Patrick Dunn, American Heart Association (Part Two)

01.09.19

Patrick Dunn is one of the leading experts in health literacy, currently focused on Connected Heart Health at The American Heart Association’s Center for Health Technology and Innovation. Last week he shared the personal motivations behind his professional journey – from studying sports medicine in college to the patient-centered innovations he’s pioneering with American Heart Association today (revisit part one of our #PackChat here). Today we’re geeking out over his health literacy research!

Time to read: 5 minutes

INTERVIEWER: Last time we spoke, we talked about how career has become more and more education focused, and how the organization you founded in 2009, “Your Heart Score,” became the foundation of your Health Literacy work. Can you tell me a bit more about that?

PATRICK: Yeah! I just got a paper published about how to build health literacy skills – it’s actually a series of articles so I’ll send you some links to them. But first I’ll tell you a story about health literacy:

It was the early 2000s, I was working on developing an educational program for cardiac rehab patients, which was a very comprehensive program – you have to learn about the condition but also things like cholesterol, nutrition, and all those things. Many of those concepts have big words, lots of syllables in them. So I created this super cool program and presented it to the people I was working with, and they told me, “we can’t use this because it’s above the 5th grade reading level”.

They said, “this doesn’t meet health literacy standards,” and at the time, I’d never even heard of health literacy. So I did some research to figure out what they meant by reading level, and really all they were doing was going into word and doing the reading level assessment. And it’s based on stuff like word length, sentence length, so you’ve got words like cholesterol, saturated fats, and carbohydrates – and I realized, oh gosh, they want me to turn cholesterol to fat, carbohydrates to sugar, sodium to salt.

 

INTERVIEWER: Wow – is that really what they were looking for?

PATRICK: I literally did a find and replace, and it dropped the reading level two grade levels, and I they were like “oh great, this is super!”

I kid you not."If you want people to understand carbohydrates but can't mention the word, you're up a creek without a paddle!"

So I’m like, “no it’s not super, because fat and cholesterol aren’t the same thing!” I mean, if you want people to understand carbohydrates but you can’t mention the word, you’re up a creek without a paddle! 

And of course that kind of led me on my journey, because I can be stubborn and want to prove myself right. I just thought, “there’s got to be a better way,” and that was that.

 

 

INTERVIEWER: That’s incredible. So did you find a better way?

PATRICK: What I found in reviewing the literature was that studies tend to consider literacy a dichotomous variable – meaning you either have it or you don’t. There’s lots of research into the folks who don’t have it, and rightly so, because that’s a real social determinant of health. But it struck me that no one’s actually addressing the spectrum.

This goes back to why I consider myself about an educator. When you think of almost anything else you do – from how to manage your bank account, to how to use a computer– it’s a spectrum. You start at the basics then you build. Think about children learning to read – you start with letters than words and sentences and one day you can write a book. You develop foundational skills, and you build those skills to the point of mastery.

Now all this stuff on health literacy – this mantra of “simplify, simplify, simplify” and “use plain language” – this is all good stuff, don’t get me wrong, but it flies in the face of normal educational processes. Let’s not say “how low can we go,” let’s figure out where they are and build from there!

There’s very little literature on actually building literacy skills, so that was clearly a gap.

 

INTERVIEWER: Interesting. Can you tell me a bit more about how you build literacy in a healthcare context?

PATRICK: When you think about what it’s like for someone who’s been diagnosed with a condition  – it’s almost like learning a new language. You’ve got new terms, new numbers to think about, new decision rules. So everybody starts at a pretty low level and whether you have low reading literacy skills to begin with or not, everyone needs to progress in those skills to the point of mastery. 

Now the kicker is defining mastery in their terms. It might be “I want to get back to work,” or it could be “I want to get back on the golf course”. The key piece of the puzzle is that there’s always goal to achieve, and you have to help someone establish that progression not only of knowledge, but also of motivation and skills.

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Want to learn more about health literacy? Patrick Dunn has published multiple articles on the topic. Take a moment to check out some of  his latest research by clicking the links below: 

Digital health literacy in cardiovascular research

Improving health literacy in patients with chronic conditions: A call to action