Health Literacy in Health Care Education and Evaluating Virtual World Exhibits

Since our last update, the project team has focused on the importance of integrating health literacy principles into health care education and on developing a checklist for evaluating the fit of virtual world exhibits with principles of health literacy.  We presented Exploring the depths of health literacy: Are we teaching this and why does it matter? at the Gerontological Society of America annual scientific meeting in November 2012. Then, in April 2013 we presented Promoting health literacy through leading edge occupational therapy education at the American Occupational Therapy Association. Most recently, we presented our ongoing work on health literacy in virtual worlds at the annual faculty development conference at Jefferson, Evaluating the fit of virtual world exhibits with health literacy principles:

Health Literacy at POTA

By: Alyssa (Alzimarie) and Annalisa (ALiesel)

On September 29, 2012, Annalisa and I had the opportunity to present at the Pennsylvania Occupational Therapy Association (POTA) state conference about health literacy in Lancaster, Pennsylvania.  This was a phenomenal opportunity to learn new skills, present to a larger audience, and empower others in our profession to work towards a more health literate society.

We spent many hours preparing for this opportunity; debating what information was most important to convey, and how to present it in a meaningful, empowering manner so that occupational therapy practitioners could immediately begin to apply health literacy principles in practice.  We discussed what health literacy is, why it matters to occupational therapists, how we can apply it to our place of work, and how we’ve begun to apply these principles at Thomas Jefferson University.  We also encouraged attendees to participate in Health Literacy Month which occurs throughout October.

About 25 occupational therapy practitioners attended our presentation and the discussion was thrilling!  It was so exciting to see people consider how health literacy was already impacting their practice and share what they were doing to promote health literacy.  We discussed that there are three levels at which we can impact change: the patient level, the provider level, and the systems level.  Change at any of these three levels can have a positive impact on health outcomes.  We learned so much from the experienced OTs in the room as they shared their ideas for change on these levels.

Practitioners shared how challenging it can be to communicate with their clients in a health literate way and also discussed some techniques they use to overcome this difficulty.  They talked about the importance of checking client’s understanding by asking them to demonstrate a new skill.  One practitioner shared that she often involves the patient’s family members in conversations as a way to promote plain language. She explained that some patients find it easier to understand directions when they hear them from a family member who uses familiar words and communication patterns. Another practitioner shared that she uses health literacy principles when providing durable medical equipment. She pointed out that this equipment can be confusing for patients to use unless they have very clear directions. One OT who works in a hand clinic said that she uses the “teach back method” with her patients’ home exercise programs. Before she finishes her treatment sessions, she asks her patients to show her how they will do their exercises at home. She said this helps her see whether or not her instructions were clear. Another OT talked about how she chooses words carefully when talking with patients. She gave the example of the word “flexion.” She explained that even though this word might not seem like jargon, it might not make sense to a patient.

This was a phenomenal learning experience for Annalisa and me.  We learned so much about what goes into applying to present at a conference, preparing a presentation, and giving a presentation in a way that facilitates discussion.  These were new skills that will help us as we move forward in our careers.  I came away exhausted from an intense weekend and weeks of preparation, but am so excited about our next opportunity to present at the American Occupational Therapy Association’s national conference in San Diego, California in April 2013.

We are so grateful to Dr. Susan Toth-Cohen for her support and help walking us through each step of this process.  Her insights and ideas were invaluable.   Thanks also to each participant who came to our presentation and shared your own ideas.  Thank you for your feedback and investment into us as future practitioners who want to provide the best possible care for our patients/clients.

Spreading the Word: New Opportunities in Health Literacy

It has been an exciting few months for our work in health literacy.  We are thrilled with the opportunities that continue to arise; opportunities to spread the word about health literacy to our peers, professors, and the occupational therapy community at large.  As we continue to learn about health literacy, we are increasingly convinced of its importance and transformative power in health care.

I recently read Helen Osborne’s book entitled Health Literacy from A to Z.  Osborne talks extensively about how all health care professionals can change the way they interact with clients and promote health literacy.  This makes the health care environment more accessible to all of our clients.  We’re now reading the book as a team and working hard to apply the principles we’ve learned to our other projects.  It is exciting to see my own writing and observation skills improving particularly in our work in Second Life ®.

Our updated Diabetes exhibit include a “Living with Diabetes Listening Station” featuring one individual’s experience managing their blood sugar.

When you visit the Garden of Healthy Aging, you’ll notice that we are updating our exhibits to be more user-friendly and provide information more clearly.  In addition, we’re working to update our wiki pages.  This is one of the most exciting ways to apply our knowledge of health literacy in writing, formatting, and design.  Our hope is that we can create a useable site that provides a lot of “need to know” information in a way that people of all different reading levels can understand.  We are making progress towards our goal, but still have a long way to go and a lot to continue learning!

