Saturday, March 23, 2013

amazing what you find

Just found this on the internet, didn't actually know it was there.  

Interviewer: Terry Laidler
Interviewees: Ms Maureen Johnson
[Opening music]

Male voice over: The VQC Quality cast Series is proudly brought to you by the Victorian Quality Council.

Terry Laidler: Hi! Welcome to the Victorian Quality Council podcast series that focuses on the work of the 2010/11 Victorian Quality Council Travelling Fellows.  My name is Terry Laidler and my guest now is Maureen Johnson, who is the Manager  of Women’s Consumer Health Information at the Women’s Hospital and was one of the Travelling Fellows. 

Did you have a good trip?

Maureen Johnson:  I had a fabulous trip, thankyou Terry.

TL:      Now, I’m just trying to conceptualise it for someone outside the field.  It seems to me you’ve got at least three communication challenges with regard to how a health service deals with someone who is trying to get a service there? 
            You’ve got the challenge of having them informed enough before they arrive at the health service to actually know to seek information and to know to seek help or services, or something!  You’ve got a level of communication when they get there, how the clinician actually talks to the people; and then you actually do need them to go away sometimes and do certain things or understand certain things.  Where’s the biggest challenge do you reckon?  Is it the general knowledge beforehand, the clinical communication, or following through on what’s needed after the clinical encounter?

MJ:     Well, probably the biggest challenge is actually getting information to people who aren’t accessing health services.  I think we tend to have this thing in Australia where we feel that everybody has equal access to health and health services, but the truth is that, the people that are least likely to access health services, and to access them appropriately, are the people who are most disadvantaged.  So, it’s trying to get information, I suppose, to those people – the people that aren’t accessing information easily.

TL:      And, did you find anything new on your trip about how to get information to those people?

MJ:     I found lots of different strategies that were being utilised across various communities.  I mean, in many ways, the strategies are very similar across the world.  But, I think the whole notion of partnerships, of working with people who had that everyday access to people – so people who were in the community, adult educators and people that are working with disadvantaged communities anyway –  are obviously the people that you would make contact with and they’re the people you would work with in order to, you know, to increase……..


TL:      Because I suppose there is a readiness question with individuals isn’t there?  I don’t think I need health information until something goes wrong with me medically.  So if you want to get the general message to me, you’ll have to talk to the people I talk to more generally!

MJ:     Yeah –  although you are making health decisions all the time.  I mean, when you go into a supermarket you are making health decisions and when you’re taking vitamins you are making health decisions and when you choose to give up smoking or when you choose to change your diet!  I mean they’re all health decisions.  So health literacy isn’t just about when you make contact with the health service, it’s about how you access information in your everyday life.

TL:      What about people who come from non English speaking backgrounds? 
Because it seems to me there’s a specific set of problems there.  It’s not just translating what was said in English into the language that they speak.  It’s also about understanding the culture within which they speak that language, or am I overstating it?

MJ:     No absolutely! I mean… and our tendency is – and especially in health services – our tendency is to make information that fits everybody.  It’s a one size fits all approach.  So we might make fact sheets that pretty much target, your white Anglo-saxon middle class person and then we just translate it into several languages and that’s a capacity thing,  We don’t have the capacity to put heaps of resources into working with individual communities, but that’s what we need to do.  We need to actually spend time with those communities.  We need to create messages that relate to them.  The classic example I think is the smoking campaign!  The smoking campaign that created social marketing messages for a wide Anglo-saxon middle class Australian, and it was really effective for that population group.  But indigenous people are still smoking in large numbers and CALD communities or people from non-english speaking backgrounds, they’re also smoking in large numbers.

TL:      So, it’s partnerships you’re saying, with communities within which people operate and move generally, that’s the main theme that you saw?  What was the best example that you saw?

MJ:     I think one of the nicest examples that I saw, and I saw lots of things so it’s really hard just to target on one thing and say that was the best.  But I suppose one of the most moving moments for me was when I attended an adult education class in Peckham in London, England – which is a very, kind of disadvantage part of London – and I was in an adult education class that was about health literacy –  it was for women!  It was actually using the fact that women really like to have information for their children and they really like to be able to develop skills, I suppose, to develop their children’s literacy; and these were all women who were from different cultural backgrounds and they came to this adult education class to make tools to support their children’s literacy, and they were all very shy and they all sat around this table making books and making pictures and things that were for their children; but the adult educator was talking to them about family violence and depression; and when their partners were depressed what did they do?  And they had this lovely conversation and these women, by the end of this hour, were so animated.  They were sharing information and they left knowing where to get support, knowing where to get information.  You know, it was just a lovely example of…………

TL:      So when’s the next bookmaking class at the Women’s?


MJ:     Well you know, I don’t know that the Women’s is the right place necessarily for us to be doing that kind of work.  But I think the Women’s may have a role in producing information that these services can use.  I think we have the expertise to do that.

TL:      Thanks to Maureen Johnson for your time today and for your insights and knowledge gained on your trip overseas and good luck on your on-going work.

MJ:     Thank you Terry.


You have been listening to a podcast from the VQC Quality cast series.  For more information go to the Victorian quality Council Website at:

Long time no post

I have been quiet on the blogging front. Caught up in doing and forgetting about the need to record.  Health literacy as a concept continues to keep its head above water in the Australian context. The National Commission for Quality and Safety is working hard to entrench health literacy in the national standards that all hospitals must strive to achieve. The Health Knowledge Network at Latrobe University is doing great work towards collaborating with hospitals to develop national guidelines for health information. The Centre for Culture Ethnicity and Health have developed a course for health professionals to build skills and conduct projects within their health services. My own workplace strives to improve access to pregnancy and parenting information focussing always on equity and access.
But the debate continues.
What is health literacy? I know right. We are still asking the question. Which of the 17 or so definitions suits out need? The IOM definition doesn't quite capture it, still too much emphasis on individual skills and not enough of the barriers put up by the health care system. Health literacy is often, quite rightly, bundled up with the other social determinants (education, income, culture - all the things that make it less easy to be healthy). Health literacy it is a social determinant say some, it is socially determined say others (its both says Dr Rima Rudd!).  And yet, all things being equal (i.e the social determinants have been cured) health literacy can be completely undermined the moment people are confronted with the health system.
I spoke to a group of medicare local folk a week or so ago. They want to promote after hours locum services to a public that has no idea the services exist, who think after hours doctors can't possible be as good as emergency services, that they would cost a fortune, that a doctor in your house in the middle of the night is kind of creepy. They have an image problem. So people take their sick and ailing bodies out into the chilly night and clog up emergency services instead.  It's a health system in constant flux and the change is hard to keep up with. A colleague broke her shoulder, was sent by a GP to a hospital fracture clinic who told her the GP would need to make an appointment - and she wouldn't get in for some time. It was a week before she was able to see someone who was able to make a proper diagnosis and she had to pay for it.
My point, though slightly rambling, is that if health literacy is a social determinant, its the one social determinant that we, in the health sector, can impact. We can make our system more accessible. We can make it easier for people to know where to go, how to use our services, how to make appointments, when we might have to pay, when its free. I recall a report on women from African communities and health information, which concluded that women have quite reasonable health literacy but struggled with understanding the Australian health system. I know how they feel.