This presentation is from a recent CALPACT webinar. To view the event archive page to access the recording and resources, please visit: https://cc.readytalk.com/cc/s/meetingArchive?eventId=ws23yprxpjgd&campaignId=xceb0hiurg66 Public Health professionals communicate with a variety of audiences in their daily work. While reasonably well-accepted that special consideration be given to low-literate health care consumers in clinical settings, less emphasis has been given to applying health literacy in diverse sectors of public health. Poor health literacy is not limited to those with language or reading skill barriers - only 12% of Americans understand the health information they receive. As public health professionals we have a responsibility to understand the health literacy barriers. This presentation will provide tips and resources where public health professionals can make a difference in increasing the success of their communication efforts. While one flu season can pass mildly and with minimal activity, another may hit the country early and hard. CDC health communicators work with subject matter experts and stakeholders to develop messages for a variety of audiences, employing different types of media for effective reach. Due to unforeseen variables, the 2012-2013 flu season posed specific challenges. This presentation will highlight some of those challenges, showcase strategies and messaging used, and preview what’s to come for the 2013-2014 season. This webinar was the second session in the CALPACT sponsored Health Communication Matters series, which will help participants in all walks of public health to apply health literacy principles to their everyday communications. Follow Us on Twitter: @CALPACT Facebook: http://www.facebook.com/CALPACTUCB Website: www.calpact.org Questions? Email sphcalpact@berkeley.edu

1. Welcome to the Webinar
Health Communication Matters!
Applying Health Literate Communications:
Examples from a Nasty Flu Season
We will begin shortly…

2. Today you’ll be hearing from.
..
Nancy Michael Yvonne Garcia,
Murphy, MSHC Villaire, MSLM, Ins Centers for Disease
, Metropolitan titute for Healthcare Control & Prevention
Group, Moderat Advancement
or

3. Agenda
1. Review of session objectives
2. Introduction of today’s speakers
3. Does your public health message work?
4. Questions & Answers
5. CDC Influenza Communication Campaign: “Examples from an
Eventful Flu Season”
6. Questions & Answers
7. Specific actions and resources
8. Next steps & conclusion

4. Objectives
• Explain definitions of health literacy and plain language,
statistics, prevalence, and costs associated with limited health
literacy
• Describe the role of health professionals as change agents for
effective communications with diverse audiences
• List strategies to develop health materials for
readability/usability
• Explain how CDC communicators apply fundamentals of risk
communication and plain language to reach a diverse
audience

5. Health Literacy:
Undervalued by
Public Health?
A tool for public health
professionals.
Prepared for the American Public Health
Association Community Health Planning &
Policy Development Section
Tammy Pilisuk, MPH AUG 2011

6. Who is in our audience
Employer/Organization
35
30
25
20
15
10
5
0
Academic City/Co Fed govt Hospital Private CBO State Other
Health industry Health
dept.

7. Who is in our audience
Geography
California
Other states
25 states represented

8. Who is in our audience
Profession
Mostly Health
Promotion/Health
Education
professionals . . . And
good representation
from
administrators, nutritio
nists, nurses, data
analysts, policy
specialists & faculty

9. What do you want to learn
from this webinar?
• About 1/3 said specifics around flu messaging
• About 2/3 said health literacy or effective
health communication tools and tactics
• Plus. . . Practical examples, tips, tools, trends
and models

10. How to Participate
• Phone line is automatically
on mute
• Send facilitator a question or
comment using Ready Talk’s chat
function
• Click “raise hand” button to be
taken off mute and ask a question
verbally
• Slides and resources will be posted
online following webinar – link will
be shared via email with all
participants

11. Who is speaking today:
Michael Villaire
Michael Villaire, MSLM
Chief Operating Officer, Institute for
Healthcare Advancement
Email: mvillaire@iha4health.org
Website: www.iha4health.org

12. Who is speaking today:
Yvonne Garcia
Yvonne Garcia,
Influenza Communication
Lead, Health Communications
Specialist, CDC/NCIRD
Email: ybg2@cdc.gov
Website: www.cdc.gov

13. Who is moderating our
discussion today:
Nancy Murphy, MSHC
Nancy Murphy, MSHC
Executive Vice
President, Metropolitan Group
Email: nmurphy@metgroup.com
Website: www.metgroup.com

14. Questions welcomed
• Submit a question at any time during this Webinar using the
chat function OR clicking the “raise hand” button to be taken
off mute.
• We will consolidate questions and pose them to the speakers
throughout the Webinar and during the Q&A session at the
end.
• We also may host additional webinars on related health
communication topics depending on the results of the
evaluation, so please tell us if you want more!