We are excited to announce that Pfizer Inc. granted us permission to use their “Newest Vital Sign”, a health literacy screen for clients, within our Second Life ® exhibit.  This will give users the opportunity to test their level of health literacy as well as tips for improving health literacy.  We hope to empower clients to take a greater control in their health and gain confidence in asking health professionals questions.

Dr. Toth-Cohen, PhD, OTR/L is currently developing a course in health literacy for students in a variety of professions at Thomas Jefferson University. This is a great opportunity to help future health professionals gain a greater understanding of the importance of health literacy and how they can interact most effectively with their patients.  This class also comes a time when the occupational therapy department at Thomas Jefferson is looking to incorporate the principles of health literacy into the curriculum.  We presented to the faculty about health literacy which opened to the door for great discussion about the future of health literacy within the department and the future of our project

Annalisa, Dr. Toth-Cohen, and I will be presenting at the Pennsylvania Occupational Therapy Association conference this September  about why health literacy matters to occupational therapists.  This is an exciting opportunity to have our work recognized by other occupational therapists in our state and for us to encourage them to integrate health literacy principles into their area of practice.  We are looking forward to sharing what we have learned and hope to be a catalyst for change within occupational therapy practice.

This is a thrilling time of change and progress with our program and I am honored to have the opportunity to be a part of it!  My hope is that others will continue to catch the dream that we have and empower others to change the way the health care system operates.  We are hoping to have many more opportunities to spread the word.

Spreading the Word: Taking Every Opportunity to Teach Others About Health Literacy

By: Annalisa (ALiesel) and Alyssa (alzimarie)

 On January 19th, we presented our work on health literacy to our classmates in our Jefferson School of Health Professions class OT 560, “Interventions: Environmental Competence.” The focus of this interventions class is to understand the therapy process in terms of the dynamic interaction between the client, their occupations, and their environment, and apply this knowledge in practice by developing client-centered environmental modifications. In our concurrent course, OT 562, “Environmental Competence in Action”, pairs of students conduct an environmental analysis project with a community dwelling client. The OT students make seven visits to the client’s home and collaborate with the client to identify and carry out five adaptations to the environment that will support the client’s health and participation in daily occupations.

For many of us, this is our first time working as an OT consultant interacting with a client, as well as our first time performing a home environmental assessment. Prior to our first visits with our clients, our instructor, Tracey Vause-Earland, MS, OTR/L, prepared a series of classes designed to give us strategies for delivering client-centered, collaborative services. It was in planning these classes that Tracey asked us to present what she believed would be “imperative information” for the class to hear: the facts about health literacy.

Tracey was familiar with our work on health literacy in the virtual world of Second Life® (read about our presentation), and felt strongly that our classmates needed to develop health literacy skills in order to effectively interact with clients. We whole-heartedly agreed. Our research on health literacy has shown us just how critical it is for health professionals to support their clients’ ability to understand and use health information to make health decisions.

We began by showing a youtube clip created by the American Medical Association that contains first person accounts of what it is like to have low health literacy.  It was obvious following the video that we had our classmates’ attention. They expressed shock and amazement that their clients could be experiencing such low health literacy without their awareness.  We discussed what health literacy is and how the healthcare system places demands on individuals to independently manage their health. This creates an environment that is difficult for our clients.  We asked our classmates to brainstorm ways in which occupational therapists could improve clients’ understanding.  We did not anticipate the enthusiastic and thoughtful answers our classmates posed to this question.  They quite literally stole our thunder!  Knowing that our peers were able to apply the small amount of information we had given them and make connections to their interactions with clients was exciting.  The room was abuzz following our presentation. Classmates kept saying, “That was great- thank you. I had never thought about health literacy like that before.”

In the three weeks since delivering our presentation, several classmates have voluntarily approached us to tell us how they have seen applications of health literacy in their own lives, and how their awareness of health literacy has shaped their interactions with their clients One classmate said, “I thought of your presentation over the weekend when I was at the doctor’s office. I had a question I wanted to ask my doctor, but I didn’t know how to phrase it, and I was too scared to bring it up in the end.” Another classmate said, “My OT 562 partner and I recalled what we learned about health literacy in your presentation when we worked with our client for our project this week. When we asked our client what kind of medication he was taking, he said he didn’t know what it was, but he takes it anyway ‘because the doctor tells him to’. He said he usually takes two kinds of medication before breakfast, but he doesn’t know if that’s the correct time of day to take them. He showed us the medications- he’s taking a blood thinner and a laxative, but he didn’t know why. We recognized this as an example of low health literacy!”

