Inquiry Magazine Northwestern School of Education and Social Policy

SPRING 2014

David Rapp

ASSOCIATE PROFESSOR DAVID RAPP USES AN EYE TRACKER TO STUDY HOW TO INCREASE HEALTH LITERACY.

SPECIALIZED SOFTWARE ENABLES RESEARCHERS TO SEE HOW COGNITIVE FUNCTION PREDICTS PERSONAL HEALTH.

SPECIALIZED SOFTWARE ENABLES RESEARCHERS TO SEE HOW COGNITIVE FUNCTION PREDICTS PERSONAL HEALTH.

A Better Prescription... Improving Health Literacy for All Patients


By Julianne Beck
SIMPLIFYING DRUG LABELS AND PATIENT COMMUNICATION CAN LEAD TO BETTER HEALTH, SAYS MICHAEL WOLF (FAR RIGHT), SHOWN WITH HIS TEAM AT A LIGHTHEARTED MOMENT.
We think that health care requires a broad array of cognitive and social skills,” says SESP Learning Sciences graduate Michael Wolf (MA07), a professor and associate division chief of research for General Internal Medicine and Geriatrics with Northwestern University’s Feinberg School of Medicine. “The tasks that we ask people to engage in when they assume the role of patient are wide-ranging and variable in complexity.”

If only it were enough to eat an apple a day to manage one’s health. Today, patients must read challenging information, make sense of numbers, do calculations and master varied technologies. Americans, who are increasingly using medications daily, are also faced with complex drug labels, vague verbal instructions and even conflicting dosage details.

RESEARCH FOR PATIENT UNDERSTANDING

Together with SESP associate professor of learning sciences David Rapp, Wolf is researching practical solutions to help patients manage everyday health care challenges. In 2005, he launched the Health Literacy and Learning Program (HeLP) in the Department of Medicine with Rapp. HeLP set out to examine the cognitive, social and medical barriers and influences impacting patients’ abilities to make informed health care decisions.

The initiative is tied to the concept that health environments, such as hospitals and pharmacies, are also informal classrooms where patients can be presented with lessons from a health care curriculum. That curriculum may be shared through a range of mediums from one-on-one discussion in doctors’ offices to instructional multimedia in waiting rooms. Shortly after launching HeLP, Wolf pursued a master’s degree in Learning Sciences in SESP. He also teamed up with Rapp, who studies how learning processes and experiences impact comprehension.

Since that time, the two have collaborated repeatedly to examine issues in health literacy and to make recommendations on a large scale.

MEDICAL MATERIALS IN NEED

“We’ve been interested in how to design medical materials so that people can read them easily and quickly and understand the important points,” says Rapp, who runs a laboratory in SESP that focuses on understanding how to enhance and support literacy in settings from schools to hospitals.

In November, the two professors completed a study on the design and content of drug labels for products containing acetaminophen. The common pain medication, found in over-the-counter products such as Tylenol and prescription medications like hydrocodone, is the leading cause of acute liver failure. Overdose and subsequent liver failure, according to Wolf, are often unintentional and due to misunderstandings by patients. Users may not be aware of the maximum dose, or they may not know that additional drugs they take contain the same active ingredient.

Study subjects ranged from current Northwestern students to individuals from underserved Chicago neighborhoods. They were invited into Rapp’s lab, where they were shown a sample drug label on a large monitor and asked to find certain pieces of information. The monitor was equipped with eye-tracking equipment that followed their gaze to see where people expected to find the answer.

DESIGNING NO-FAIL DRUG LABELS

“One particularly relevant finding we keep uncovering over and over again is that people look in the wrong places,” says Rapp. “If we know something about how people think and read, we can use that to build labels that are better than what we have now.” Such labels, for example, would make it easy to see what the active ingredient is, acetaminophen or otherwise.

In related studies, Wolf and Rapp have found that even if patients can find the needed information on a label, they may not be able to understand it. According to Wolf, those with poor reading proficiency, numeracy skills or language barriers may not be able to absorb what they see.

For example, what happens if patients miss a dose? Can patients adequately problem solve or calculate when to take the next pill from the instructions they receive? Or, what if a measurement meter included in a package does not align with the measurement instructions from a physician?

Revised labels could offer diagrams and more specific details on how to proceed. Research by Wolf and Rapp suggests that simplifying the label to reduce the number of required behaviors, or adding charts or icons, may facilitate better understanding.

REINFORCING HEALTH LEARNING

In addition to strategic changes in drug label layout, patients may need far more verbal support than they receive now. “What we found is that with labeling changes even like the ones we are proposing, we still need to increase spoken counseling,” Wolf explains. “We need to effectively teach people about these risks.” From multimedia displays on monitors in doctor offices to increased time with physicians, there are many possible solutions. However, they must be balanced with what is realistic for the health care industry.

Wolf and Rapp recently published results from a similar study on medication guides — the written materials often stapled to a prescription bag by a pharmacy. Again using eye tracking equipment, they analyzed patients’ abilities to find and comprehend important information. “We found a dramatic improvement in enhancing patients’ functional understanding and ability to safely use prescription medications by improving the quality of that material,” states Wolf.

A longer-term study is underway to assess the cognitive skill set, including memory ability, needed to manage one’s health. Study subjects are older adults from the Chicago area.

PREPPING PATIENTS FOR UNDERSTANDING

Why are the researchers so focused on patient understanding? According to Wolf, for most people, 99 percent of the management of their personal health happens outside of a doctor’s office or hospital. It is therefore imperative that patients have good information to support their ability to think critically and react to the situations they encounter.

“I think what we are looking for is a health care system that is better matched to the consumers it serves. We want to eliminate as much as possible the complexity that’s imparted across many different facets of the health care system,” says Wolf.

It’s largely about preparing patients, possibly even before they become patients, to be ready to take an active role in the management of their health.

“Health literacy is ultimately about whether people have familiarity with their health and the terms that are often used in health care, and their ability to access, understand and apply that information,” says Wolf. “It’s going to get more complicated as patients’ roles are changing as we have greater expectations of patients, due to new technologies, expectations and choice that is being imparted.”

SUCCESSES TO START

Despite the challenges, there have been successes along the way. The team’s studies have led to redesigned drug labels at Target pharmacies, a California law on standardized drug labels, guidelines in the U.S. pharmacopeia, and Food and Drug Administration guidelines for consumer information.

“We feel like we’ve actually made a difference with that, and we want to keep going and figuring out where else can we find ways to just make it easier,” summarizes Wolf. Among his 15 active studies, he will next take a bite out of the communication process between insurance companies and patients.

As the health care industry continues to evolve, so does the need for expanded partnerships between researchers in medicine and education. Wolf and Rapp are leading the way to create major breakthroughs in improving the health literacy of all patients.