Which came first, dropping out of high school or poor health?
Adults without a diploma live a decade less than their peers who attended college. They’re also more likely to have more chronic health conditions and functional limitations and disabilities.
But poor health may be a reason for low educational attainment. The Journal of School Health found that health problems such as poor vision, asthma, and inattention and hyperactivity all influence students’ motivation and ability to learn.
Conversely, healthy kids perform better in school, score higher on standardized tests, and achieve higher educational outcomes, according to an article published in the journal Pediatrics.
Whatever the cause, lack of higher education is associated with poor overall health and a shorter lifespan.
Why a college degree means better health
Theories abound to explain the divide between education and health. A college degree may confer greater health literacy, money to support healthy behaviors, and a job that provides health insurance.
A degree is also associated with numerous other social determinants of health, such as income, social status, and housing.
Broad inequalities require broad solutions
Education and health are central to well-being and inextricably embedded in the social context and structure, observed researchers Anna Zajacova and Elizabeth M. Lawrence in an article published in the journal Annual Review of Public Health in 2018.
“Reducing macrolevel inequalities in health will require macrolevel interventions,” they said.
Over the past decade, health systems have implemented solutions that go well beyond hospital walls to address social determinants, including prescribing fresh produce and providing housing for people with chronic conditions.
“I think the key is to link people with the resources they need to do what their doctor advises,” says Dr. Melody Goodman, associate professor of biostatistics at New York University. “If you want someone to be more physically active, make sure they have the time, safe space, and resources to do so.”
When it comes to addressing lower education levels, there are three key ways providers can intervene:
#1 Start with health literacy
“Health literacy is really important to consider when dealing with patients with limited education,” Goodman says. “Don’t assume people are health literate.”
Health literacy is the ability to gather and understand the information needed to make informed health decisions. If a patient can’t understand most of the information their doctor or health system provides, how can they act on it?
For example, patient materials across medical specialties are written at near-college levels, well above the guidelines given by the American Medical Association and the National Institutes of Health, between a third- and seventh-grade level.
Goodman recommends using plain language and pictures when communicating with patients.
For example, don’t ask, “Are you ambulatory?” when you could say, “Are you able to walk on your own?”
She also recommends providing information to take home in both written and video format — “YouTube is great for this,” she says.
The Institute for Healthcare improvement offers a helpful guide for 8 ways to improve health literacy.
#2 Use the teach-back approach
Goodman also recommends using the Teach-back approach. The research-backed method involves having patients explain in their own words what they need to know and do. If they can’t, providers can explain it again, using simpler language and then re-check for comprehension.
Teach-back also provides a learning opportunity for providers. Terminology that may seem obvious to medical professionals might not be so obvious to patients — especially if they haven’t attended college. Providers can learn what works and what doesn’t and adapt their communication style accordingly.
#3 Communicate with patients in a way that works for them
Most Americans own a cell phone, and four out of five want to use it to communicate with their healthcare providers, according to a FICO survey.
And it goes both ways — providers see greater success in helping patients make changes when they send the recommendations via text. Research published in the journal Annual Review of Public Health in 2015, found that text messaging interventions were effective in addressing diabetes management, weight loss, physical activity, smoking cessation, and medication adherence.
The potential impact may be even higher among people who don’t go to college or don’t finish high school. Their reliance on cell phones for internet access is seven times higher than it is for college graduates.
This makes mobile communication an especially promising communication method for healthcare providers reaching this demographic.
Here are four benefits to using text messaging to reach patients, especially those with less education:
- Improve health literacy: Use WELL to send broadcast messages (text messages to a large group) to your patients giving them general health information, such as flu prevention or healthy nutrition tips.
- Increase medication adherence: Use WELL to send medication reminders via text to individual patients or groups of patients.
- Reduce no-shows: No-shows affect more than just a practice’s bottom line — they affect individual patients. Use WELL to send HIPAA-compliant text appointment reminders to patients and reduce no-shows by 50 percent or more.
- Improve access to care: If a patient needs to ask a quick question, they’re more likely to text their doctor than call a nurse hotline. With WELL’s bidirectional texting, patients can easily ask health questions.
When it comes to patient engagement, WELL believes in talking to people like they’re people — whatever their educational background. We’d love to help your health system improve patient outcomes through better communication. ♥
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Pamela Ellgen is WELL’s Health Editor. She began her career in community journalism and is the author of more than a dozen published books. She is a graduate of Washington State University.