When some people with asthma try to use an inhaler, they can't figure out the directions. Others have the same problem with prescription drug labels. Now with a new grant, SESP associate professor David Rapp is collaborating with Feinberg School of Medicine and SESP faculty member Michael Wolf (MS07) on an innovative project to improve patients' understanding of medical information that is critical to their health."The real issue is how we can design materials and learning experiences that will foster comprehension," says Rapp of his work through Northwestern's Health Literacy and Learning Program (HeLP). HeLP research has linked low literacy with a higher risk of poor health care and death.
A new $1.9 million grant from the National Institute on Aging is enabling Wolf and Rapp to investigate comprehension of medical instructions by 500 elderly patients with low literacy. The researchers will identify types of communications that aid in understanding medical information, such as directions for inhalers and prescription drugs. "Explanations are not geared toward patients' particular abilities or comprehension skills, so unless patients have the opportunity and initiative to ask follow-up questions, they may not understand the directions," Rapp explains.
The work of HeLP focuses on helping people become better educated health consumers by studying how to provide information in the most accessible way. Goals include helping doctors make better diagnoses, developing systems to assist pharmacists in delivering clearer instructions, and redesigning drug labels to provide more understandable directions.
Northwestern is among the first institutions to link education and medicine in an effort to improve communication for people's health. "The partnership between the Northwestern schools of education and medicine is crucial for understanding how patients learn about their health and the health care system," says Wolf. "The Health Literacy and Learning Program was formed to engage researchers from both fields to develop innovative ways to create effective learning environments using innovative health communication strategies."
In addition to the new grant, a gift from Northwestern Trustee Muneer Satter and his wife Kristen Hertel (BS86) will extend the study into design work. This summer Rapp will use a machine called an eye tracker to pinpoint where patients falter and hesitate as they read. "We will use the eye tracker to see what the patients' processing looks like, where they're having difficulty," Rapp explains. Then he will examine the consequences for redesigning medical instructions and prescription labels.
Rapp will also use the eye tracker with college students to see if they make similar errors in reading such materials. "If individuals who are trained as students to carefully evaluate what they read don't understand, this would really suggest such materials need to be redesigned," Rapp says.
A redesign of medical communications may be more visual, including color-coding and other changes, Rapp says. For example, Wolf was involved with recent redesigns in the shape of prescription drug bottles to allow more space for information and documentation. Pamphlets in doctors' offices could also be designed better too, Rapp says, pointing to research showing the myth-fact delivery of most such materials can lead to confusion rather than comprehension.
In addition to this study, the program that Rapp and Wolf lead also has federal grants to test out a better prescription drug container label design. They are also evaluating in a large-scale clinical trial a diabetes curriculum for medically underserved patients, and they are finding ways to do away with Latin abbreviations in medication prescribing. "All of our projects seek to simplify the healthcare experience and provide clear, concise, and consistent information to patients," says Wolf.
In the future, Rapp envisions the possibility of a recognized center for health literacy at Northwestern that could expand research. The goal would be to develop practical solutions to helping people become educated about their health and helping health systems communicate better by applying educational approaches.
Meanwhile, he looks forward to making an impact with his current study. "The most important part is that it could have consequences for real health outcomes," says Rapp. "It would be exciting if we could positively impact people's health by understanding when and how to more effectively design health-related materials."
Photo: David Rapp (right) demonstrates the use of an eye tracker with undergraduate students.
Last Modified: 8/14/09