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Sunday, September 03, 2006

Health Access Technology and Education Ramblings

So, how does this apply to the general practice and function of health education? For educators and students it is obvious. For general population and practitioners it seems…

1. Many high risk person experience access and comprehension barriers.

2. Although "high end" users may always need and use all 5 stages or functions--- "low end" users have different needs and should not be expected to "progress" through stages but rather utilize later stages. The stages are not progressive in application but rather a reflection of function in society. Functionality of the 5 stages is inverted…widespread applications will disproportionately benefit or hinder the general population (depending upon access and design) where specific applications will benefit specific audiences. For example, researchers will not be expected to "give up" the computational capacity of the computer. So, topics of special interest to public health would include…in my opinion…

1. Media literacy AND Health literacy training…analysis

2. Accessibility/Decreasing ALL barriers both physical and cognitive…design

3. Inclusion of ALL persons for programs and campaigns…broad

4. Interactivity and individualization…specificity.

3. Traditional educational structure has emphasized memorization of health related facts and figures with little application based analysis. Example; the food pyramid is recognizable but often not applied. Students are tested on memorization of this information…."how many servings of meat…" but do not have the ability to identify a serving size in day to day life. The use of technology in stages 1-3 supports this traditional teaching and learning…routine memorization and lecture formats are enhanced. But, if technology is integrated at the current level possible(due to technological advances and diffusion of technology) then technology can become a communication tool which is not constrained by time, source, linear progression, cognitive/learning styles, and other factors. By allowing both teachers and learners access to and use of technology, there is more support for theories that emphasize analytic ability over memorization. There is also a lot of research citing a need for analysis of information rather than memorization. The synthesis of information is more difficult to test in a multiple choice or true/false format…calling for new methods of assessment in addition to new methods of instruction. This supports the goals and needs of health literacy for the public and calls for new methods of preparing health education specialist. Example: prescription drugs. A study demonstrating many persons unable to understand basic instruction on taking their medication. Big public health concern. It is not enough to write information at an 8th grade level if have non-readers, foreigners, etc. In fact, that might just be the average between college educated persons and those who read at a second grade level…so it conceivably is not meeting anyone's needs…plus, many studies fail to account for ability to understand numbers, directions, and abstract concepts. Some have advocated a basic health literacy test be given to determine a patients level of understanding. Good idea for at least two reasons…can write a prescription for education…and informed consent issues. Informed consent is a joke if a person is unable to understand the basic information given to them…first hand knowledge tells me this is WRONG and dangerous!!! So, beside the issue of morality and legality…the prescription for education is a bonus for the field of health education which is possibly a money saving initiative overall given the dismal state of health literacy in this country. (Going back to the prescription example; why couldn't a short video or kiosk in a drug store could enhance understanding by presenting information in a variety of ways…patients could be given written instructions with a short "quiz" to ensure they "got the point". If yes, then okay…if not, then a second set of instructions in a different format (say audio) could be used. If still not then video…finally a live demonstration from a living person. Or choices of preferred styles could be used to with alternatives available on request.) Okay back to the point. True health literacy combined with media literacy is well supported by educational reform theories which have a tendency to emphasize concepts and analysis over memorization. There is a need for this! Given technological advances, educational reform in professional preparation and practice plus an emphasis on health literacy and communication is essential. Just training people to use software programs does little to increase the publics ability to understand complex health related information without understanding how and why people learn. By increasing access and understanding of information, people can truly have informed consent, take a more active role in their own health, and apply information in meaningful ways. In much the same manner that instructors become facilitators to learning in the new educational models…doctors will also become less authoritative and more facilitative as patients ask for information or question procedures/treatments/etc …opening the door to communication between doctors and patients. That may be idealistic but it is not absurd. Finally, I think technology is moving toward an integration stage (for lack of a better word). As information becomes more general and specific it will become even more important for people to analyze and access information. It will widen the gap between those who can and those who cannot.



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