistical concepts, on the news, in everyday conversations and on social media. But how many are you getting wrong?Jacques Raubenheimer, Senior Research Fellow, Biostatistics, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1435312020-08-04T19:55:06Z2020-08-04T19:55:06ZRemote interpreting services are essential for people with limited English — during COVID-19 and beyond<figure><img src="https://images.theconversation.com/files/351009/original/file-20200804-18-nn30or.jpg?ixlib=rb-1.1.0&rect=9%2C9%2C6005%2C4003&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>According to <a href="https://profile.id.com.au/australia/speaks-english">2016 Census data</a>, 3.5% of Australians have limited English proficiency.</p>
<p>When they’re receiving health care, it’s essential these Australians have access to interpreters. Research has shown <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1955368/">professional interpreters</a> facilitate effective communication between the patient and clinician, boost the quality of care, and improve the patient’s health outcomes.</p>
<p>With COVID-19, we’ve seen a shift towards interpreting services being delivered remotely. </p>
<p>These remote services are important for vulnerable groups during the pandemic. They should also pave the way for improved care for people with limited English in the future.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/nearly-1-in-4-of-us-arent-native-english-speakers-in-a-health-care-setting-interpreters-are-essential-115125">Nearly 1 in 4 of us aren't native English speakers. In a health-care setting, interpreters are essential</a>
</strong>
</em>
</p>
<hr>
<h2>The importance of interpreters during COVID-19</h2>
<p>Certain groups of people are at <a href="https://www.health.gov.au/news/health-alerts/novel-coronavirus-2019-ncov-health-alert/advice-for-people-at-risk-of-coronavirus-covid-19/coronavirus-covid-19-advice-for-older-people#people-most-at-risk">increased risk</a> of serious illness from COVID-19. These include people aged 70 and over (or 65 and over with a chronic medical condition), Aboriginal and Torres Strait Islander people aged 50 and over with a chronic condition, and people with compromised immune systems.</p>
<p>Vulnerability <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7270489/">to COVID-19</a> can also relate to factors like homelessness or insecure housing and socioeconomic status.</p>
<p>Many people with limited English proficiency will fit into these vulnerable groups.</p>
<p>People with limited English may also be at increased risk of COVID-19 because they don’t have <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/hpja.333">the language and literacy skills</a> to understand and respond to pandemic-related information.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/351011/original/file-20200804-14-boksv0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/351011/original/file-20200804-14-boksv0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/351011/original/file-20200804-14-boksv0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/351011/original/file-20200804-14-boksv0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/351011/original/file-20200804-14-boksv0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/351011/original/file-20200804-14-boksv0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/351011/original/file-20200804-14-boksv0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">People with limited English proficiency can have trouble understanding general public health messaging.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>While data on language and COVID-19 cases is regrettably <a href="https://insightplus.mja.com.au/2020/25/melbournes-covid-19-second-wave-exposes-multicultural-data-hole/">lacking in Australia</a>, evidence from overseas suggests people from non-English-speaking backgrounds may be faring worse.</p>
<p>In the United States, for example, communities with large numbers of people with limited English account for a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7304953/">high percentage</a> of COVID-19 hospitalisations and deaths, disproportionate to the general population. </p>
<p>So as well as providing suitable health messaging to multilingual communities, providing interpreting services is vitally important at this time.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/multilingual-australia-is-missing-out-on-vital-covid-19-information-no-wonder-local-councils-and-businesses-are-stepping-in-141362">Multilingual Australia is missing out on vital COVID-19 information. No wonder local councils and businesses are stepping in</a>
</strong>
</em>
</p>
<hr>
<h2>Interpreters are underused across health care</h2>
<p>Independent of the pandemic, evidence suggests interpreters are underused in health-care settings in Australia. </p>
<p>In acute care, for example, <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/hpja.373">one recent study</a> found 54% of hospital patients who required an interpreter received one. But this rate is considerably higher than those reported in <a href="https://pubmed.ncbi.nlm.nih.gov/30374856/">other</a> <a href="https://pubmed.ncbi.nlm.nih.gov/30729417/">studies</a>.</p>
<p>Professional interpreters are also underused in <a href="https://pubmed.ncbi.nlm.nih.gov/29144184/">emergency care</a> and <a href="https://www.racgp.org.au/afp/2016/januaryfebruary/consultations-conducted-in-languages-other-than-english-in-australian-general-practice/">primary care</a> settings in Australia.</p>
<p>We don’t know how often interpreters are used in <a href="https://www.publish.csiro.au/ah/AH17032">aged care</a>, but there’s clearly a need there too.</p>
<p>COVID-19 gives us an opportunity to improve the use of interpreters in these areas.</p>
<h2>A shift to remote delivery</h2>
<p>Before the pandemic, professional interpreting services in health care were delivered through a combination of face-to-face and remote services (via telephone or video conferencing).</p>
<p>In Australia, these services are made available through a range of private and government-funded services. For example, in New South Wales there are five <a href="https://www.health.nsw.gov.au/multicultural/Pages/health-care-interpreting-and-translating-services.aspx">health-care interpreting services</a>. Nationally, the Department of Home Affairs funds the Translating and Interpreting Service <a href="https://www.tisnational.gov.au/">(TIS)</a>, which offers free interpreting for eligible health organisations and clinicians. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/we-asked-multicultural-communities-how-best-to-communicate-covid-19-advice-heres-what-they-told-us-142719">We asked multicultural communities how best to communicate COVID-19 advice. Here's what they told us</a>
</strong>
</em>
</p>
<hr>
<p>There are no data from before COVID-19 to tell us what proportion of interpreting services were delivered face-to-face, rather than remotely. But during the pandemic, consistent with the sharp <a href="https://www.health.gov.au/ministers/the-hon-greg-hunt-mp/media/australians-embrace-telehealth-to-save-lives-during-covid-19#:%7E:text=The%20use%20of%20telehealth%20instead,health%20professionals%2C%20and%20saving%20lives.&text=Every%20patient%20who%20uses%20a,the%20coronavirus%20curve%20in%20Australia">increase in telehealth</a>, we’ve seen a sudden shift to remote delivery of interpreting services across Australia.</p>
<p>At the <a href="https://www.sbs.com.au/news/video-interpreters-are-helping-people-in-australia-to-access-healthcare-in-their-language">Royal Melbourne Hospital</a> for example, video interpreting appointments have increased from 10-15 appointments per month before COVID-19 to 100-200 a month currently.</p>
<h2>There are pros and cons</h2>
<p>Research shows remote interpreting is an <a href="https://journals.sagepub.com/doi/abs/10.1258/1357633053688679">acceptable</a> and <a href="https://www.publish.csiro.au/AH/AH16195">accurate alternative</a> to face-to-face interpreting.</p>
<p>Importantly, it allows for continued access to services in a COVID-safe way (minimising physical contact between interpreters, health-care professionals and consumers). </p>
<p>Other benefits include rapid and increased access to interpreters in a wide range of languages, and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2992399/">improved efficiency</a>. It allows interpreters to spend more time interpreting rather than commuting between sites. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/351010/original/file-20200804-24-2ij9zg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/351010/original/file-20200804-24-2ij9zg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/351010/original/file-20200804-24-2ij9zg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/351010/original/file-20200804-24-2ij9zg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/351010/original/file-20200804-24-2ij9zg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/351010/original/file-20200804-24-2ij9zg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/351010/original/file-20200804-24-2ij9zg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">During COVID-19, interpreters are increasingly working remotely.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>But there are also some potential disadvantages. There’s the absence of visual communication, especially associated with <a href="https://www.publish.csiro.au/AH/AH16195">telephone interpreting</a>. A person might offer cues via their body language, but a telephone consultation will miss these.</p>
<p>Drawbacks could also include <a href="https://pubmed.ncbi.nlm.nih.gov/25796404/">technical problems</a> such as poor video or audio quality, and issues related to digital literacy and participation more broadly, particularly for <a href="https://www.esafety.gov.au/sites/default/files/2019-08/Understanding-digital-behaviours-older-Australians-summary-report-2018.pdf">older Australians</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/telehealth-in-lockdown-meant-7-million-fewer-chances-to-transmit-the-coronavirus-141041">Telehealth in lockdown meant 7 million fewer chances to transmit the coronavirus</a>
</strong>
</em>
</p>
<hr>
<h2>An opportunity to improve care</h2>
<p>The rapid transition in service delivery necessitated by COVID-19 presents an opportunity for systemic change to professional interpreting services.</p>
<p>To ensure safe, quality care is provided during the pandemic, and to capitalise on the opportunity COVID-19 has afforded for improved care into the future, we need to see several things happen:</p>
<ul>
<li><p>all health-care personnel providing services to people with limited English proficiency should take up appropriate remote interpreting services</p></li>
<li><p>providers and staff should undergo training to increase familiarity with available technology and ensure its appropriate use</p></li>
<li><p>health services’ rates of remote interpreting uptake should be measured and reported as an indicator of access</p></li>