15. Before we launch into our presentations,
here is a question for you:
What drew you to this webinar?
A. Learn more about health literacy for myself
B. To help colleagues apply health literacy
C. I am interested in flu messaging

16. Introducing Michael Villaire
Michael Villaire, MSLM
Chief Operating Officer, Institute for
Healthcare Advancement

17. Health Literacy 101:
Does Your Public Health Message
Work?
Public Health Matters Webinar
March 27, 2013
Michael Villaire, MSLM
Chief Operating Officer
Institute for Healthcare Advancement
www.iha4health.org
mvillaire@iha4health.org
(800) 434-4633 x202

18. Literacy
• “Using printed and written information to function
in society, to achieve one’s goals, and to develop
one’s knowledge and potential” (Kirsch et al, 1993)

19. Definitions
Health Literacy
• “The degree to which individuals have the capacity
to obtain, process, and understand basic health
information and services needed to make
appropriate health decisions” (Ratzan and Parker, 2000)
• “Health literacy allows the public and personnel working in
all health-related contexts to
find, understand, evaluate, communicate, and use
information. Health literacy is the use of a wide range of
skills that … include
reading, writing, listening, speaking, numeracy, and critical
analysis, as well as communication and interaction skills.”
(Calgary Charter on Health Literacy, 2008)

21. Why Does Health Literacy Matter?
Those with limited literacy skills:
• Report poorer overall health
• Have poorer ability to manage chronic diseases
• Have poorer outcomes
• Less likely to understand their diagnosis
• Less likely to have screening / preventive care
• Present in later stages of disease
• Are more likely to be hospitalized / rehospitalized

22. Why Does Health Literacy Matter?
Cost of Poor Health Literacy
• $73 billion in unnecessary costs annually
(Friedland, Georgetown University, 2003)
• $106-$238 billion in unnecessary costs annually
(Vernon, University of Connecticut, 2007)
Cost of Chronic Disease
• $1.7 trillion (75% of HC expenditures)
• Nearly 1 in 2 Americans live with a chronic disease
• 90% >65 have a chronic disease;
77% have 2+
• 70% of annual US deaths (CDC 2008)

23. NAAL Health Literacy Findings
• 36% have limited health literacy skills
(22% Basic, 14% Below Basic)
• About 12% considered Proficient
• Women’s avg. HL score 6 pts. higher (4% more men
in Below Basic)

24. You know
what you
mean…
But does
he?

25. A question for Michael
So we can see that we
clearly have a problem!
What are some specific
ways that we can increase
the likelihood of the public
understanding our public
health messages?

26. 7 Points to Ensure Your Materials
are On Target
• Audience
• Message
• Readability
• Design
• Culturally Appropriate
• Learnable
• Field-test

27. Audience
• Who is your audience?
• What are their needs?
• What are they interested in?
• What is their ability?
• What are their barriers?

28. Message
• What do you want them to do?
• Limit to no more than 3 concepts.
• What do they need to do the behavior?

29. Readability
• Grade reading level
• Active voice
• Short sentences (10-15 words max)
• Short, simple words (no jargon)
• Use examples
• Define unfamiliar / technical words

30. Readability
• Readability measures
– SMOG (Simple Measure of Gobbledygook)
– Count words with more than 3 syllables in 30
sentences
– Use conversion table to obtain grade reading
level
http://www.harrymclaughlin.com/SMOG.htm

32. Design
• White space
• Large type size (12-14 point) and double-
spaced
• Standard font (no italics or ALL CAPS)
• Two type faces (Arial-headings; Times
New Roman-body)
• Simple headings. . .

33. More Design
• Usable, appropriate, explanatory
graphics (no abstract graphics)
• Use columns
• Bulleted lists (keep to 7-8 max)
• Color / Navigation

34. A question for Michael
Do you have a sample
document that we might
engage our participants in
evaluating based on the
tips you have shared with
us so far?

