# Presentation: 658192

## Health Communications

**Health Communications**
**Progress Review**

**Focus Area 11**

## 11-1. Household internet access by race and ethnicity, 1998-2001

**Asian/Pacific Islander**

**White**

**Hispanic**

**Black**

- Note: Asian/Pacific Islander, Black, and White are not Hispanic; Hispanic can be of any race.
- Source: U.S. Department of Commerce, Bureau of the Census, Computer and Internet Use
- Supplement to the Current Population Survey.

**2010 target**

**Total**

**Percent**

**Notes:**
Asians or Pacific Islanders and Whites more likely than Hispanics and Blacks to be wired.

## 11-1. Household internet access by gender, 1998-2001

**11-1. Household internet access by gender, 1998-2001**

**Female**

**Male**

- Source: U.S. Department of Commerce, Bureau of the Census, Computer and Internet Use
- Supplement to the Current Population Survey.

**2010 target**

**Percent**

**Notes:**
Although males somewhat more likely than females to have household internet access, females are more likely to search for health information on the internet (JAMA May 14, 2003)

## 11-1. Household internet access by education level of head of household, 1998-2001

**Less than high school**

**High school graduate**

**At least some college**

- Source: U.S. Department of Commerce, Bureau of the Census, Computer and Internet Use
- Supplement to the Current Population Survey.

**2010 target**

**Percent**

## 11-1. Household internet access by geographic location, 1998-2001

**11-1. Household internet access by geographic location, 1998-2001**

**Urban**

**Rural**

**2010 target**

- Source: U.S. Department of Commerce, Bureau of the Census, Computer and Internet Use
- Supplement to the Current Population Survey.

**Percent**

## 11-1. Household internet access, 2001

**11-1. Household internet access, 2001**

**Black**

**Less than high school**

**Urban**

**Percent**

**2010 target**

**White**

**Female**

**Male**

**Hispanic**

**High school**

**At least some college**

**Rural**

**A/PI**

- Note: A/PI (Asian/Pacific Islander), Black, and White are not Hispanic; Hispanic can be of any race.
- Source: U.S. Department of Commerce, Bureau of the Census, Computer and Internet Use
- Supplement to the Current Population Survey.

## 11-6 a-d. Provider-patient communication, 2000

**Percent of patients who report providers always:**

**Listen carefully**

**11-6 a-d. Provider-patient communication, 2000**

**Explain things**
**clearly**

**Show respect**

**Spend enough**
**time**

**2010 target**

- Source: Agency for Healthcare Research and Quality (AHRQ), Medical Expenditure Panel Survey.

**Notes:**
There are 4 components to the MEPS.  These questions are in the self-administered Household Component questionnaire.
Items are from the National CAHPS (Consumer Assessment of Health Plans Survey) Benchmarking Database funded by AHRQ.  
In the last twelve months, how often did doctors or other health providers...
listen carefully to you? 
explain things in a way you could understand?
show respect for what you had to say?
spend enough time with you?
Response categories for each item are: Never; Sometimes; Usually; Always; I had no visits in the last 12 months.
Responses of “always” divided by all responses will be the baseline percent (after weighting and nonresponse adjustments).

## 11-6a-d. Provider-patient communication by race/ethnicity, 2000

**11-6a-d. Provider-patient communication by race/ethnicity, 2000**

**Listen carefully**

**Explain things**
**clearly**

**Show respect**

**Spend enough**
**time**

**Percent of patients who report providers always:**

- Source: Agency for Healthcare Research and Quality (AHRQ), Medical Expenditure Panel Survey.

## 11-6a-d. Provider-patient communication by health insurance status, 2000

**11-6a-d. Provider-patient communication by health insurance status, 2000**

**Listen carefully**

**Explain things**
**clearly**

**Show respect**

**Spend enough**
**time**

**Percent of patients who report providers always:**

- Source: Agency for Healthcare Research and Quality (AHRQ), Medical Expenditure Panel Survey.

**Notes:**
Patients with public health insurance rate provider communication highest (esp. for listening carefully and spending enough time); patients with no health insurance rate provider communication lowest (esp. for listening carefully and explaining things clearly).