<li><p>barriers to the use of remote interpreting services should be explored to ensure they’re addressed and overcome</p></li>
<li><p>cost and effectiveness of remote delivery should be further evaluated. This includes comparing modes (for example, telephone versus video) to inform best practice and policy.</p></li>
</ul><img src="https://counter.theconversation.com/content/143531/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Darcy Morris, Senior Administrative Officer at the University of Wollongong, contributed significantly to this article.</span></em></p>Interpreters are a critical part of health care for people with limited English. The shift to remote interpreting during COVID-19 could ensure more Australians who need these services can access them.Judy Mullan, Associate Professor, School of Medicine, University of WollongongLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1403542020-06-15T11:44:12Z2020-06-15T11:44:12ZBAME people need a better chance of fighting off coronavirus – here’s what can be done now<p>The death rate from COVID-19 in England is four times higher for black people and three times higher for Asian people than for their white counterparts, according to the <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/890258/disparities_review.pdf">recent report</a> by Public Health England. We know that socio-economic and cultural factors linked to <a href="https://theconversation.com/coronavirus-its-impact-cannot-be-explained-away-through-the-prism-of-race-138046">racism and inequality</a> impact negatively on the underlying health of black, Asian and minority ethnic (BAME) people. And this may leave them less able to deal with the virus. </p>
<p>This means that to reduce the outsized effect that COVID-19 is having on BAME communities, we need to find ways to help people improve their overall health and immune responses in both the short and long term.</p>
<p>BAME people are more likely to be employed in low-paid, insecure and high-risk jobs, and live in poorer conditions in more deprived areas. <a href="https://digital.nhs.uk/data-and-information/publications/statistical/health-survey-for-england/health-survey-for-england-2004-health-of-ethnic-minorities-main-report#:%7E:text=Summary,on%20cardiovascular%20disease%20(CVD).">They have on average</a> poorer diets, lower rates of physical activity and inferior access to sanitation facilities.</p>
<p>A lack of money and time to devote to maintaining a healthy lifestyle combined with lower levels of health literacy often results in BAME people having weaker immune systems than more affluent groups. They are also more likely to suffer long-term conditions affecting the immune system, such as cardiovascular disease, type 2 diabetes and hypertension. And darker skin and cultural factors that mean BAME people are more likely to cover their bodies outside are linked to higher rates of <a href="https://theconversation.com/does-vitamin-d-protect-against-coronavirus-138001">vitamin D deficiency</a>, which can also affect the immune system.</p>
<p>With this in mind, one short-term way to improve people’s chances of surviving COVID-19 would be to boost their immune systems by encouraging them to improve their diets and increase their exposure to sunlight. In particular, this would involve encouraging people to increase their intakes of zinc, iron and vitamins A, C and D, which <a href="https://www.mdpi.com/2072-6643/12/1/236">are crucial</a> to the body’s immune response to infection.</p>
<p>To <a href="https://bmcresnotes.biomedcentral.com/articles/10.1186/s13104-017-3104-9">achieve this</a>, the NHS or local authorities could run information campaigns through the media and through employers, schools, healthcare facilities, places of worship and other community groups. Exercise schemes, groups and classes could also be targeted at BAME people according to their gender and age group, in order to encourage more physical activity. Such campaigns <a href="https://issuu.com/weawestmidlands/docs/tandrustiresearch">have been shown</a> to improve BAME people’s health at a local level. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/341796/original/file-20200615-65930-1nfq3oy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/341796/original/file-20200615-65930-1nfq3oy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=385&fit=crop&dpr=1 600w, https://images.theconversation.com/files/341796/original/file-20200615-65930-1nfq3oy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=385&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/341796/original/file-20200615-65930-1nfq3oy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=385&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/341796/original/file-20200615-65930-1nfq3oy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=484&fit=crop&dpr=1 754w, https://images.theconversation.com/files/341796/original/file-20200615-65930-1nfq3oy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=484&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/341796/original/file-20200615-65930-1nfq3oy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=484&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Community groups and champions could help improve health literacy and access to services.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/people-meeting-seminar-office-concept-524249461">Rawpixel/Shutterstock</a></span>
</figcaption>
</figure>
<p>The other aspect to consider is the cultural and language barriers that create problems to accessing health services. For instance, the uptake of national cancer screening programmes (for breast, bowel and cervical) is <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-8-346">very low among BAME</a> people.</p>
<p>Evidence suggests <a href="https://bmcresnotes.biomedcentral.com/articles/10.1186/s13104-017-3104-9">the best way</a> to engage with BAME people in this respect is to recruit and train health champions from the each community who can work to improve people’s health literacy and access to services. The charity <a href="https://www.bbc.co.uk/news/health-18117565">Diabetes UK</a> has already had some success in improving diabetes management among BAME patients in this way.</p>
<h2>Long-term solutions</h2>
<p>Given that the coronavirus doesn’t appear to be going away anytime soon and we don’t know when, or even if, a vaccine will be developed, we also need long-term strategies to improve the underlying chances of BAME people who catch COVID-19. A key aspect of this longer term approach would be to redefine the role of central and local government in public health to focus on BAME people specifically as well as deprived people in general. For example, policy changes designed to <a href="https://www.local.gov.uk/sites/default/files/documents/changing-behaviours-publi-e0a.pdf">“nudge” people</a> to improve their health could be directed at BAME communities. </p>
<p>We also need long-term action to <a href="http://www.healthliteracyplace.org.uk/media/1239/hl-and-hi-ucl.pdf">improve the health literacy</a> of BAME people and other disadvantaged groups. This could be done through short, locally delivered courses in colleges and community centres that improve their understanding of nutrition, fitness and their specific needs. This approach would be similar to the way that computer and IT skills have been delivered.</p>
<p>Simultaneously, healthcare and other community professionals could be given more training on how to help BAME people better manage the long-term conditions that they are more likely to have and that increase the risks of COVID-19, such as diabetes and cardiovascular disease. </p>
<p>Another more specific strategy would be to ensure BAME patients are included in the development of vaccines and antibody therapies, which is <a href="https://bjgp.org/content/63/612/342">often not the case</a> in clinical trials. This would make the treatments more likely to be widely effective because they would have been tested more thoroughly on BAME people’s specific health characteristics.</p>
<p>However, behind all of these issues lies the fundamental inequality caused by the inferior employment and living conditions that BAME people typically face. We won’t be able to address the disparity in the death rate from COVID-19 until we tackle the disparity in the all-round life opportunities that BAME people have to deal with every day.</p><img src="https://counter.theconversation.com/content/140354/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Anil Gumber does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Improving health literacy and access to services could empower ethnic minorities to boost their immune systems.Anil Gumber, Senior Health Economist, Sheffield Hallam UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1340462020-03-19T13:47:16Z2020-03-19T13:47:16ZCOVID-19: a guide to good practice on keeping people well informed<figure><img src="https://images.theconversation.com/files/321906/original/file-20200320-22618-ke5enp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Commuters outside Nairobi Railway Station wash their hands before entering the train station as a preventive measure against COVID-19. </span> <span class="attribution"><span class="source">Photo by Dennis Sigwe/SOPA Images/LightRocket via Getty Images</span></span></figcaption></figure><p>The <a href="https://www.who.int/health-topics/coronavirus">coronavirus disease (COVID-19)</a> is <a href="https://experience.arcgis.com/experience/685d0ace521648f8a5beeeee1b9125cd">spreading</a> across the world. For those who catch it, the vast majority will experience mild symptoms, but for a few it can cause severe disease and death. Some groups - like older people and those with pre-existing health conditions - <a href="https://theconversation.com/coronavirus-who-is-at-risk-and-how-do-we-know-133547">are more</a> vulnerable when exposed than others. </p>
<p>Because of this, the primary objectives in fighting the outbreak are to contain the virus and help the infected to get well again. In this context, health literacy is a valuable tool because it can affect <a href="http://www.euro.who.int/en/health-topics/disease-prevention/health-literacy/why-health-literacy-is-important">health outcomes in multiple ways</a>. Health literacy is the degree to which people can get, understand and use basic health information to make decisions about health issues. </p>
<p>A health literate society is one with a population that will be aware of the severity of the situation and is able to understand how to protect themselves, and others, through basic actions. In the case of this new virus, this includes physical distancing and washing hands. It’s also a society in which the systems and services in place can ensure clear, timely and appropriate communication. </p>