35. Design critique
• What’s good?
• What’s not so good?

36. Real-life
Examples
From “What To Do When Your
Child Gets Sick” Institute for
Healthcare Advancement
www.iha4health.org

37. Real-life
Examples
From “Living With Diabetes:
An Everyday Guide for You
and Your Family”
American College of
Physicians Foundation
foundation.acponline.org/hl
/hlresources.htm

38. Real-life
Examples:
Photonovela
From “From Junk Food to
Healthy Eating: Tanya's
Journey to a Better Life”
Inter-Cultural Association
of Greater Victoria
www.photonovel.ca/phot
onovels.htm

39. “The Bible”
Available from:
•http://www.hsph.
harvard.edu/
healthliteracy/
resources/doak-book/
•IHA Health Literacy
Conference

40. Key takeaways
• Only about 12% of American adults are
estimated to have the level of skill
necessary to understand health
information. That leaves 88% of us with
some serious challenges!
• Failure to address health literacy
challenges effectively has real and
significant costs.
• There are simple tools that can make a
real difference – focus on white
space, short words and sentences, limited
number of concepts – readability and
design matter.

41. Join the Conversation!
Questions or comments for
Michael?
Please submit questions by using
the chat function OR clicking the
“raise hand” button to be taken
off mute
We have our first question for
Michael. . .

42. Discussion/Q&A
Ask Michael!
Share with Michael!

43. Poll Question
To check the reading level on a document, I:
a. Use the grade level scoring on MSWord
b. Use another readability calculator
c. Is that the same as “spell check?”
d. I need to check the reading level???!!

44. Introducing Yvonne Garcia
Yvonne Garcia
Influenza Communication Lead
Health Communications Specialist
CDC/NCIRD Atlanta, Georgia

45. CDC Influenza Communication Campaign
“Examples from an Eventful Flu Season”
Yvonne Garcia
March 27, 2013
Centers for Disease Control and Prevention
National Center for Immunization and Respiratory Diseases

46. Objectives
 Provide CDC communication strategies designed to
address different types of challenges, such as flu vaccine
hesitancy
 Describe effective health communication strategies with
disparate populations that may be vaccine hesitant
 Explain how CDC communicators apply fundamentals of
risk communication and plain language in materials to
reach a broad and diverse audience

47. CDC Communication Goals
Consistent messages about importance of universal flu
vaccination and benefits: Keep top of mind.
Steady increases in flu vaccination coverage over time.
Special focus on people at high-risk for complications from
flu.
Foster knowledge and favorable beliefs regarding influenza
vaccine and vaccination recommendations.
Maintain and extend confidence in flu vaccine safety.
Address disparities in vaccination coverage.

48. Communication Challenges
 Vast number of messages and misinformation out there
 Vaccine safety and efficacy
 Many vaccine formulations for different groups of
individuals
 Misconceptions: flu is a bad cold; flu vaccine will give you
the flu; flu vaccine in not effective
 Audiences: similarities and differences
 Adult vaccination disparity and health disparate
population reach
 Shrinking budgets

49. Target Audiences
 Everyone 6 months of age and older
 Special Focus
 Parents of young children
 Older adults (65+)
 People with chronic medical conditions
 Pregnant women
 People who live with or care for those at
high risk for complications from
flu, including:
• Health care workers
• Household contacts and caregivers of
children less than 5 years of age, especially
children less than 6 months of age
 Minority/ethnic populations

50. A question for Yvonne
Wow! So you have many
challenges in messaging
AND you’re trying to reach
broad and diverse
audiences. What are some
specific ways you
addressed those challenges
and reached those
audiences effectively in the
2012-2013 flu season?

51. Campaign Elements
General Audience: national, multi-sector partners
representing business, health, retail, national
organizations, sports organizations, universities, multi-
media, etc.
Minority Populations: grassroots stakeholder engagement
and cross collaboration with health
departments/organizations, CBOs, faith-based, pharmacies
and other vaccinators, ethnic media outlets, business, etc.