## 11-6a-d. Provider-patient communication by age, 2000

**11-6a-d. Provider-patient communication by age, 2000**

**Listen carefully**

**Explain things**
**clearly**

**Show respect**

**Spend enough**
**time**

**Percent of patients who report providers always:**

- Source: Agency for Healthcare Research and Quality (AHRQ), Medical Expenditure Panel Survey.

**Notes:**
Patient evaluation of good provider-patient communication increases as patient’s age increases.

## 11-6a. Patients reporting that doctors or other health providers always listen to them by race/ethnicity and gender, 2000

**Percent**

**  ****Total                      **_**Not Hispanic**_**    Hispanic             Female     Male**
**                               ****Black    White**

**2010**
**Target**

**11-6a. Patients reporting that doctors or other health providers always listen to them by race/ethnicity and gender, 2000**

- Source: Agency for Healthcare Research and Quality (AHRQ), Medical Expenditure Panel Survey.

## 11-6a. Patients reporting that doctors or other health providers always listen to them by education level, geographic location, and health insurance status, 2000

**Percent**

**          **_**Education**_
**    ****<12       12       13+  **

**2010**
**Target**

**11-6a. Patients reporting that doctors or other health providers always listen to them by education level, geographic location, and health insurance status, 2000**

- Source: Agency for Healthcare Research and Quality (AHRQ), Medical Expenditure Panel Survey.

**Urban  Rural          **

_**Health insurance status**_
**Private  Public  None**

**years  years  years**

## 11-6a. Patients reporting that doctors or other health providers always listen to them by disability  status and age, 2000

**Percent**

**2010**
**Target**

**11-6a. Patients reporting that doctors or other health providers always listen to them by disability  status and age, 2000**

- Source: Agency for Healthcare Research and Quality (AHRQ), Medical Expenditure Panel Survey.

**          **_**Disabilities**_
**       ****With      Without**

_**Age groups**_
**18-24       25-44       45-64       65+**

## 11-6b. Patients reporting that doctors or other health providers always explain things clearly by race/ethnicity and gender, 2000

**Percent**

** ****Total                      **_**Not Hispanic**_**     Hispanic               Female     Male**
**                               ****Black    White**

**2010**
**Target**

**11-6b. Patients reporting that doctors or other health providers always explain things clearly by race/ethnicity and gender, 2000**

- Source: Agency for Healthcare Research and Quality (AHRQ), Medical Expenditure Panel Survey.

## 11-6b. Patients reporting that doctors or other health providers always explain things clearly by education level, geographic location, and health insurance status, 2000

**Percent**

**          **_**Education**_
**    ****<12      12       13+                 **
**   ****years  years  years**

**2010**
**Target**

**11-6b. Patients reporting that doctors or other health providers always explain things clearly by education level, geographic location, and health insurance status, 2000**

- Source: Agency for Healthcare Research and Quality (AHRQ), Medical Expenditure Panel Survey.

**Urban  Rural          **

_**Health insurance status**_
**Private  Public  None**

## 11-6b. Patients reporting that doctors or other health providers always explain things clearly by disability status and age, 2000

**Percent**

**          **_**Disabilities**_
**      ****With     Without**

**2010**
**Target**

**11-6b. Patients reporting that doctors or other health providers always explain things clearly by disability status and age, 2000**

- Source: Agency for Healthcare Research and Quality (AHRQ), Medical Expenditure Panel Survey.

_**Age groups**_
**18-24       25-44       45-64       65+**

## 11-6c. Patients reporting that doctors or other health providers always show respect for what they have to say by race/ethnicity and gender, 2000

**Percent**

** ****Total                      **_**Not Hispanic**_**     Hispanic               Female     Male**
**                               ****Black    White**

**2010**
**Target**

**11-6c. Patients reporting that doctors or other health providers always show respect for what they have to say by race/ethnicity and gender, 2000**

- Source: Agency for Healthcare Research and Quality (AHRQ), Medical Expenditure Panel Survey.