<p>In the current situation, well-informed individual behaviour <a href="https://blogs.bmj.com/bmj/2020/02/28/behavioural-science-must-be-at-the-heart-of-the-public-health-response-to-covid-19/">is a key intervention</a> alongside medical and governmental action. It’s crucial that health authorities apply <a href="https://www.cdc.gov/healthliteracy/training/page1619.html">health literacy principles</a> and provide information that is easy-to-understand, easy-to-access, and barrier-free. Health literacy is vital to slowing down the spread of the virus and mitigating the impact and effects of COVID-19. </p>
<p>This isn’t always done well. In Europe, <a href="https://academic.oup.com/eurpub/article/25/6/1053/2467145">research</a> has shown that health literacy is a neglected public health challenge. More than a third of the population faces difficulties in finding, understanding, evaluating and using information to manage their health. </p>
<p>Another challenge is fake information. Instead of real facts, people’s information channels might be dominated by fake news and fear due to the uncertainties. We’ve seen that during this pandemic – it’s not only the virus that is spreading quickly but <a href="https://www.politico.com/news/2020/03/16/coronavirus-fake-news-pandemic-133447">“a wildfire of false and unverified information”</a> on <a href="https://www.politico.eu/pro/the-coronavirus-covid19-fake-news-pandemic-sweeping-whatsapp-misinformation/amp/">WhatsApp</a>, <a href="https://www.nytimes.com/2020/03/08/technology/coronavirus-misinformation-social-media.html">Twitter</a>, <a href="https://www.nbcnews.com/tech/social-media/facebook-groups-coronavirus-misinformation-thrives-despite-broader-crackdown-n1151466">Facebook</a> and other <a href="https://www.factcheck.org/2020/01/new-coronavirus-wasnt-predicted-in-simulation/">social media</a> in the so called <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30461-X/fulltext">“infodemic”</a>.</p>
<p>Along with more than 100 other health literacy experts, we put together a handbook on <a href="http://www.oapen.org/search?identifier=1005225">health literacy</a>. This highlights cutting edge research, policy and practice from the field and is aimed at audiences from education, public health, health care and social science. Readers will learn about health promotion and prevention programmes for school children, patients, and the elderly. They can also learn about government and community policies that improve population health literacy. </p>
<h2>What’s needed</h2>
<p>Health literacy information must be understandable and it needs to meet the literacy needs of the people it’s directed at. People with reading difficulties, hearing and sight impairments, for example, will need different formats. They’ll need more explanation. For instance, animations help in explaining the virus, the disease, its transmission and protective measures. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/mOV1aBVYKGA?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
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<p>For parents and children, the <a href="https://news.un.org/en/story/2020/03/1059622">UN</a>, <a href="https://www.unicef.org/stories/novel-coronavirus-outbreak-what-parents-should-know">UNICEF</a> and <a href="https://www.savethechildren.org/us/what-we-do/emergency-response/coronavirus-outbreak/coronavirus-outbreak-how-to-explain-children">Save the Children</a> provide tips for how to talk to children about the virus. For example comics <a href="https://www.npr.org/sections/goatsandsoda/2020/02/28/809580453/just-for-kids-a-comic-exploring-the-new-coronavirus?t=1584541381186">might help</a>.</p>
<p>Other criteria health authorities must keep in mind include:</p>
<ul>
<li><p>Explain the situation transparently and clarify the overriding objectives repeatedly to prepare people for the fact that interventions and recommendations might change based on new evidence and adapt to future scenarios. </p></li>
<li><p>Be adaptable: information providers must be able to continuously communicate new evidence and information. Authorities should not be afraid to correct earlier messages and statements if new information is available, especially if it is contradicting yesterday’s news.</p></li>
<li><p>Avoid a blame game: blaming false security promises and scandalous over-interpretations of studies and figures are of little help. Rather, the aim should be to strengthen the well-informed responsibility of the individual, solidarity with particularly vulnerable population groups and targeted collaborative action. </p></li>
</ul>
<p>Linked to this is the need to prepare people for a barrage of misinformation. Health literacy can apply some <a href="https://www.cdc.gov/healthliteracy/training/page1619.html">basic principles</a> that ensure people get the right information, and know how to distinguish the bad. </p>
<p>This will:</p>
<ul>
<li><p>Help people cross check the accuracy and credibility of information found on TV, radio, internet, and social media, including aggressive ads for products. </p></li>
<li><p>Enable people to ask questions to family members and trusted health professionals about the fake news, misinformation and harmful content and messages. </p></li>
<li><p>Guide people to evidence-based messaging. As the <a href="https://www.iuhpe.org/index.php/en/iuhpenews/1359-covid-19">Global Working Group on Health Literacy of the International Union for Health Promotion and Education</a> stated, “the dissemination of quality, timely and understandable information is key in slowing down transmission and avoiding overburdening the healthcare system”.</p></li>
<li><p>Encourage people to check the source of information (where does it come from, who is behind the information, what is the intention, why was it shared, when was it published)</p></li>
<li><p>Encourage people to search a second source verifying the information and to double check with family, friends, colleagues and trusted health professionals</p></li>
<li><p>Encourage people to think hard before sharing information and not to share anything they haven’t checked and to visit fact-checking websites. These include credible sites such as the <a href="https://newslit.org/coronavirus/">News Literacy Project</a>, their <a href="https://guides.lib.jjay.cuny.edu/c.php?g=618074&p=4300854">fake news check questionnaire</a> and CUNY’s Graduate School of Journalism’s <a href="https://guides.lib.jjay.cuny.edu/c.php?g=618074&p=4300843">fake check guide</a>.</p></li>
</ul>
<p>If followed, some of the information and guidelines we’ve set out in the handbook can go a long way to building citizens’ health literacy on COVID-19 and contribute to containing the disease.</p><img src="https://counter.theconversation.com/content/134046/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Orkan Okan receives funding from the German Federal Ministry of Education and Research (BMBF) and the German Federal Ministry of Health (BMG)</span></em></p><p class="fine-print"><em><span>Kristine Sørensen is the president of the International Health Literacy Association</span></em></p><p class="fine-print"><em><span>Melanie Messer does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Health literacy is the degree to which people can get, understand and use basic health information to make decisions about health issues.Orkan Okan, Researcher, Interdisciplinary Centre for Health Literacy Research, Bielefeld UniversityKristine Sørensen, Director, Global Health Literacy Academy and Associated Guest Researcher, University of Education FreiburgMelanie Messer, External Lecturer, APOLLON University of Applied Sciences Licensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1178362019-10-09T19:01:53Z2019-10-09T19:01:53ZIs this study legit? 5 questions to ask when reading news stories of medical research<figure><img src="https://images.theconversation.com/files/296114/original/file-20191009-3935-yjqvtr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">It can be difficult to work out whether you should believe a study's reported findings.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/cropped-image-male-freelancer-sitting-table-262335083">GaudiLab/Shutterstock</a></span></figcaption></figure><p>Who doesn’t want to know if drinking that second or third cup of coffee a day will improve your memory, or if sleeping too much increases your risk of a heart attack? </p>
<p>We’re invested in staying healthy and many of us are interested in reading about new research findings to help us make sense of our lifestyle choices. </p>
<p>But not all research is equal, and not every research finding should be interpreted in the same way. Nor do all media headlines reflect what was actually studied or found. </p>
<p>So how can you tell? Keep these five questions in mind when you’re reading media stories about new studies.</p>
<h2>1. Has the research been peer reviewed?</h2>
<p>Peer review is a process by which a study is checked by experts in the discipline to assess the study’s scientific validity.</p>
<p>This process involves the researcher writing up their study methods and results, and sending this to a journal. The manuscript is then usually sent to two to three experts for peer review.</p>
<p>If there are major flaws in a study, it’s either rejected for publication, or the researchers are made to address these flaws. </p>
<p>Although the peer-review process isn’t perfect, it shows a study has been subjected to scrutiny. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/peer-review-has-some-problems-but-the-science-community-is-working-on-it-99596">Peer review has some problems – but the science community is working on it</a>
</strong>
</em>
</p>
<hr>
<p>Any reported findings that haven’t been peer reviewed should be read with a degree of reservation.</p>
<h2>2. Was the study conducted in humans?</h2>
<p>Findings from studies conducted in animals such as mice or on cells in a lab (also called <em>in vitro</em> studies) represent the earliest stage of the scientific discovery process. </p>
<p>Regardless of how intriguing they may be, no confident claims about human health should ever be made based on these types of study alone. There is no guarantee that findings from animal or cell studies will ever be replicated in humans.</p>
<h2>3. Are findings likely to represent a causal relationship?</h2>
<p>For a study to have relevance to our day-to-day health, the findings need to reflect a <em>causal</em> relationship rather than just a <em>correlation</em>. </p>
<p>If a study showed that coffee drinking was associated with heart disease, for example, we want to know if this was because coffee actually <em>caused</em> heart disease or whether these to things happened to occur together.</p>