Our hope is that we can continue to educate those around us about health literacy: our peers, our professors, our clients, and our future employers and colleagues.  Evidence shows that the health care system is demanding more and more of clients to manage their own health (Smith & Gutman, 2011). This means that health professionals need to become skilled in supporting health literacy in their clients. We have developed a firm belief that health literacy is the future of health care and that it is imperative that we continue to spread the word.

For additional resources and information, visit our wiki.


Smith, D. L., & Gutman, S. A. (2011).  Health literacy in occupational therapy practice and research.  American Journal                                                    of Occupational Therapy, 65, 367-369.  doi: 10.5014/ajot.2011.002139

Women with Disabilities

Women and girls with disabilities was not a topic I had previously considered.  Although it seemed interesting, I really didn’t think we would be able to find much information about the topic.  When we started researching we found that this was not true at all.  There was so much information about the struggles that women with disabilities experience.  Many articles talked about how these individuals experience may experience discrimination on two accounts, because they are women and because they have a visible disability.  These women may experience discrimination when looking for a job, when looking for a place to live and even in their medical care.  We found that many doctors will not discuss these women’s sexual health because they assume they cannot be intimate.  I thought this was very interesting and must really impact the patients.

Our presentation of this material went very well.  We did two presentations on the 15th.  We had a fairly large turnout and our audience was very diverse.  We had visitors from all over the world, including Brazil, Germany, Australia, The United Kingdom, and America.  Many of our visitors also shared that they had disabilities.  The women with disabilities who were in the audience shared their own personal experiences, which was very interesting.  The women all seemed to agree with the information we were presenting.  Many of them said that they had experienced discrimination in the areas that we had discussed.  They were very open with their own struggles of depression and feeling isolated.  The women said that sometimes they felt like they were standing in their own way but could not pull themselves out of the depression.  There was one young woman who said she had just finished her first semester at college. She said that she was so exhausted from proving to herself and others that she could do everything that any able bodied person could do.  Her partner was also in the audience and said that after her accident she was very depressed and it took her a long time to get over the depression.  Another topic that the women were very vocal about was their sexual health needs being ignored by doctors.  They said that many times they felt like doctors seemed to think of them as being asexual.  The one thing that seemed to surprise the audience was that women with disabilities are more at risk for violence.  Our research showed that this population was more at risk for physical, verbal and sexual abuse.  None of the women spoke of any personal experience with this, however they all seemed very concerned at the possibility.

I think our audience added such a great component to our presentation. We learned so much from their discussion and it seemed like they really enjoyed speaking with each other.  They explained that they often feel alone with the issues that go along with having a disability, and it was great to see them interacting with other people who face the same issues.  Overall I think the sessions went very well and our very diverse audience added so much to the discussion.

Health Literacy Grant

This fall, we were funded by the Jefferson School of Health Professions‘ (JSHP) Research and Scholarship program to develop a program that uses Second Life as a training center for JSHP graduate students in occupational therapy. This program is designed to help students learn best practices for promoting health literacy in older adults by implementing evidence-based consumer education.

The current phase of the program provides students in the Fall 2011 class, Older Adults and Their Living Environments with the opportunity to learn about health literacy and develop a presentation on area relevant to older adults.  The four participating students, Mollie Bear, Bonnie Bennett, Aly Binck, and Lauren Lovinger first attended a presentation on basic tenets of health literacy. They then developed and presented talks on Transitioning to the Caregiving Role and  Staying Involved throughout Life. These talks will be summarized in a subsequent post.

Carpal Tunnel Syndrome Presentation

On October 16th we held a presentation focusing on carpal tunnel syndrome. To prepare for this presentation a lot of research was done on general carpal tunnel syndrome information such as the signs, symptoms, treatment approaches, and how to decrease your risk for developing this condition. The research used for this presentation was the most up to date information available and evidence based to ensure that the most accurate information was being presented. Most of the information was found in occupational therapy journals and on hospital based websites. After the research was complete a power point and script were created along with several interactive aspects such as hand splint, carpal tunnel wrist animation,  and a 3D image demonstrating proper seated positioning at a desk.

                     This picture shows the wrist animation

The audience was very interested in this topic and most of them have had some experience with carpal tunnel syndrome. One attendee was diagnosed with carpal tunnel syndrome and was very interested in gaining more information about it. The audience members asked a lot of interesting questions and shared their personal experiences with carpal tunnel.

