COVID-19: A Renewed Call to Improve the Nation’s Health Literacy

By M. Elaine Auld, MPH, MCHES®, Chief Executive Officer, Society for Public Health Education, Inc.

Is it just me, or do you sense the challenges of COVID-19 risk communication are getting more complicated? Just when it appears the public has gotten most messages to prevent the spread of the virus, such as hand washing, the “goal posts” in terms of recommended consumer behaviors are changing.

As the nation moves into the COVID-19 recovery phase, we are faced with new communication challenges in the absence of a national strategy, and contradictory recommendations issued in mid-March. For example, it was widely reported that touching any surface -- such as a shopping cart or credit card machine when making a purchase -- could result in virus transmission. Now, CDC reports a low likelihood of contracting COVID-19 from touching surfaces. Likewise, early on, consumers were advised not to wear face coverings unless they tested positive for the virus, then many states required all consumers to wear masks outside of their homes; now wearing face coverings in public settings is optional in many jurisdictions. 

How will changing scientific advisories affect public acceptance of future COVID-19 recommendations such as vaccine uptake? According to a May 2020 poll by the Associated Press-NORC Center for Public Affairs Research, only 50% of respondents said they plan to get vaccinated when a vaccine against COVID-19 becomes available, while 31% are not sure and 20% said they will not get vaccinated. African Americans and Hispanics are less likely than whites to get vaccinated. These findings beg the question by Allegrante and colleagues, “Are our (communication) strategies sufficiently agile (with changing policies and changing behavioral opportunities) to flexibly engage individuals through real-time digital and other channels of communication, and to counter sources of misinformation?”

Our challenge looms even larger when considering the sad state of Americans’ health literacy. More than a third of all adults have basic health literacy, or below basic health literacy skills. Adults 65 years and older -- those at higher-risk for contracting COVID-19 – have lower average health literacy than adults in younger age groups. Scientific terms such as “herd immunity,” “apex of the outbreak” and “mitigation steps” are not widely understood. Unwittingly, many consumers are turning to sources of misinformation on the internet, lured by likes, comments, shares, and views. 

Although digital strategists from government, academia, and industry are collaborating to improve access to accurate COVID-19 information on social media, citizens in a democratic society need guidance today on sorting out fact from fiction. Following are five tips that can improve health and media literacy, whether the latest study related to coronavirus or a future health report:

1.      Is the source of this information a trusted scientific authority, such as the National Institutes of Health or Centers for Disease Control and Prevention? Was the study or report published in a peer-reviewed journal? 

2.      Was the study on animals or humans? Was the study on a single population? What was the sample size? Does the report suggest a correlation between two items or direct causation? 

3.      Who funded the research and is there any potential conflict of interest? Who is sending the report or message and who profits from it? Is there a product being sold or advertised?

4.      Does the report or message fairly state the findings or put them into context of reputable research already conducted? Is the message suggesting broad generalizations or “proof” by one study, which is rarely the case?   

5.      What creative techniques such as images, words, or music are being used in the report that could influence my action? What values, lifestyles and points of view are included or omitted from this report? 

Our challenge of COVID-19 risk communication continues to evolve with the science and moving goal posts. Like our fellow bench scientists, health communicators are gaining new insights from this pandemic as we go. Let us not, however, miss this “teachable moment” to strengthen Americans’ health literacy and build our national capacity for a more informed and engaged citizenry in making health decisions and actions. Their future – and ours – depends on it.

The contributions and challenges of digital media to health literacy were amongst the topics discussed at the recent 3rd Annual Digital Health Promotion Executive Leadership Summit, presented virtually by the Society for Public Health Education (SOPHE).  