<p>In a number of studies that found this association, researchers <a href="https://www.ncbi.nlm.nih.gov/pubmed/18328848">subsequently found</a> that coffee drinkers were more likely to be smokers and therefore, these results were more likely to reflect a true causal relationship between smoking and heart disease. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/296132/original/file-20191009-3887-1odwcjl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/296132/original/file-20191009-3887-1odwcjl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/296132/original/file-20191009-3887-1odwcjl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/296132/original/file-20191009-3887-1odwcjl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/296132/original/file-20191009-3887-1odwcjl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/296132/original/file-20191009-3887-1odwcjl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/296132/original/file-20191009-3887-1odwcjl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Just because something is common among coffee drinkers, doesn’t mean coffee caused it.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/female-hands-holding-cups-coffee-on-261247157?src=DYbOCy048cq5gPoe7MdxSA-1-20">Africa Studio/Shutterstock</a></span>
</figcaption>
</figure>
<p>In observational studies, where researchers observe differences in groups of people, it can sometimes be difficult to disentangle the relationship between variables.</p>
<p>The highest level of evidence regarding causality comes from double-blind placebo controlled randomised controlled trials (RCTs). This experimental type of study, where people are separated into groups to randomly receive either an intervention or placebo (sham treatment), is the best way we can determine if a something causes disease. However it, too, is not perfect. </p>
<p>Although other types of studies in humans play an important role in our understanding of health and disease, they may only highlight associations that are not indicative of causal relationships.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/clearing-up-confusion-between-correlation-and-causation-30761">Clearing up confusion between correlation and causation</a>
</strong>
</em>
</p>
<hr>
<h2>4. What is the size of the effect?</h2>
<p>It’s not enough to know that an exposure (such a third cup of coffee or more than nine hours of sleep a night) causes an outcome, it’s also important to clearly understand the strength of this relationship. In other words, how much is your risk of disease going to increase if you are exposed?</p>
<p>If your risk of disease is reported to increase by 50% (which is a <em>relative</em> risk), this sounds quite frightening. However, if the original risk of disease is low, then a 50% increase in your risk may not represent a big actual increased risk of disease. A 50% increased risk of disease could mean going from a 0.1% risk of disease to your risk being 0.15%, which doesn’t sound quite so dramatic.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-you-need-to-know-to-understand-risk-estimates-67643">What you need to know to understand risk estimates</a>
</strong>
</em>
</p>
<hr>
<h2>5. Is the finding corroborated by other studies?</h2>
<p>A single study on its own, even if it’s a well-conducted randomised controlled trial, can never be considered definitive proof of a causal relationship between an exposure and disease.</p>
<p>As humans are complex and there are so many variables in any study, we can’t be confident we understand what is actually going on until findings are replicated in many different groups of people, using many different approaches. </p>
<p>Until we have a significant body of evidence that is in agreement, we have to be very careful about our interpretation of the findings from any one study.</p>
<h2>What if these questions aren’t answered?</h2>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/296133/original/file-20191009-3880-153el8k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/296133/original/file-20191009-3880-153el8k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/296133/original/file-20191009-3880-153el8k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/296133/original/file-20191009-3880-153el8k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/296133/original/file-20191009-3880-153el8k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/296133/original/file-20191009-3880-153el8k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/296133/original/file-20191009-3880-153el8k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Switch news sites or try to see the original study.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/serious-woman-using-laptop-checking-email-1156208407?src=LnIBx_qkb1znqLKD0vsXKg-1-57">Fizkes/Shutterstock</a></span>
</figcaption>
</figure>
<p>If the media report you’re reading doesn’t answer these questions, consider changing news sites or looking at the original paper. Ideally this would be linked in the news article you’re reading, or you can search <a href="https://www.ncbi.nlm.nih.gov/pubmed/">PubMed</a> for the article using a few keywords.</p>
<p>The journal article’s abstract should tell you the type of study, whether it was conducted on humans and the size of the effect. If you’re not blocked by a paywall, you may be able to view the full journal article which should answer all of the questions you have about the study.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/wheres-the-proof-in-science-there-is-none-30570">Where's the proof in science? There is none</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/117836/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Hassan Vally does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Wondering if that latest study finding is too good to be true, or whether it’s as bad as we’re told? Here are five questions to ask to help you assess the evidence.Hassan Vally, Associate Professor, La Trobe UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/917512018-07-31T20:15:28Z2018-07-31T20:15:28ZWhen is it OK to call an ambulance?<p>When would you call 000 for an ambulance? When a fall results in a nasty fracture? Concern that labour is progressing so rapidly that you’ll give birth before you can get to hospital? Weakness from prolonged vomiting and diarrhoea? </p>
<p>If you take a look at some <a href="http://www.ambulance.nsw.gov.au/Calling-an-Ambulance/When-to-call-Triple-Zero-000.html">Australian ambulance websites</a>, none of these examples meet their definition of a “medical emergency” suitable for an ambulance response. But that doesn’t mean you shouldn’t call for an ambulance in these situations.</p>
<p>In <a href="https://www.pc.gov.au/research/ongoing/report-on-government-services/2018/health/ambulance-services">2016-17</a>, Australian ambulance services attended 3.5 million incidents. These include cases categorised as urgent but not a “lights and sirens” response, as well as transport between hospitals and other health facilities. Only 1.1 million of the incidents, or approximately 37%, were classified as emergencies. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/paramedics-need-more-support-to-deal-with-daily-trauma-97315">Paramedics need more support to deal with daily trauma</a>
</strong>
</em>
</p>
<hr>
<h2>What happens when you call 000?</h2>
<p>When someone calls the emergency number and asks for an ambulance, the call-taker typically takes the caller through a computer-based script. They attempt to define the health problem, and determine the response required: lights and sirens, or not.</p>
<p>Call-takers are not medically trained, but use a call screening program to identify the health problem. This system includes non-urgent categories such as “sick person”, which includes complaints such as an earache, sore throat and hiccups.</p>
<p>People may find it easiest to call 000 for a broad range of health problems, particularly after hours. But the deployment of paramedics for non-urgent health problems reduces their availability to respond to medical emergencies and major incidents.</p>
<h2>Where are we going wrong?</h2>
<p>Media campaigns have been used to educate the public about when it’s appropriate to call an ambulance. Strategies such as the Ambulance Victoria <a href="https://www.ambulance.vic.gov.au/community-education/ambulances-are-for-emergencies/">Ambulances are for Emergencies</a> campaign includes stories of lives saved that may have been lost had ambulances been tied up with non-emergency calls.</p>
<p>Health promotion bodies have also highlighted the types of problems that should be considered health emergencies: chest pain, breathing difficulty, altered level of consciousness, sudden numbness, or paralysis of the face or limb.</p>
<p>But attempts to define a “health emergency” often fail to appreciate that the definition is dynamic and depends on context. A complaint of weakness associated with prolonged vomiting and diarrhoea may not be an emergency when you have family support and transport options. But it may be an emergency when the patient is an elderly person living alone without support. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/229929/original/file-20180731-176698-9fk08.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/229929/original/file-20180731-176698-9fk08.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/229929/original/file-20180731-176698-9fk08.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/229929/original/file-20180731-176698-9fk08.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/229929/original/file-20180731-176698-9fk08.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/229929/original/file-20180731-176698-9fk08.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/229929/original/file-20180731-176698-9fk08.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Patients who arrive at hospital by ambulance are likely to believe their condition is more serious than if they got there themselves.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/medical-team-working-on-patient-emergency-168769238?src=CRCnZ-2UKKWBIUb0mQBTmg-1-4">Shutterstock</a></span>
</figcaption>
</figure>
<p>There is also a difference between the patient’s perception of a health emergency and a health professional’s definition. This has been investigated by an <a href="http://www.publish.csiro.au/ah/AH10922">Australian study</a> that found patients cannot be expected to accurately evaluate the urgency of a health event. Social and emotional cues are often used to identify medical urgency. Understandably, people may be poorly placed to make rational, informed decisions about care options during a health crisis.</p>
<p>Research on ambulance use in Queensland <a href="http://onlinelibrary.wiley.com/doi/10.1111/acem.12149/full">aimed to understand</a> why people use ambulance services for minor health problems. It found that people who arrived at an emergency department by ambulance had a higher self-reported perception of the seriousness or urgency of their problem than patients who self-presented to hospital emergency departments. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-do-we-wait-so-long-in-hospital-emergency-departments-and-for-elective-surgery-54384">Why do we wait so long in hospital emergency departments and for elective surgery?</a>
</strong>
</em>
</p>
<hr>
<p>The ambulance users were more likely to believe that ambulance services were for everyone to use, irrespective of the severity of their condition. They were also more likely to believe that arriving by ambulance would lead to priority treatment at the hospital.</p>
