Targeting & Tailoring

I missed class this week because I had a medical appointment. The UCSD Medical Group seems to have incorporated a number of new ideas into their practice, such as electronic medical records. Related to the course topic this week, part of the "patient demographics" they designated a literacy level. A nurse or medical assistant handed me a visit summary printout with this on there and I remember commenting on it. She seemed embarrassed--she must have printed the wrong version of the form and I wasn't supposed to see how they categorized me. I never completed a (health) literacy questionnaire such as REALM or TOFHLA--somewhere along the line someone made a judgment or assumption about my health literacy based on interaction with me or my education level. As reported by the AMA (1999), education level is not a good predictor of health literacy. I wonder if this designation in my chart makes any difference in how my doctors choose to communicate with me.

The SMOG reading grade level calculations floored me. I didn't know how this was done and was shocked at how simplistic it is. Polysyllabic words don't seem like they would necessarily be the best indicator, but the more I think about it I understand how people with low literacy levels would struggle more with longer words. There are short, one- and two-syllable challenging vocabulary words that would be missed using this rubric (e.g., efficacy or endemic or obviate). As pointed out in the lecture, medical jargon may fit into this category.

The Freimuth & Mettger (1990) article on supposed "hard-to-reach audiences" was thought-provoking. I agree that using pejorative terms can be counterproductive, but nowhere did I see him focus on alternative positive traits of marginalized groups. Nevertheless, it added strength to the lessons we're going over about formative research and audience segmentation on more than just demographics.

Word-of-mouth (WOM) communication may be useful for those "hard-to-reach" audiences. The HIV prevention effort used trained peer educators to get the word out in their communities, which represented an otherwise marginalized group unlikely to seek out the information on their own (until perhaps they felt the need because they were sick). If they do have limited access to communication channels and distrust of dominant institutions, WOM presents an excellent strategy to get around these barriers.

I wonder how great the difference in effectiveness of WOM is when coming from friends or family vs. peer educator. Does the peer educator gain some status of authority like a doctor? Sexual assault prevention began pushing for peer educators, particularly college men for campus prevention efforts, and a bystander approach which generally calls for peer-to-peer dialogue.