Sunday, June 21, 2009

Health Literacy Toolkit

With one key life sciences focus shifting to health as opposed to healthcare (as HealthCamp founder Mark Scrimshire exhorts) and to preventive, predictive health management as opposed to therapy and treatment, there should be the concept of a health literacy toolkit that would be a component of standardized knowledge, such as how to write, drive or get a job.

Definition of health literacy
Surprising but emblematic of the traditional health mentality (e.g.; treat illness) is the prevailing definition of health literacy…”a patient’s ability to acquire and understand information about a condition and options once diagnosed…” Moving into the preventive era, the definition of health literacy needs to shift from being backward-looking to forward-looking. Having health knowledge ahead of time could inform behaviors to prevent, slow or lessen the development of disease. Health literacy should be a general set of knowledge for everyone to know, not related to a condition once a patient has it.

Gap between health literacy and demand for health information
A U.S. Department of Health and Human Services (HHS) study finds that only 12% of adults have proficient health literacy (p. 26); that nearly 9 out of 10 adults may lack the skills needed to manage their health and prevent disease.

The biggest reason for low health literacy could be a lack of appropriately accessible and presented health information.
A Pew Internet Study “The Social Life of Health Information” in June 2009 finds that 61% of U.S. adults are looking for health information online. The gap between health literacy and the demand for health information suggests that there is a substantial opportunity for a range of health information services and management tools, many of which could be fee-based such as the LIVESTRONG nutrition and exercise management program.

Health literacy toolkit
What should be the components of a standard health literacy toolkit? Many professionals (e.g.; physicians, academicians, etc.) believe that even HDL/LDL cholesterol information is too complicated for the lay public, but this just cannot be correct. When simple numeric information is presented clearly, people of any background and capability are often quite able to understand it and take action. For example, when utility bills started to provide straightforward quantitative data regarding power consumption, including day/night usage and costs, many people shifted their behavior in a positive informed way.

Figure 1: Ongoing Total Cholesterol readings for one individual

Figure 1 illustrates an example individual’s ongoing total cholesterol readings presented in a clear and informative way. Anyone inspecting the chart can easily identify the overall trend, down, which is good, wonder about the range of numeric measurements (157-185) vs. the average and how this translates into good or bad health tiers (e.g.; under 200 is generally good, but a rising trend that is still under 200 could be an indication of arising health issues for that individual), and inquisitively wonder about the peaks. The next level of information would be HDL and LDL readings, small lipids as is now de rigueur and triglycerides, but even this simple plot of total cholesterol measures is understandable, useful and potentially actionable. It is also the perfect level of information for individuals who are interested in being responsible for self-managing their health but from an efficient, easily-actionable level that does not require deep engagement of time or knowledge acquistion.

Some of the most obvious aspects to include in a health literacy toolkit would be nutritional information and its interpretation, caloric consumption and expenditure and ongoing quantitative measures of health from blood analysis and other tests (e.g.; blood pressure, glucose, cholesterol, BMI, weight, VO2 max, etc.). The data can be summarized (with detail available) and directly linked to actionable explanatory information (e.g.; measures may go up or down if they were not measured at the same time or situation, for example if a meal had been eaten before some but not all of the measurements). Other components of a standard health literacy toolkit could include where and how to obtain information and tools for self-tracking, how to integrate multiple data sources into a unified view, and how and what to expect when interacting with the medical community. Genomics is already part of the health literacy toolkit for early adopters and could become a standard toolkit component for everyone within five years, already helpful Genetics 101 sites are emerging.

Automated health monitoring tools
Health-self management in large quadrants of the population could accelerate with the advent of automated health monitoring tools that would capture frequent datapoints and aggregate the information into easily viewable web-based charts. Many devices such as blood pressure monitors, heart monitors and scales are now battery-intensive Bluetooth-enabled which is a nice intermediate step but what is really needed is for all of these monitoring devices to be directly on home WiFi networks. Where possible, having the monitoring applications directly on the smartphone is another obvious step rather than having separate devices. There are some WiFi-enabled devices, for example the FitBit calorimeter, which has been delayed in launching, and glucose monitors such as the GlucoMON, however its $75/month subscription fee appears exorbitant.

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