<p>One possible explanation for these findings relates to health literacy. Poor health literacy affects the person’s ability to interpret health advice and navigate the health system to identify options for unscheduled care. Low levels of health literacy also limit the effectiveness of interventions that are designed to change behaviour. </p>
<p>Research from the <a href="https://www.pc.gov.au/inquiries/completed/productivity-review/report">Productivity Commission</a> found the majority of Australians have inadequate health literacy. The proportion is greatest for those with chronic conditions. Even 40% of people with a health-related qualification have inadequate health literacy.</p>
<h2>Where can we improve?</h2>
<p>Taking into account the difficulties of making crucial decisions during a crisis situation, there are a number strategies which may facilitate more effective use of ambulance resources.</p>
<p>One alternative approach is to use experienced clinicians to screen emergency calls and direct the caller to the most appropriate health pathway.</p>
<p>Several Australian ambulance services have introduced such a system, and the outcome of this screening process may be to dispatch an ambulance, or initiate a home visit by a doctor, nurse or paramedic trained to manage non-urgent health problems. </p>
<p>These systems have been shown to provide <a href="http://www.publish.csiro.au/ah/ah15134">effective referral options</a> for cases that don’t represent medical emergencies. Instead of discouraging people to call 000, they use call screening systems to identify emergency cases, which may include those not explicitly listed on ambulance service websites.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/in-the-future-your-ambulance-could-be-driverless-78974">In the future your ambulance could be driverless</a>
</strong>
</em>
</p>
<hr>
<p>If you you’re confident navigating health information, you may find sites such as <a href="https://www.healthdirect.gov.au/">healthdirect</a> useful. This service uses a web-based algorithm to question the user about the nature of the health problem to direct the patient to local health services based on the nature of the complaint. It also provides a national phone number to contact a registered nurse about your health problem. </p>
<p>But if you’re unsure whether an ambulance is required, it’s OK to call 000 for advice. After all, delaying a call for a serious health problem can lead to a catastrophic outcome.</p><img src="https://counter.theconversation.com/content/91751/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Bill Lord has received funding from the Office for Learning and Teaching Innovation and Development grant: Expert in my pocket: a mobile-enabled repository of learning resources for the development of clinical skills in student health professionals. (Ref: ID13-2962). $180,000.</span></em></p>If you’re unsure whether you need an ambulance, it’s OK to call 000 for advice.Bill Lord, Associate Professor in Paramedicine, University of the Sunshine CoastLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/853392017-11-07T13:22:21Z2017-11-07T13:22:21ZThe public’s knowledge of anatomy is sketchy – here’s why it matters<figure><img src="https://images.theconversation.com/files/193314/original/file-20171105-1020-iibz18.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/666053218?src=szM_wR-FsF2zQFavbsWN7Q-1-41&size=medium_jpg">Bangkoker/Shutterstock</a></span></figcaption></figure><p>British people don’t seem to know their armpit from their elbow. Our latest study found that only 15% of the participants could locate their adrenal glands, and only 20% knew where their spleen and gallbladder was. </p>
<p>Perhaps it’s not surprising that people struggle to identify structures in their abdomen. It’s a pretty congested space, filled with all the organs for digestion: stomach, pancreas, liver, gallbladder, 20ft of intestines and the rectum, as well as the kidneys and all the blood vessels. But understanding the abdomen is important because lots of visits to the emergency department are for problems related to these structures: <a href="https://www.nhs.uk/conditions/appendicitis/symptoms/">appendicitis</a>, <a href="https://www.nhs.uk/conditions/gallstones/symptoms/">inflamed gallbladder</a>, <a href="https://www.nhs.uk/conditions/kidney-stones/symptoms/">kidney stones</a>, <a href="https://www.nhs.uk/conditions/diverticular-disease-and-diverticulitis/">diverticulitis</a>, <a href="https://www.nhs.uk/conditions/abdominal-aortic-aneurysm/">aortic aneurysm</a>.</p>
<p>Anatomy isn’t just a subject, it is also a <a href="https://www.ncbi.nlm.nih.gov/pubmed/20069644">language</a>. When patients and healthcare professionals share this common language, consultations are smoother and patients report being more <a href="https://www.ncbi.nlm.nih.gov/pubmed/15520032">satisfied</a>. However, research has shown that when doctors <a href="https://www.ncbi.nlm.nih.gov/pubmed/17140758">over-estimate</a> their patients’ knowledge of anatomy, it can lead to worse health outcomes for the patient. </p>
<p>Although it’s not the patient’s job to have a detailed knowledge of anatomy, it can help doctors make a diagnosis more quickly and accurately.</p>
<p>Having some anatomical knowledge is part of what’s known as <a href="https://health.gov/communication/literacy/quickguide/factsbasic.htm">health literacy</a> – the ability to “obtain, process and understand health information and services needed to make an appropriate decisions”. Being health literate can help you know when something is wrong and help you decide whether to make an appointment with your doctor or go straight to an emergency department – a fairly important choice to make as winter approaches and those departments <a href="http://www.independent.co.uk/life-style/health-and-families/health-news/nhs-crisis-a-and-e-waiting-times-record-levels-leak-bbc-data-government-failing-to-grasp-seriousness-a7570791.html">begin to come under strain</a>.</p>
<h2>Lifesaving knowledge</h2>
<p>A hint that the British public have poor knowledge of their own anatomy came from an earlier poll, conducted by Prostate Cancer UK. The charity found that <a href="https://prostatecanceruk.org/about-us/news-and-views/2016/4/almost-1-in-5-men-lethally-ignorant-they-even-have-a-prostate-new-survey-finds">more than half</a> of the 2,000 men they surveyed did not know where their prostate was. Alarmingly, 17% of the men surveyed didn’t know they had a prostate. Only <a href="https://journals.rcni.com/doi/abs/10.7748/ns.30.40.17.s20">8%</a> knew what it did.</p>
<p>If you’re a man, knowing where your prostate is, is fairly crucial. In 2014, just under <a href="http://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/prostate-cancer">47,000</a> men were diagnosed with prostate cancer, and over 11,000 men died from the disease.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/193315/original/file-20171105-1017-g5bbeg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/193315/original/file-20171105-1017-g5bbeg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=432&fit=crop&dpr=1 600w, https://images.theconversation.com/files/193315/original/file-20171105-1017-g5bbeg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=432&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/193315/original/file-20171105-1017-g5bbeg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=432&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/193315/original/file-20171105-1017-g5bbeg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=543&fit=crop&dpr=1 754w, https://images.theconversation.com/files/193315/original/file-20171105-1017-g5bbeg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=543&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/193315/original/file-20171105-1017-g5bbeg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=543&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Nearly one in five men don’t know that they have a prostate (it’s the yellow bit).</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/458875147?src=9cHzrKo0D4K39vqJipLTMg-1-89&size=medium_jpg">Anatomy Insider/Shutterstock</a></span>
</figcaption>
</figure>
<p>For our own study, we asked 63 members of the public, ranging in age from eight to 74 to place 20 body organs and structures onto a map of the body. Thankfully, all of the participants knew <a href="http://dx.doi.org/10.1002/ase.1746">where their brain was located</a>. They were also quite good at identifying the cornea and the biceps muscle. But when it came to the abdomen, things got worse. Some people located the liver on the wrong side, adrenal glands in the neck, stomach in a variety of locations and diaphragm in the wrong place.</p>
<p>Men were better at identifying specific muscles than women, but not at internal organs, where females were better. </p>
<p>We also asked the participants if they’d visited a healthcare professional in the last seven days – ten said that they had. This had two objectives. The first was to see if people could recall what they had been informed about. Our results suggested they couldn’t. The second was to see if going home and using the internet after their consultation would make them better at answering questions about their anatomy. It didn’t. </p>
<p>I was relieved to find that healthcare professionals performed significantly better than the rest. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/193312/original/file-20171105-1046-11fbqgf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/193312/original/file-20171105-1046-11fbqgf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/193312/original/file-20171105-1046-11fbqgf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/193312/original/file-20171105-1046-11fbqgf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/193312/original/file-20171105-1046-11fbqgf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/193312/original/file-20171105-1046-11fbqgf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/193312/original/file-20171105-1046-11fbqgf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Cluttered space.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/495646264?src=PDwMwu4woRUzdi2s2e5HoQ-1-41&size=medium_jpg">Tefi/Shutterstock.com</a></span>
</figcaption>
</figure>
<p>Finally, there was no significant difference in performance based on academic qualifications. We saw a peak in the knowledge level around the age of 40, which coincides with <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)00620-6/fulltext?rss%3Dyes">increased</a> GP referral rates, suggesting that this is the age bracket where people begin to take more notice of their anatomy. </p>
<p>Reassuringly, pre-adolescent children also fared well. There is no formal anatomical education in the UK for children in this age group, but there is obviously a thirst for knowledge about the subject, given how well they performed in the study. </p>