 About the author

References

Allegrante, J.P., Auld, M.E., Natarajan, S. (2020). Preventing COVID-19 and Its Sequela: "There is No Magic Bullet . . .  It's Just Behaviors. American Journal of Preventive Medicine.  https://doi.org/10.1016/j.amepre.2020.05.004     

Centers for Disease Control and Prevention. How COVID-19 spreads. https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/how-covid-spreads.html  Accessed June 8, 2020

Kent State Magazine. Fake Versus Factual News. https://www.kent.edu/magazine/news/flash-forward-3  Accessed June 8, 2020.

Koh, H. K.  We need one response — not 50 — to fight Covid-19. Stat.  May 22, 2020 https://www.statnews.com/2020/05/22/we-need-one-response-to-fight-covid-19-not-50/ Accessed June 8, 2020.

Smith, J.A. (2015). Ten questions to ask about scientific studies. Greater Good Magazine. https://greatergood.berkeley.edu/article/item/10_questions_to_ask_about_scientific_studies  Accessed June 8, 2020.

The Associated Press-NORC Center for Public Affairs Research. Expectations for a COVID-19 Vaccine. http://www.apnorc.org/projects/Pages/Expectations-for-a-COVID-19-Vaccine.aspx  Accessed June 8, 2020.

Additional Reading

Carroll, L. N., Smith, S. A., & Thomson, N. R. (2015). Parents as Teachers Health Literacy Demonstration Project: Integrating an Empowerment Model of Health Literacy Promotion Into Home-Based Parent Education. Health Promotion Practice, 16(2), 282–290. https://doi.org/10.1177/1524839914538968

Chesser, A., Drassen Ham, A., & Keene Woods, N. (2020). Assessment of COVID-19 Knowledge Among University Students: Implications for Future Risk Communication Strategies. Health Education & Behavior. https://doi.org/10.1177/1090198120931420

Gold, R. S., Auld, M. E., Abroms, L. C., Smyser, J., Yom-Tov, E., & Allegrante, J. P. (2019). Digital Health Communication Common Agenda 2.0: An Updated Consensus for the Public and Private Sectors to Advance Public Health. Health Education & Behavior, 46(2_suppl), 124S-128S. https://doi.org/10.1177/1090198119874086

IUHPE Position Statement on Health Literacy: a practical vision for a health literate world. (2018),  Global Health Promotion, 25(4), 79-88. https://doi.org/10.1177/1757975918814421

Kobayashi, L. C., & Smith, S. G. (2016). Cancer Fatalism, Literacy, and Cancer Information Seeking in the American Public. Health Education & Behavior, 43(4), 461–470. https://doi.org/10.1177/1090198115604616

Linnebur, L. A., & Linnebur, S. A. (2018). Self-Administered Assessment of Health Literacy in Adolescents Using the Newest Vital Sign. Health Promotion Practice, 19(1), 119–124. https://doi.org/10.1177/1524839916677729

Miller, C. A., Guidry, J. P. D., & Fuemmeler, B. F. (2019). Breast Cancer Voices on Pinterest: Raising Awareness or Just an Inspirational Image? Health Education & Behavior, 46(2_suppl), 49S-58S. https://doi.org/10.1177/1090198119863774

Rosenbaum, J. E., Johnson, B. K., & Deane, A. E. (2018). Health literacy and digital media use: Assessing the Health Literacy Skills Instrument – Short Form and its correlates among African American college students. Digital Health. https://doi.org/10.1177/2055207618770765

St. Amant K. (2020). Communicating About COVID-19: Practices for Today, Planning for Tomorrow

Journal of Technical Writing and Communication, 50(3), 211-223.  https://doi.org/10.1177/0047281620923589

Sykes, S., & Wills, J. (2018). Challenges and opportunities in building critical health literacy. Global Health Promotion, 25(4), 48–56. https://doi.org/10.1177/1757975918789352

Veldwijk, J., van der Heide, I., Rademakers, J., Schuit, A. J., de Wit, G. A., Uiters, E., & Lambooij, M. S. (2015). Preferences for Vaccination: Does Health Literacy Make a Difference? Medical Decision Making, 35(8), 948–958. https://doi.org/10.1177/0272989X15597225