52. CDC Partners in Action
from Times Square to small town USA

53. Campaign Elements
 CDC Support Mechanisms:
 Digital and social media
 Materials and Tools
 Flu Partner Portal
 Capacity Building Plans (Webinars, Flu 101, Social Media)
 Traditional Media: television/radio/print PSAs, interviews
 Education and outreach to health care professionals

54. Digital and Social Media Tools
New and Digital Media
• Publisher Outreach
• Content syndication
• CDC email alerts
• Mobile messaging
• Smart phone/iPad
apps
Social Media
• Twitter chats
• Blogs

55. Digital and Social Media Tools
Content Syndication: http://tools.cdc.gov/syndication/
RSS Feeds: http://www2c.cdc.gov/podcasts/rss.asp
CDC Flu Twitter: http://twitter.com/CDCFlu
CDC Facebook: http://www.facebook.com/CDC
Receive notices as CDC posts updates to specific flu web pages:
http://www.cdc.gov/Other/emailupdates/

56. Flu Vaccine Hesitancy
 “The flu vaccine will give you the flu…I got sick with the
flu after I got a flu shot ”
 “I’m healthy and don’t need a flu shot”
 “I’ve never had the flu so why get a flu shot”
 “ I’m afraid of needles.”

57. A question for Yvonne?
And so in spite of all those
great outreach
strategies, some people still
hesitate to get vaccinated.
What additional messages
did you use in educating
the public?

58. Educating the public about influenza
 Influenza (the flu) is a contagious respiratory illness caused
by influenza viruses.
 Influenza (the flu) can be a serious disease that can lead to
hospitalization and sometimes even death. Anyone can get
sick from the flu.
 Some people, such as older people, young children, and
people with certain health conditions, are at high risk for
serious flu complications.

59. Educating the public about influenza
 It takes about two weeks after vaccination for the body’s
immune response to fully respond and for you to be
protected.
 “It’s not too late to get vaccinated.” National Influenza
Vaccination Week (NIVW)
 People have several options in terms of where they can get
vaccinated and the type of influenza vaccine to choose.
http://flushot.healthmap.org/
 The best way to protect against the flu is by getting
vaccinated each year.

61. 75034

64. Resources
• Matte articles
• PSA’s
• Print Materials
• Web Buttons,
Banners,
and Widgets

65. Cold vs flu
Influenza Symptoms: can be mild to severe
The flu usually comes on suddenly. People who have the flu often feel
some or all of these symptoms:
• Fever or feeling feverish/chills
• Cough
• Sore throat
• Runny or stuffy nose
• Muscle or body aches
• Headaches
• Fatigue (tiredness)
• Some people may have vomiting and diarrhea, though this is more
common in children than adults.

66. Educating the public about flu vaccine
 There are two reasons for getting a yearly flu vaccine:
1. Flu viruses are constantly changing, flu vaccines may be updated to protect
against the viruses predicted to circulate the most during the coming flu
season.
2. A person’s immune protection from vaccination declines over time and annual
vaccination is needed for optimal protection.
 Each season many flu viruses spread but most of these viruses fall into
four main categorized groups: two influenza A and 2 influenza B viruses.
 The 2012-2013 flu vaccine protects against the three influenza viruses
that research indicates will be most common during the season. This
includes an influenza A (H1N1) virus, an influenza A (H3N2) virus, and an
influenza B virus.
 The timing of influenza outbreaks is unpredictable. They have occurred
as early as October and as late as May.

67. Flu Season Communication Tactics
 Provide media, the public, clinicians, public health and other partners with
rapid, accurate, transparent, clear, and actionable information on influenza
disease activity, prevention, and treatment
 National press briefings: Flu season kick-off, NIVW
 Radio media tours with national, local and ethnic media outlets
 CDC Website traffic tripled in page views this flu season
 Maintain weekly e-mail distribution of updates, resources, key messages to
public health providers, organizations, private sector partners and other
stakeholders
 Web and social media activities
 Materials distribution and partner driven flu promotion activities

69. Resources
http://www.cdc.gov/flu/freeresources/index.htm

70. 2013-2014 Flu Season
 Goals: Focus groups to test new logo and theme, quadrivalent
vaccine message testing and fact sheets.
 Continue messaging that conveys importance of universal
vaccination with a focus on people with high risk health conditions
and health disparities.
 New materials to reach African American, Hispanics and American
Indian/Alaska Native populations.
 National Influenza Vacccination Week- December 8-14, 2013

71. Thank you!
Contact: fluinbox@cdc.gov
 For more information please contact Centers for Disease
Control and Prevention
1600 Clifton Road NE, Atlanta, GA 30333
Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348
E-mail: cdcinfo@cdc.gov Web: http://www.cdc.gov/flu

72. Key takeaways
• Understanding perceived benefits
and barriers to vaccination among
target audiences is key in designing
an effective campaign.
• Partnerships and collaboration
strategies can increase visibility and
target audience reach.
• Clear messages and materials +
community engagement can build
awareness about the importance and
benefits of universal flu vaccination.