<p>But we really could do more to teach basic anatomy in primary and secondary school. It may help people live longer, healthier lives, and it would certainly make doctors’ lives easier.</p><img src="https://counter.theconversation.com/content/85339/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Adam Taylor is affiliated with the Anatomical Society</span></em></p>Basic anatomical knowledge can save lives.Adam Taylor, Director of the Clinical Anatomy Learning Centre & Senior Lecturer in Anatomy, Lancaster UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/674692016-11-18T10:43:33Z2016-11-18T10:43:33ZHealth literacy can be a matter of life or death<figure><img src="https://images.theconversation.com/files/146110/original/image-20161115-31144-1qlu1rx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption"></span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-327109946/stock-photo-doctor-helping-patient-with-medication.html?src=deRvlzuIhiD69yVWyjoh9g-1-0">Phovoir/Shutterstock.com</a></span></figcaption></figure><p>The basic ability to read is essential in looking after one’s health, especially when managing a chronic illness that requires various treatments and medications. It is estimated that patients with low health literacy cost anywhere from <a href="http://publichealth.gwu.edu/departments/healthpolicy/CHPR/downloads/LowHealthLiteracyReport10_4_07.pdf">US$106 billion to US$238 billion</a> each year in the US alone, which equates to roughly 10% of the healthcare budget. In the UK, it’s estimated that the financial cost of low health literacy is <a href="https://www.england.nhs.uk/2016/10/jonathan-berry/">3% to 5%</a> of the yearly NHS budget.</p>
<p><a href="https://health.gov/communication/literacy/quickguide/factsbasic.htm">Health literacy</a> is defined as the degree to which a person has the capacity to obtain, process and comprehend health information in order to make decisions about their own health. Around <a href="http://www.aafp.org/afp/2015/0715/p118.html">75% of health information</a> is written at a high school to undergraduate reading level. </p>
<p>This presents serious problems – take the US for example, where the average reading ability of adults is between grade 8 and 9, with around a quarter of adults reading at a <a href="http://literacyprojectfoundation.org/community/statistics/">grade 5 level</a> and below. In England, the current research shows that <a href="https://www.england.nhs.uk/2016/10/jonathan-berry/">approximately 43% to 61%</a> of English working age adults regularly experience problems understanding health information. </p>
<p>As a result, most healthcare information is written at a level more advanced than the reader’s ability. Imagine the anxiety caused by not understanding what your doctor has said, or by being puzzled by your prescription, all with the knowledge that your health is at stake. Or if you’re a parent and making the health decisions for your child, that you could end up making a mistake that puts them at risk. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"772149141346611200"}"></div></p>
<p>Hospitals and other healthcare facilities can be stressful, daunting places. They’re often very busy with a distracting amount of information that all demand your attention. The health literacy standards of these environments are often mismatched with the health literacy levels of the patients using them, especially when it comes to signage. A problem faced by participants in one study was that the clinic they were looking for was given <a href="https://www.researchgate.net/publication/299066586_A_Health_Literacy_Walk_Through_a_Paediatric_Neurology_Service">three distinct names</a>: one in their appointment letter, one in the hospital directory and a different one again in the signposts. </p>
<p>When navigating a healthcare facility, a patient is expected to be able to read and understand a wide range of written information, from appointment letters to complex consent and medical history forms to information pamphlets and maps. Many patients are unable to make sense of these <a>sources of information</a>, leading to late or missed appointments, dissatisfaction with the facility and, in the worst case, a decision to end their treatment. </p>
<h2>The problem of jargon</h2>
<p>We all come across jargon in the workplace, probably on a daily basis. Yet the use of jargon by doctors and other medical staff can be troubling. It’s easy for doctors to forget that most of their patients don’t have the same education, training and years of experience that they do, and that the complex terms they’re familiar with might sound like a foreign language to others. A patient being told that they have “renal adenoma” or “a benign kidney tumor” can be misunderstood, causing them pointless worry. A less extreme example would be using “hypertension” in the place of “high blood pressure” when the latter is more commonly understood. </p>
<p>Patients with low levels of health literacy are more likely to make mistakes with their <a href="https://www.stfm.org/fmhub/fm2004/september/lisa588.pdf">medication</a> and often misread the instructions. Instructions such as “take two pills twice a day” can be misread, with research showing that fewer mistakes were made if phrased “<a href="http://www.aafp.org/afp/2013/0601/p755.pdf">take two pills with breakfast and two pills with dinner</a>”. Most research in this area found that around half of patients were recorded as misunderstanding their medication’s purpose, the frequency taken, or the specific dosage instructions involved. Errors with medication can be very dangerous for patients, even life threatening in some cases. </p>
<p>The concept of health literacy was first introduced in the 1970s, so it’s still a fairly new field of research, but it has been gaining traction in recent years. It’s hoped that future research will highlight this as a significant area of concern, instigating the changes necessary to accommodate those with low health literacy.</p><img src="https://counter.theconversation.com/content/67469/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Keegan Clay Shepard does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Most healthcare information is written at a level more advanced than the reader’s ability.Keegan Clay Shepard, Postdoctoral Research Associate, University of OxfordLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/494932015-10-22T19:08:15Z2015-10-22T19:08:15ZConfused about your private health insurance coverage? You’re not alone<figure><img src="https://images.theconversation.com/files/99290/original/image-20151022-8024-yxblax.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Consumers are often unclear about the benefits and exclusions.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/justingaynor/10614438/in/album-265661/">Justin Gaynor/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span></figcaption></figure><p>Anyone who has purchased private health insurance or thought about changing policies knows the system is complex and confusing. It’s almost impossible to compare coverage between the <a href="http://www.abc.net.au/news/2015-10-20/private-health-insurance-system-failing-consumersi/6869742">34 providers</a> and their various 20,000 or so plans. </p>
<p>The Australian Competition and Consumer Commission’s (ACCC) <a href="http://accc.gov.au/media-release/accc-report-on-the-private-health-insurance-industry">annual report on the industry</a>, released this week, shows that half (48%) of private health insurance customers have thought about changing plans and took steps to do so, but only 14% followed through. </p>
<p>Private health insurers use different terminology, technical language and make bold but vague advertising claims. Consumers are often unclear about the benefits and exclusions, and may end up opting for lower-cost plans that lack adequate coverage. </p>
<p>The ACCC report on the disconnect between what consumers expect and what insurers provide echoes <a href="https://theconversation.com/explainer-why-do-australians-have-private-health-insurance-38788">our own research</a>. Along with rising premiums, consumers are often slugged with unexpected out-of-pocket expenses. And they’re often encouraged to use their private health insurance rather than using the taxpayer-funded public health system. </p>
<p>Better information – about private health insurance policies, but also how the health system works – is key to fixing these problems. </p>
<h2>Should you use your private health insurance?</h2>
<p><a href="http://www.apra.gov.au/Pages/phiac-redirect.aspx">Half the Australian population</a> already has private health insurance and there is increasing pressure on others to sign up, either to avoid higher taxes, avoid higher premiums if aged over 30, or to ease the burden on the public hospital system. </p>
<p>When people with private health insurance are ill or injured they must decide whether to use the public system or use their private health insurance. According to the ACCC, “public hospitals are becoming increasingly active in pressuring patients to use their insurance in a public hospital”.</p>
<p>Once an initial decision has been made about which health system to use, it’s difficult to change course. And, if using private health insurance, costs can quickly cascade. As one of our research participants, pregnant with her first child, explained: </p>
<blockquote>
<p>I figure I’ve got [private health insurance] so should use it. We know that the hospital is covered as far as I only have to pay my excess for that, but the obstetrician is costing us about $3,500. If I need to have a cesarean there will be extra costs for the anaesthetist, a paediatrician at the time, so there could be extra costs if that happens… And to do the antenatal classes it’s $160 and most private health funds cover it except for mine. </p>
</blockquote>
<p>People need “system knowledge” to successfully navigate health care, such as whether to use private health insurance when admitted to a public hospital. Such system knowledge can be gained through personal experiences, the experiences of close friends or family, or health advocates. </p>
<p>In <a href="http://sydney.edu.au/health-sciences/research/healthcare-choice/index.shtml">our research</a>, many participants described being asked if they would “help the hospital” by using their private cover. </p>
<p>Those with system knowledge generally did not do so. They knew there would be out-of-pocket expenses if they did, but none if they did not. They assessed their quality of care as likely to be no different. </p>
<p>People without “system knowledge” agreed to using private health insurance and were surprised that there was little difference in the care received. They thought private health insurance provided an entitlement to superior care and experience, such as a private room. </p>
<h2>Towards more informed health consumers</h2>
<p>The ACCC report outlines a number of stakeholder recommendations to reduce confusion and help consumers navigate the health care and health financing maze. This includes:</p>
<ul>