## 11-6c. Patients reporting that doctors or other health providers always show respect for what they have to say by education level, geographic location, and health insurance status, 2000

**Percent**

**          **_**Education**_
**    ****<12      12       13+                 **
**   ****years  years  years**

**2010**
**Target**

**11-6c. Patients reporting that doctors or other health providers always show respect for what they have to say by education level, geographic location, and health insurance status, 2000**

- Source: Agency for Healthcare Research and Quality (AHRQ), Medical Expenditure Panel Survey.

**Urban  Rural          **

_**Health insurance status**_
**Private  Public  None**

## 11-6c. Patients reporting that doctors or other health providers always show respect for what they have to say by disability status and age, 2000

**Percent**

**          **_**Disabilities**_
**      ****With     Without**

**2010**
**Target**

**11-6c. Patients reporting that doctors or other health providers always show respect for what they have to say by disability status and age, 2000**

- Source: Agency for Healthcare Research and Quality (AHRQ), Medical Expenditure Panel Survey.

_**Age groups**_
**18-24       25-44       45-64       65+**

## 11-6d. Patients reporting that doctors or other health providers always spend enough time with them by race/ethnicity and gender, 2000

**Percent**

** ****Total                      **_**Not Hispanic**_**     Hispanic               Female     Male**
**                               ****Black    White**

**2010**
**Target**

**11-6d. Patients reporting that doctors or other health providers always spend enough time with them by race/ethnicity and gender, 2000**

- Source: Agency for Healthcare Research and Quality (AHRQ), Medical Expenditure Panel Survey.

## 11-6d. Patients reporting that doctors or other health providers always spend enough time with them by education level, geographic location, and health insurance status, 2000

**Percent**

**          **_**Education**_
**    ****<12      12       13+                 **
**   ****years  years  years**

**2010**
**Target**

**11-6d. Patients reporting that doctors or other health providers always spend enough time with them by education level, geographic location, and health insurance status, 2000**

- Source: Agency for Healthcare Research and Quality (AHRQ), Medical Expenditure Panel Survey.

**Urban  Rural          **

_**Health insurance status**_
**Private  Public  None**

## 11-6d. Patients reporting that doctors or other health providers always spend enough time with them by disability status and age, 2000

**Percent**

**          **_**Disabilities**_
**      ****With     Without**

**2010**
**Target**

**11-6d. Patients reporting that doctors or other health providers always spend enough time with them by disability status and age, 2000**

- Source: Agency for Healthcare Research and Quality (AHRQ), Medical Expenditure Panel Survey.

_**Age groups**_
**18-24       25-44       45-64       65+**

## Developmental Objectives

- 11-3:	Increase the proportion of health communication 	activities that include research and evaluation
- 11-4:	Increase the proportion of health-related World 	Wide Web sites that disclose information that can 	be used to assess the quality of the site.
- 11-5: 	Increase the number of centers for excellence that 	seek to advance the research and practice of health 	communication (now has baseline)

**Developmental Objectives**

## 11-2. Health literacy

- 	The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.

## Scope and nature of literacy problem

- Lowest level: Simple, routine tasks involving brief and uncomplicated texts and documents, e.g., can locate time and place of a meeting on a form or identify a specific piece of information in an article
- About 25% of Level 1 individuals are non-native speakers of English; about 66% didn’t finish high school; about 33% are 65+; and about 25% have disabilities
- Second lowest level: More varied than Level 1 but still limited; can make simple inferences, integrate easily identifiable information, and perform simple numerical calculations

- About 50% of U.S. adults are in the two lowest levels of five
- levels of functional literacy skills

**Notes:**
Data source: National Assessment of Adult Literacy, 2002, U.S. Department of Education.
•  90 million adults have inadequate or marginal literacy skills
Most health education materials/Web sites are at the 10th grade level or more
Closing gap in health literacy is essential to reduce health disparities
Guidelines for effective, culturally and linguistically appropriate, plain language health communications 
Principles of organization, writing style, layout, and design
Need both improved communication and health literacy training