73. Poll Question
If I were trying to persuade someone to get a flu shot, I would:
a) Tell them how many people die from flu every
year
b) Tell them about someone you know who got the
flu
c) Ask them if they know the difference between
the cold and the flu

74. Join the Conversation!
Questions or comments for
Yvonne?
Please submit questions by using
the chat function OR clicking the
“raise hand” button to be taken
off mute
We have our first question for
Yvonne. . .

75. Discussion/Q&A
Ask Yvonne!
Share with Yvonne!

76. Join the Conversation!
Questions or comments for either
panelist?
Please submit questions by using
the chat function OR clicking the
“raise hand” button to be taken
off mute

77. Questions for our speakers
Michael Villaire, MSLM Yvonne Garcia
Chief Operating Centers for
Officer, Institute for Disease Control &
Healthcare Advancement Prevention (CDC)

78. Health Literacy:
Undervalued by
Public Health?
A tool for public health
professionals.
Prepared for the American Public Health
Association Community Health Planning &
Policy Development Section
Tammy Pilisuk, MPH AUG 2011

79. Learning more. . .
• Following today’s webinar, you will receive an email
with a link to
• A recording of today’s webinar, which will be
archived for future access
• Presenters’ slides
• List of resources related to today’s topic

80. Evaluation & Questions
• An evaluation will pop up on your screen
immediately following the conclusion of today’s
webinar ─ please share your feedback that will help
us improve future webinars
• Please let us know if you would like to follow-up on
anything we touched on today
• Have additional questions? Contact our presenters
or moderator

81. Resources
• CDC: Health
Literacyhttp://www.cdc.gov/healthliteracy/index.html
• National Institute For Literacy (NIFL) health literacy
listserve:
http://www.nifl.gov/lincs/discussions/subscribe_all.ht
ml
• American Medical Association’s health literacy site:
http://www.ama-assn.org/ama/pub/about-ama/our-
people/affiliated-groups/ama-foundation/our-
programs/public-health/health-literacy-program.shtml
81

82. Additional Resources
• www.nlm.nih.gov/medlineplus/etr.html
• www.coveringkidsandfamilies.org/resources/docs/stylemanual.pdf
• www.health.gov/healthliteracyonline
• www.cdc.gov/healthmarketing/pdf/Simply_Put_082010.pdf
• www.hsph.harvard.edu/healthliteracy/resources/doak-book
• www.hsph.harvard.edu/healthliteracy/practice/additional-
resources-for-creating-and-assessing-materials
• www.healthcommunications.org/resources/Improving%20Readabil
ity%20with%20Appropriate%20Design.pdf
• www.slideshare.net/SPHCalpact/plain-writing-training-tool

83. Speaker Contact Information
Michael Villaire, MSLM, Chief Operating Officer
Institute for Healthcare Advancement
mvillaire@iha4health.org
(800) 434-4633 x202
Yvonne Garcia, Influenza Communication Lead
Health Communications Specialist
CDC/NCIRD
ybg2@cdc.gov

84. Thank you to our Sponsors
Community Health
Planning and Policy
Development
Section, APHA

85. Thank you to our planning
committee
• Tammy Pilisuk, MPH, APHA-CHPPD
• Erin Brigham, MPH, CareSource, APHA-CHPPD
• Amanda Crowe, MA, MPH, Impact Health
Communications, LLC
• Meghan Bridgid Moran, PhD, San Diego State
University, School of Communications
• Nancy Murphy, MSHC, Metropolitan Group

86. Thank you to our speakers!
Michael Yvonne Garcia
Villaire, MSLM, Institute for Centers for
Healthcare Advancement Disease Control &
Prevention (CDC)

87. About This Series
• The Health Communication Matters series will help participants in all
walks of public health to apply health literacy principles to their
everyday communications.
• What audiences do you communicate with—consumers, health
professionals, disenfranchised communities, your public health peers?
Whatever your role in public health, it’s likely that you need to
communicate effectively. But how do you know your communication is
effective?
• Only about 10 percent of the general population is considered “health
literate.” That leaves the vast majority of us with barriers to
understanding the health-related information we read.

88. Conclusion
Thank you!
www.calpact.org