<li>standardising terminology and reviewing policy standard information statement (SIS) requirements so consumers can more easily compare policies</li>
<li>improving minimum policy coverage requirements</li>
<li>allowing consumers to more easily calculate their out-of-pocket expenses. </li>
</ul>
<p>Consumers also need access to trusted information. While many comparator websites are available to help consumers select private health insurance policies, the extent to which they are sponsored by various providers is often unclear. </p>
<p>Groups that advocate for consumers, such as the <a href="https://www.chf.org.au/">Consumers Health Forum</a> or <a href="https://www.choice.com.au/">Choice</a>, may be better placed to provide accessible and trusted information. This would ensure that consumers receive the information they require through independent evaluation of products, consumer forums for sharing information and experiences, and clear information about switching insurers.</p>
<p>The ACCC report also highlights the benefits of the little-used and accessed government website: <a href="http://privatehealth.gov.au">privatehealth.gov.au</a>. With a name change and redesign, this site could be become an information portal for more than just private health insurance.</p>
<p>People also need information about what is available in the public health care system. Taxpayers pay for health care via the Medicare levy, and this can be overlooked when making decisions about health care. Clear information about access, navigation and services provided in the public system would help consumers decide what, if any, additional health insurance they need. </p>
<p><a href="http://sydney.edu.au/health-sciences/research/healthcare-choice/index.shtml">Our research</a> found consumers want more information, in particular, about waiting lists for public hospitals in their region and how they compare to the private system; and clarity around what is considered “elective”. </p>
<h2>What should you do in the meantime?</h2>
<p>To assess whether you’ve got the right private health insurance coverage, you should review your policies on an annual basis. Carefully read your policy documents, along with any communications from the insurer, in case the terms change. </p>
<p>If you have ancillary or “extras” cover, consider the costs and benefits and whether you’re better off paying for these expenses upfront. </p>
<p>Finally, check what your insurer means when they use language such as “no gap”, whether annual limits are based on a “membership year” or a “calendar year”, and the items that are excluded in your policy.</p><img src="https://counter.theconversation.com/content/49493/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Karen Willis is lead investigator on an Australian Research Council funded project titled 'Navigating the Healthcare Maze - the differential capacity to choose' (2013-2015).</span></em></p><p class="fine-print"><em><span>Sophie Lewis does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Anyone who has purchased private health insurance or thought about changing policies knows the system is complex and confusing.Karen Willis, Associate Dean (Learning and Teaching), Australian Catholic UniversitySophie Lewis, Lecturer, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/375802015-02-24T03:31:14Z2015-02-24T03:31:14ZDr Google can improve older people’s health – if we bridge the technology gap<figure><img src="https://images.theconversation.com/files/72841/original/image-20150224-32244-braz34.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Only 3% of elderly people know how to access health-related information.</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-172679258/stock-photo-old-woman-working-on-laptop-computer-at-home.html?src=tGmWIibEJb9WpZBkNooJYw-1-92&ws=1">LoloStock/Shutterstock</a></span></figcaption></figure><p>With more <a href="http://health.nih.gov/">health information</a> going online every day, it has never been easier to proactively manage our health. The problem is, the people who would benefit the most seem to be using it the least. </p>
<p>Older adults typically have a greater need for health-related information but their <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2818317/">health literacy</a> – their capacity to obtain, process and understand health information to make appropriate health decisions – is the lowest among all age groups.</p>
<p><a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2818317/">Research</a> shows that only about 3% of the elderly know how to access health-related information. And of those older adults who seek health information online, few are careful to evaluate its credibility. This points to the need for interventions to assist older adults’ use of computers and the internet.</p>
<p>There are clear <a href="http://www.sciencedaily.com/releases/2014/11/141125205831.htm">benefits</a>, both at a personal and social level, to teaching the elderly how to <a href="http://www.revistacomunicar.com/indice-en/articulo.php?numero=42-2014-17">access health information</a> and to use the internet generally. Efforts have been made to address this skills gap, but with limited success. </p>
<h2>What works?</h2>
<p>Sometimes the best solutions to behavioural problems are those that graft naturally onto people’s <em>instinctive</em> behaviours. The European Union has done just that with the <a href="http://www.geengee.eu/geengee/">Grandparents and Grandchildren</a> program that puts old and young together so that the old might learn from the young. </p>
<p>This approach is working, probably because it taps into the natural instinct we have to <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1741-3737.2001.00001.x/abstract;jsessionid=071E019E0280CB51713C895E3F5CE09A.f03t04?deniedAccessCustomisedMessage=&userIsAuthenticated=false">connect</a> with our blood relatives. School and college-age people are spending time with their grandparents for the purpose of learning how to use technology.</p>
<p>Beyond the family benefits, there is the potential for great savings to be made on health-care costs, keeping people in their own homes and out of hospital; a win-win situation.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/72842/original/image-20150224-32251-1u5dqxh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/72842/original/image-20150224-32251-1u5dqxh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=419&fit=crop&dpr=1 600w, https://images.theconversation.com/files/72842/original/image-20150224-32251-1u5dqxh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=419&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/72842/original/image-20150224-32251-1u5dqxh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=419&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/72842/original/image-20150224-32251-1u5dqxh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=527&fit=crop&dpr=1 754w, https://images.theconversation.com/files/72842/original/image-20150224-32251-1u5dqxh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=527&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/72842/original/image-20150224-32251-1u5dqxh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=527&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">There are clear benefits to teaching older people to source health information online.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/krawcowicz/9127401762">Barbara Krawcowicz/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span>
</figcaption>
</figure>
<p>Several health literacy programs are <a href="http://her.oxfordjournals.org/content/early/2012/06/29/her.cys067">being trialled</a> that involve helping the elderly to use the internet to find and appraise web-based cancer information. The participants in these programs reported getting better at doing this. </p>
<p>Follow-up studies show that once having learnt, the participants continued to use the internet to search for health-related information.</p>
<h2>Benefits of digital literacy</h2>
<p><a href="http://www.wired.com/2015/02/google-health-search/">Google</a> heads recently announced they will improve the validity of health-related searches by creating a database of commonly searched medical conditions that have been fact-checked by doctors. When consumers search for these conditions, these pre-vetted facts will appear at the top of the search results. It is hoped that this will get people the right information faster. </p>
<p>Once the elderly know how, they can proactively manage their health by accessing a wealth of information on many topics. A person with <a href="http://www.sciencedaily.com/releases/2014/12/141219160556.htm">type 2 diabetes</a>, for instance, could learn how to live on a low-glycaemic index diet, thus reducing the need for medication and lowering their risk of heart attack. They could also make use of the many health and fitness <a href="http://www.hongkiat.com/blog/iphone-health-app/">apps</a> now available. <a href="https://theconversation.com/whats-next-for-the-smartphone-in-a-rapidly-changing-market-32485">SmartWatch technology</a> is taking the whole business to a higher level of sophistication. </p>
<p>Important for healthy ageing is keeping the social bonds of family and friends strong and maintaining a sense of social connection. Not an easy thing to do in today’s world with friends and family living far and wide for employment. Skype, email and social media can go a long way to making people feel connected with those they love. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/72843/original/image-20150224-32238-1i1cft2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/72843/original/image-20150224-32238-1i1cft2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=428&fit=crop&dpr=1 600w, https://images.theconversation.com/files/72843/original/image-20150224-32238-1i1cft2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=428&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/72843/original/image-20150224-32238-1i1cft2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=428&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/72843/original/image-20150224-32238-1i1cft2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=538&fit=crop&dpr=1 754w, https://images.theconversation.com/files/72843/original/image-20150224-32238-1i1cft2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=538&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/72843/original/image-20150224-32238-1i1cft2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=538&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Skype can help older people connect with family and friends.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/deab/3195706220">Dea Bee/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span>
</figcaption>
</figure>