## 11-2. Nature of health literacy problem

- Health literacy requires written as well as other communication skills to understand and act on health information and services
- Selected research findings on health literacy:
- Low literacy diabetic patients are less likely to know symptoms and disease management
- Low literacy asthma patients have less effective management
- Low literacy is associated with poorer self-reported health status and greater risk of hospitalization

## 11-2. Baseline data source

- Health Literacy Component, 2003 National Assessment of Adult
-  	Literacy, National Center for Education Statistics, U.S. Dept. of
-  	Education
- Three clusters of health literacy:
- Clinical (e.g., filling out a patient information form)
- Prevention (e.g., deciding to get a cancer screening)
- Navigation of the health care system (e.g., understanding co-pays and deductibles in health insurance plans)
-  Expected results in 2004: Health literacy index scores on the
- 	 ability of U.S. population groups to understand health-related
- 	 information

## 11-3. Research and evaluation of health communication activities 

- Most likely focus for measurement: Federal health communication campaigns
- Campaigns are typically assessed against internal goals, not external criteria related to campaign design
- Need for consensus-building on criteria for objective research and evaluation components in campaign designs

**Notes:**
Internal goals: What campaign wants to accomplish (e.g., eat more fruits and veggies, exercise more, stop smoking, etc.)
External goals: Specific criteria imbedded in design of campaign including, e.g., pre-test/post-test, formative research, long-term follow-up.

## 11-3. What needs to be assessed 

-  	The universe of health communication activities 	that **should** have research and evaluation 	components (the denominator)
-  	The actual number of health communication 	activities that **do** have research and evaluation 	components (the numerator).
-   	Short-term goal: the measurement of research 	and evaluation within federally-funded or HHS 	communication activities.
-   	Long-term goal: to identify and target for 	improvement any health communication 	programs not typically expected to include 	research and evaluation.

## Number of health-related Web sites is constantly changing, which makes measurement difficult

Model of disclosure of quality criteria is still evolving

Government role in assessing quality of Web sites is unclear

- Model of disclosure of quality criteria is still evolving
- Government role in assessing quality of Web sites is unclear

**11-4. Quality of internet health information**

**Notes:**
Internal goals: What campaign wants to accomplish (e.g., eat more fruits and veggies, exercise more, stop smoking, etc.)
External goals: Specific criteria imbedded in design of campaign including, e.g., pre-test/post-test, formative research, long-term follow-up.
11-3. What needs to be assessed:
- The universe of health communication activities that should have research and evaluation components (the denominator)
- The actual number of health communication activities that do have research and evaluation components (the numerator).
- Short-term goal: the measurement of research and evaluation within federally-funded or HHS communication activities.
- Long-term goal: to identify and target for improvement any health communication programs not typically expected to include research and evaluation.

## 11-4. Information that should be disclosed to users of health Web sites

-    	Identity and contact information of the developers 	and sponsors of the site and information about any 	potential conflicts of interest or biases
-      	Explicit purpose of the site, including any 	commercial purposes and advertising
-      	Original sources of content on the site
-      	How the privacy and confidentiality of any personal 	information collected from users is protected
-     	How the site is evaluated
-      	How the content is updated

## 11-5. Centers for excellence in health communication criteria

- A focus on health communication research and practice
- An operational emphasis on multi/interdisciplinary research teams
- Solid institutional support
- Translation of research into practice
- Training of health communication professionals and integration of health communication training into other disciplines

## 11-5. Centers for excellence in health communication baseline

- Four centers have been identified by NCI (baseline) in 2003
- These centers are focused on cancer communication
- A target-setting method has been proposed

- Source: National Institutes of Health, National Cancer Institute.

**Notes:**
Centers for Excellence criteria:
A focus on health communication research
An operational emphasis on multi/interdisciplinary research teams
Solid institutional support
A well-defined research program
Training in health communication research

## Data and slides for  
Healthy People 2010 progress reviews
are available at:

http://www.cdc.gov/nchs/
hphome.htm 

- <date/time>

**Data and slides for  **
**Healthy People 2010 progress reviews**
**are available at:**
- _[http://www.cdc.gov/nchs/](http://www.cdc.gov/nchs/)_
_**hphome.htm**_** **