According to the National Library of Medicine, there are some 80 million U.S. adults with low health literacy, and the U.S. Department of Education’s Health Literacy Report found that 65% of those come from Black, Hispanic, or other underrepresented communities.
Simply providing health education to patients doesn’t solve this issue of inequality of health literacy. Educational materials – whether printed or multimedia – need to be created with an intentional effort toward health diversity, equity, and inclusion (DE&I). Materials that reflect a broad range of patients and patient experiences – including races/ethnicities, ages, genders, sexual orientations, family structures, abilities, and socioeconomic statuses – have been shown to:
- Increase medical accuracy of the information presented.
- Build trust among a greater cross-section of patients.
- Help providers and payers build better relationships as their patient and member demographics change.
What is diversity, equity, and inclusion in healthcare?
One simple way to think of DE&I is to use the metaphor of a party. With the patient as your potential party guest, each layer of intentional representation and involvement takes them further from outsider to warmly welcomed center of attention:
Diversity
Think of this step as being invited to the party and seeing people you recognize already there. Some patients have never seen anyone who looks like them in healthcare educational resources. We can start by celebrating our patient population’s differences and representing as broad and varied a sampling of them as possible.
Equity
Next, we have to make space for our guests to enjoy themselves however they wish at the party – providing opportunities for people to dance, play games, and quiet space to talk, depending on their preferences. It isn’t enough to have diverse representation in your content, you need to deliver that content effectively to all patients and consumers regardless of potential limitations to access they may encounter.
Inclusion
In the final phase, your guest has to be given a chance to express themselves; for example, selecting their own songs for the party playlist. Educational materials need to be personalized and actionable enough to be practical and actually used by patients.
Developing representation and diversity in healthcare materials
As part of the design team behind Wolters Kluwer’s UpToDate® Patient Engagement solutions (formerly Emmi®), I’ve experienced first-hand the challenges of creating more diverse representation in patient-facing materials. Our UpToDate Educate patient education offering features more than 8,000 leaflets and nearly 300 videos to help consumers understand anatomy, medications, procedures, and conditions. It would be impossible to customize that much material to precisely reflect the wide variety of experiences of all the patients and members who might use them.
The best answer we have found is to consciously work toward the broadest variety of experiences and perspectives so that the materials do not become repetitive visually and the storytelling is richer and more medically accurate.
The ways we do this include:
- Using our custom design tool to vary skin, eye, and hair color; hair texture; and even subtleties of nail and lip tones in patient illustrations.
- Showcasing a wider range of clinician experiences as well as those of patients.
- Using diversity to augment clinical accuracy; for example, showing how a skin disease might manifest differently on varying skin tones.
- Employing voice-over artists from different cultures to reflect different experiences; a viewer is more likely to trust a voice that comes from their own community.
How can we make health education more accessible?
In order to create greater equity among patients, we always say we need to make healthcare education more accessible. That is a two-prong effort:
- Making materials easier for all patients to obtain, regardless of barriers they may face.
- Providing materials that are easier for patients to consume and absorb, so they are more likely to retain the information and less likely to feel alienated by it.
Modern healthcare education is largely delivered in digital formats, which creates a variety of ways to improve experiences and equity across patient populations:
- Comply with standards for Web Content Accessibility Guidelines (WCAG).
- Ensure all video content has closed captioning with variable text size and provide transcripts to audio.
- Add ARIA labels to all visual content so that screen readers can share what is being shown.
The philosophy is not just to make content access better for those with varying abilities, but to simplify and improve the patient education experience for the entire patient population overall.
The same applies to how the content is designed to be consumed and understood. Following Agency for Healthcare and Research Quality guidelines helps serve as a roadmap to make complex clinical information clearer for patients and members. To improve health literacy, best practices include:
- Using a conversational tone and commonly understood words in educational materials.
- Keeping written materials at or around a fifth-grade reading level.
- Whenever possible, providing materials in other language options, in addition to English and Spanish, to reach as many patient populations as possible.
Can inclusion make education more personal and actionable?
Patients and members tend to feel more empowered to take an active role in making their healthcare decisions when they feel engaged and included. Patient education can play a large role in helping them see themselves in the decision-making process by broadening inclusive representation. For example:
Gender and sexual orientation
Patient depictions in artwork can be non-gender-specific when warranted by using silhouettes or partial figures. This would be appropriate when discussing cervical cancer. For example, instead of showing a woman’s figure, use a partial figure in order to be inclusive of transgender or non-binary audiences who are also affected by the disease.
Ranges of age and mobility
Patient education often recommends exercise or movement. Depicting that as a young or fit person running around the block doesn’t recognize the varying physical abilities of many patients. The materials should also offer tips and options of different levels of activity, so patients can self-select what they are comfortable with.
Socio-economic realities
Healthcare educational materials should offer practical advice and be sensitive to the range of economic realities patients or members may face. For example, instead of simply instructing members to set up a telehealth appointment, materials might first remind them to connect to Wi-Fi to avoid data usage costs.
Ultimately the content within patient education needs to not only make people feel represented but give them clear actions they can take as the next steps in their health journey.
Learn more about UpToDate Educate multimedia patient education solutions.
Note: At the time the article was written, UpToDate Patient Education solutions were named Emmi and EmmiEducate.