Nearly 9 out of 10 adults have difficulty understanding and using the everyday health information that is routinely available in our health care facilities, retail outlets, media, and communities. Studies show that today’s health information is presented in a way that isn’t usable by most Americans, with the result that people are more likely to skip necessary medical tests, end up in the emergency room more often, and have a hard time managing chronic diseases, such as diabetes and hypertension.
In 2003 the U.S. Department of Education, Institute of Education Sciences, did an extensive assessment of the health literacy of American adults. The study revealed that only 12 percent of U.S. adults had proficient health literacy. Over a third of U.S. adults—77 million people— had difficulty with common health tasks, such as following directions on a prescription drug label or adhering to a childhood immunization schedule, using a standard chart.
The study also revealed that limited health literacy affects adults in all racial and ethnic groups, and that all adults, regardless of their health literacy skills, got their health information from radio/television, friends/family, and health professionals. Not much has changed in over a decade, except that there is a growing number of individuals who now get much of their health information from the Internet. This does not make them more or less health literate.
Health literacy affects people’s ability to:
Navigate the healthcare system, including filling out complex forms and locating providers and services
Share personal information, such as health history, with providers
Engage in self-care and chronic-disease management
Understand mathematical concepts such as dosing instructions.
Unfortunately, even people with strong literacy skills can face health literacy challenges, including:
Difficulty with medical terms
Interpreting numbers or risks to make a health care decision.
Confusion about a diagnosis
Inability to carry out complicated self-care associated with complicated chronic conditions.
There are many ways to foster health literacy including public health forums, public television programming, better information coming from healthcare professionals and clinicians. However the reach with these approaches is minimal. There is also a way, using a standard cellphone or a smartphone that health literacy can improve.
Over 98% of the world’s population, including many in developing nations have a cellphone available to them. There are more than 5.3 billion mobile phone users globally. By 2012, more than 50% of these mobile phones were equipped with global positioning systems (GPS) and web-connectivity (i.e., “smartphones”). Smart- phones allow information to be delivered by voice, texts, pictures, and videos as well as to be triggered by location and date.
Using mobile phone technology to send short messages (SMS short message systems) to people, in the form of prompts and reminders, has proven to improve patients’ access, quality, and utilization of care, and helps patients receive health information, skills, support, and crisis services directly for a specific health condition.
SMS technology is cost efficient, easy to set up and maintain and has the broadest possible reach. It is a way to get out messages to the general population and to encourage people to be more engaged and proactive in their health
Short messages offer advice on nutrition, alcohol, tobacco and drug use; early warnings about potential epidemics; instructions on how to monitor chronic conditions and reminders to take medications and get immunizations. With more than 50% of people not adhering to the drugs that their primary care givers prescribe it is kind of obvious that SMS has value in so many ways. So how do patients benefit from the increased use of mobile health technology?
Better communication reduces the risk of serious medical errors. For example, the Joint Commission estimates that 80 percent of medical mishaps occur due to poor communication. One example of this includes when patients are handed off to a new physician or specialist. For clinicians, the ability to send a secure text message facilitates a real-time exchange of health information and removes the need for pagers, email and voice mail, which are not timely and often not secure.
Secure text messaging can be used to remind patients to take prescribed medicines and to comply with recommended care practices, such as pre-surgical procedures designed to reduce infections. A study published in the Journal of the American College of Surgeons found that patients prefer text messaging when partnering with their physicians on the specifics of their health management. Researchers at the Medical College of Wisconsin, Milwaukee, used texts, emails and voice mails to remind patients to take antiseptic showers 24 to 48 hours before a scheduled surgery. Text messages were the most popular electronic communication method (80 percent) among the patients. Those who received the texts were significantly more compliant with the pre-admission orders.
Other examples include the numerous Text4Health projects recognized by the U.S. Department of Health and Human Services. These initiatives show the immense opportunities to engage under-served groups and improve health. For example, the National Cancer Institute’s SmokeFreeTXT effort more than doubled the smoking quit rate among teens by texting smoking cessation messages to them.
A series of studies looked at how providing diabetic patients with health information using their cellphone improved their health status. In 9 out of 10 studies that measured hemoglobin A1c patients and clinicians reported significant improvement among those receiving education and care support. Cell phone and text message interventions increased patient–provider and parent–child communication and satisfaction as well.
SMS has been around for several years. As the use of smartphones proliferate and people become more accustomed to sending and receiving short messages, understanding basic health information will become more widespread. This should insure a more health literate population.