Health Literacy - Words Fail to Tell the Story

As reported in the Washington Post: "A new report by the National Center for Education Statistics found that most adults have intermediate health literacy. But intermediate is far from good, because so many health instructions are written in a way that is foreign to how people talk and think, said Rima Rudd of the Harvard School of Public Health." [See "U.S. Adults Deficient In Health Literacy"]

Find the report here: "The Health Literacy of America's Adults"

The summary of the report states: "Health literacy was reported using four performance levels: Below Basic, Basic, Intermediate, and Proficient. The majority of adults (53 percent) had Intermediate health literacy. About 22 percent had Basic and 14 percent had Below Basic health literacy." The average health literacy score was 242 for men and 248 for women (highest score = 500). If these were SAT scores, they would be about 400 (the actual average SAT score this year, BTW, was 502-505).

What does it take to attain the "proficient" level in health literacy? Two key proficient-level abilities measured were:

• reading lengthy, complex, abstract prose texts as well as synthesizing information and making complex inferences
• integrating, synthesizing, and analyzing multiple pieces of information located in complex documents

"Lengthy, complex, abstract prose" is a perfect description of the "brief summary" -- the part of direct-to-consumer (DTC) print ads that conveys detailed risk information.

While FDA and the drug industry are looking for ways to strike the right balance between benefit and risk information in print DTC ads, some organizations, including the conservative Washington Legal Foundation (WLF), want to allocate the task of communicating risk in DTC ads completely to the brief summary (see "WLF: A No-Risk Ad is a Good Ad").

According to the health literacy report, only 12% of US adults are at the proficient health literacy level; that is, only 12% of us have any hope of understanding the typical brief summary statement. (Keep reading for more on communicating risk in DTC ads.)

TV "Literacy" vs. Internet Literacy
There are a couple of interesting charts in the report, which I reproduce here.


Focus on the 3rd bar from the left in each of these charts. This bar represents where the majority of us (53%) stand with regard to health literacy -- at the intermediate level. Ninety-three percent (93%) of these people get health information from TV and radio (chart on left), whereas only 67% get health information from the Internet (chart on right). [BTW, if you can read these charts and use the quantitative information in them to solve a complex problem, which I am asking you to do, then you are at the "proficient" literacy level.]

A higher percentage of adults with Proficient health literacy than adults with lower levels of health literacy got a lot of information about health issues from the Internet. Higher percentages of adults with Below Basic or Basic health literacy than adults with Intermediate health literacy received a lot of information about health issues from radio and television. Adults with Proficient health literacy were least likely to receive a lot of information about health issues from those same nonprint media sources.

What I am getting from this is that TV is a good channel through which to reach people with low health literacy, whereas the Internet is a good channel to reach those with high health literacy. You have a two-tier, red state vs. blue state, system here! I don't think many pharmaceutical eMarketers realize who they are talking to on the Internet. The tendency is to use the Internet like another TV channel (for more on this see "Web DTC Video: Boon or Bane?").

But TV is not a literary medium -- it is visual. Practically all of the information it conveys is through visual means, which is just fine for the health "illiterates" that tend to get their information from TV. However, the visuals exclusively convey benefit statements, not risk statements.

Print DTC ads also depend heavily on visuals. In a study of over 60 print DTC ads I am doing for the article "Drug Print Ad Analysis: A Quantitative Approach" in the upcoming September issue of Pharma Marketing News (Subscription Required), I found that 46% of the ad space is devoted to images (a recent Rozerem ad devotes 81% of its creative space to a visual; see "Rozerem Ads Dis Lincoln, Show Beaver").

My point is that drug marketers understand well how to communicate the benefits of drugs in TV and print DTC ads -- ie, by using visuals to compensate for the low intermediate level of health literacy of the average US adult.

According to the health literacy report, someone at the intermediate health literacy level is capable of "reading and understanding moderately dense, less commonplace prose texts as well as summarizing,making simple inferences, determining cause and effect, and recognizing the author's purpose."

That's all that any DTC marketer could wish for; namely, the ad viewer should understand the ad's purpose: go see your physician, ask for the advertised drug, and you will enjoy the benefits shown. This purpose of DTC was stated succinctly not long ago by the Coalition for Healthcare Communication in its petition to the FDA: "the patient is the decision-maker only with respect to whether a practitioner should be approached" (see "DTC without the Risk").

Speaking of Risk
If DTC advertising is to live up to the drug industry's claim that it is educational, marketers need to get serious about communicating risk information as well as benefit information. There has been some progress toward that goal. About 57% of the DTC print ads that I have studied attempt to present the brief summary (detailed risk information) in a consumer-friendly, easy-to-read (and understand) question-and-answer format. Not all succeed, however.

I agree wholeheartedly with Mark Senak, author of the blog eyeonFDA, who said:

"Product marketing is more these days, than just being experienced at launching a drug -- it is about crisis, it is about regulatory preparation and it is about a track record in providing support services related to the proper use of medication and the management of risk in order to maximize benefit."

You can learn more about risk communication in DTC ads by listening in to the following LIVE AUDIOCONFERENCE:

Risk Communications: Balancing FDA Expectations, Physician Needs and Patient Health

WEDNESDAY, OCTOBER 25, 2006, 1:00-2:30 P.M. (Eastern)

TO REGISTER: Please visit the conference website.
When you register and use the code "RVIR", I get a few bucks! Thanks.

OVERVIEW
Is your product marketing adequately conveying risk and safety information to your customers? Are you fully aware of the common and emerging pitfalls in communicating risk information to consumers and healthcare providers? Hear from a former FDA insider Peter Pitts, risk communication expert Jeff Stier and consultant Jeffrey J. Stoddard to get a lessons learned perspective and a case study analysis on how FDA and EMEA guidance on risk management can be effectively implemented as the emerging regulatory and legal hurdles continue to intensify.

I will be listening in myself and hope to have a few questions for these experts. I'll report on anything I learn here.