Some of the questions that surprised me were about how you can develop carpal tunnel syndrome. One question that was particularly interesting was about if yoga could cause carpal tunnel of make the symptoms worse. We had not conducted any research specifically on yoga and had not thought about how something like yoga could affect the wrists. Any excessive bending or stretching of the wrist can cause increased pressure on the median nerve (which is the cause of carpal tunnel) so yoga could cause the symptoms if it is done for a long period of time or very frequently. Many of our guests were coming up with other ideas and activities that could potentially cause carpal tunnel of make the symptoms worse.

The audience was very interested in the section our presentation on proper positioning and how to decrease your risk of developing carpal tunnel. Many of the audience members participate in activities, such as typing a lot, that can increase the risk of developing this condition so they were anxious to hear about how to decrease this risk and protect themselves and their bodies while continuing to do the activities they like (such as being on second life!).

Overall, this presentation went very well. The audience was interested and had good questions and discussions. I was surprised by how many of them had heard about carpal tunnel syndrome and new a fair amount of information on the topic. This presentation gave them extra information about carpal tunnel and also provided them with ways to avoid developing this disease.

Grad students discuss healthy aging and recent well elderly study

Healthy aging event 8-19-11

On August 18, at two sessions, OT students Rukii Marenwolf (Kaitlin Rodriquez) and Vironica Loxingly (Veronica Souter) gave a presentation and discussion on Healthy Aging. Held at the Garden of Healthy Aging, the event produced some very interesting discussion, a bit of controversy, and suggestions for new ventures. Here is a short excerpt from their talk:

People are living longer so it is important to learn how to keep people healthy as they age. Occupational Therapists believe that engaging in meaningful activities is essential in order to live a healthy life at any age. To continue to be as healthy as possible into late adulthood a person should continue living a healthy lifestyle and doing the things that are important to him or her. This study is extremely important because it shows that changes in lifestyle can be used to help prevent the onset of illness and disability.

Rukii and Vironica combined presentation of the Well Elderly 2 study with questions such as “Have any of you made any lifestyle changes?” and discussion of strategies participants had found beneficial to them. The presenters and participants all emphasized the importance of small changes but consistent changes in daily activities directed by the person him/herself.
Controversy came in when all discussed the issue of “whose responsibility is a person’s health?” Rukii and Vironica brought up the point that it’s one thing to hear a healthcare provider’s advice but may be quite another to actually put lifestyle changes into practice. All agreed that the approach of most physicians is prescriptive and focuses on “fixing a problem;” this needs to change to more fully include consumer perspectives. This brings to mind Linda Hunt et. al.’s seminal work, Compliance and the patient’s perspective: Controlling symptoms in everyday life. Although published in 1987, findings of the study are equally relevant today and make the point that changes must fit well into the person’s lifestyle and their own ideas about what is best for them. The second author, Brigitte Jordan has made this publicly accessible via her blog–a highly recommended and thought-provoking read for any interested in the topic of patient compliance/consumer adherence.

An exciting development was the suggestion by two participants that we form a group to discuss issues of healthy aging. All agreed that there are many on Second Life who could benefit from such a group. We will be discussing the feasibility/possible directions of this in the next several weeks so stay tuned!

ISTE 2011 Presentations

Our activities at ISTE, the International Society for Technology in Education, international conference
Poster/learning station

Machinimafest Entry

Universal Design Events in Second Life

Update 4-30-11

Universal design event 4-30-11

Students gave a repeat performance of their talk on universal design on Saturday, April 30. This was a much larger group (about 25) than Thursday’s event. Gentle Heron and ISkye Silverweb from Virtual Ability and Health Info Island and others from the U.S. and Europe attended. Discussion was lively and included questions about advantages, disadvantages, and application of specific universal design features and how universal design can promote inclusion. We set up tours of the adapted home and playground at Eduisland 2 (main location) and the Garden of Healthy Aging for Saturday, May 7 and Wednesday, May 11, both at 11 am SLT. The starting point will be Eduisland 2 both times). Students will also present their talk on universal design again on May 18, at 11 am at Health Info Island.

universal design event 4-28-11

Universal Design event 4-28-11

To celebrate Occupational Therapy Month, first year OT students Vironica and Rukii are presenting, “Universal design: Why should we care?” at two sessions at the main site of the OT Center at Jefferson in Second Life. The first of these was held on Thursday, April 28 from 7:30 AM to 8:30 AM EDT and included a presentation, discussion, and 3D illustration. The session will be repeated on Saturday, April 30 from 2-3 PM EDT.
When we do these events, we like to provide Second Life residents with different time options, since our audience is from all over the world. Thursday’s presentation included an individual from Germany in the audience. We are looking forward to Saturday’s presentation and hope to see you there!