<p>With an ocean of knowledge just a few key-strokes away, there is plenty of scope for people to explore their interests. No matter how specialised they might be, you can find a community of interest to get involved with. It is well-known that keeping one’s mind active helps to delay <a href="http://biomedgerontology.oxfordjournals.org/content/69/9/1117.abstract">cognitive decline</a> and the <a href="http://www.sciencedaily.com/releases/2014/08/140812163709.htm">on-set of dementia</a>. </p>
<p>Many elderly people have lived interesting lives. They have things to say, but no-one on hand who is prepared to listen. These folks might want to record their experiences for posterity by writing their richly-textured biographies. Who knows what gems of wisdom might be contained in such accounts? </p>
<h2>Next steps</h2>
<p><em>It takes a village to raise a child</em>, as the old saying goes, but we might also add that it is a two-way street – it takes a community to look after the elderly. We need to put in some time and effort into finding better ways to do this. </p>
<p>One of the best things we can do for the older members of our community is to give them the means to better look after themselves by teaching them how to use the technology that the rest of us take for granted. An Australian pilot study to adapt the <a href="http://www.geengee.eu/geengee/">Grandparents and Grandchildren</a> would be a good start. </p>
<p>It is true that not everyone in this age group will want to learn. Some will be content to let it pass them by. But others will see the possibilities and eagerly embrace the potential for improvements to both quality and quantity of life.</p><img src="https://counter.theconversation.com/content/37580/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>With more health information going online, it has never been easier to proactively manage our health. Problem is, the people who would benefit the most are using it the least.David Tuffley, Lecturer in Applied Ethics and Socio-Technical Studies, School of ICT, , Griffith UniversityAmy Antonio, Lecturer, University of Southern QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/209512014-02-12T03:38:23Z2014-02-12T03:38:23ZDon’t panic! Healthy consumers look online for medical advice<figure><img src="https://images.theconversation.com/files/38577/original/hdd6jys2-1389087701.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Health consumers don't necessarily use the internet to bypass their GP, they use it as an additional source of information.</span> <span class="attribution"><span class="source">Flickr/Chelsea Louise</span></span></figcaption></figure><p>We’ve all heard the warnings against googling your symptoms in search of a diagnosis: you’ll uncover a range of daunting illnesses and launch into panic-mode over something like a measly cold. There is even a term to describe the compulsive searching for information about symptoms of illness online: <a href="http://theconversation.com/web-research-could-give-you-a-bad-dose-of-cyberchondria-20877">cyberchondria</a>.</p>
<p>Our research shows the plethora of health information online isn’t something we should necessarily be worried about: for the most part, it complements the role of medical practitioners and helps patients make more informed decisions. </p>
<p>But when it’s combined with poor health literacy, problems may occur. </p>
<h2>Why do we google symptoms?</h2>
<p><a href="http://sydney.edu.au/health-sciences/research/healthcare-choice/index.shtml">Our study</a> found that online self-diagnosis of symptoms is now a normal, everyday activity. People have always sought information and diagnoses from <a href="http://www.sciencedirect.com/science/article/pii/0037785673900024">other sources</a>, often before they decide to see their doctor. The internet is an extension of this practice. </p>
<p><a href="http://theconversation.com/dont-rely-on-dr-google-for-health-information-on-the-wild-wild-web-4332">Concerns</a> have been raised that online self-diagnosis websites encourage people to self-medicate. Again this is not new; <a href="http://www.bmj.com/content/312/7031/629?view=long&pmid=8595343">self-medication</a> with over-the-counter and alternative medications has always been part of people’s health strategies. </p>
<p>Our research found that people are not googling their symptoms as a <a href="http://theconversation.com/dont-rely-on-dr-google-for-health-information-on-the-wild-wild-web-4332">replacement</a> to their GP. Rather, they use the internet as an additional source of information to learn about their health condition and make decisions about treatment options. </p>
<p>Ultimately, consumers tend to feel more confident about their health care decisions when they are actively involved in the decision-making process. One interviewee said:</p>
<blockquote>
<p>I look on the internet always. I don’t always trust what you read in there. You can’t always do your own diagnosis. Then I’d definitely go to my GP, and we’d have a discussion about it [and] whatever advice she gives me, I’d probably take it. </p>
</blockquote>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/40879/original/zwgh8kw3-1391663460.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/40879/original/zwgh8kw3-1391663460.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/40879/original/zwgh8kw3-1391663460.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/40879/original/zwgh8kw3-1391663460.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/40879/original/zwgh8kw3-1391663460.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/40879/original/zwgh8kw3-1391663460.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/40879/original/zwgh8kw3-1391663460.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Seeking health advice from other sources is nothing new.</span>
<span class="attribution"><a class="source" href="http://www.flickr.com/photos/bcymet/3498738259/sizes/l/">bcymet/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc/4.0/">CC BY-NC</a></span>
</figcaption>
</figure>
<p>The internet was just one of many sources of information that participants drew on when seeking to learn about their symptoms. They also talked to family, friends and colleagues, read newspapers, listened to the radio and used Facebook or chat rooms. As one interviewee said:</p>
<blockquote>
<p>I’d go online or phone a friend [then] I’d talk to the doctor. The doctor might say something, and I might think, oh I don’t know whether that’s right. I wonder what [my friend] thinks. I might get some sort of diagnosis from the doctor and then say “oh, well that’s interesting, but I’d like to do a bit more research on that”, or ask somebody that’s had that problem. </p>
</blockquote>
<p>Our research found that participants were aware that not all online sources are reliable and were cautious about where they searched for information.</p>
<h2>Improving health literacy</h2>
<p>As we gain increasing access to the growing volume of health information online, there is a growing imperative for consumers to gain the skills and knowledge to understand online information. </p>
<p>However, an estimated 60% of Australian adults <a href="http://www.safetyandquality.gov.au/wp-content/uploads/2012/01/Consumers-the-health-system-and-health-literacy-Taking-action-to-improve-safety-and-quality3.pdf">have poor health literacy</a> and may struggle to make sense of the information they find on the internet. </p>
<p>People with <a href="http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/4102.0Main+Features20June+2009">low healthy literacy</a> have more dependence on health services and providers because they are less able to self-manage chronic health conditions and have less knowledge about the links between health and lifestyle behaviours such as nutrition, exercise, alcohol and smoking.</p>
<p>Health care is a big business and some online information is focused on generating profit rather than providing evidence-based advice. Sometimes, the distinction between business and information is not clear.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/38579/original/w223qgg5-1389088091.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/38579/original/w223qgg5-1389088091.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=686&fit=crop&dpr=1 600w, https://images.theconversation.com/files/38579/original/w223qgg5-1389088091.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=686&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/38579/original/w223qgg5-1389088091.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=686&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/38579/original/w223qgg5-1389088091.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=863&fit=crop&dpr=1 754w, https://images.theconversation.com/files/38579/original/w223qgg5-1389088091.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=863&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/38579/original/w223qgg5-1389088091.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=863&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Health providers can no longer rely on authority alone to convey information.</span>
<span class="attribution"><span class="source">Flickr/PBrewer</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Health care providers can help. They can direct people to websites from recognised health organisations such as <a href="http://www.healthinsite.gov.au/">Healthinsite</a>, <a href="http://www.betterhealth.vic.gov.au/">Better Health Channel</a>, <a href="http://www.mayoclinic.org/">MayoClinic</a> and <a href="http://www.nhsdirect.nhs.uk/">NHS Direct</a>. </p>
<p>Some health care providers and advocacy groups are now using <a href="http://theconversation.com/move-over-dr-google-the-future-of-health-is-social-4249">social media sites</a> such as Facebook, Twitter, Youtube and mobile apps to provide quality health information to consumers. In an environment where there are multiple sources of information – and not just the authority of medicine – health care providers are increasingly realising they can’t ignore social media. </p>
<p>Online information, including social media, needs to be part of health care workers’ approach to providing high-quality health care. </p>
<p>For those with high health literacy, credible online information is a valuable addition to their health care regime. Health care workers can assist those with lower health literacy to use online information.</p><img src="https://counter.theconversation.com/content/20951/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Karen Willis receives funding from The Australian Research Council for a project on healthcare choice.</span></em></p><p class="fine-print"><em><span>Marika Franklin and Sophie Lewis do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>We’ve all heard the warnings against googling your symptoms in search of a diagnosis: you’ll uncover a range of daunting illnesses and launch into panic-mode over something like a measly cold. There is…Sophie Lewis, Postdoctoral Research Associate, University of SydneyKaren Willis, Health sociologist, qualitative researcher, University of SydneyMarika Franklin, Senior Research Assistant, University of SydneyLicensed as Creative Commons – attribution, no derivatives.