Health Literacy: What Teens and Parents Need to Know – PediaCast 201

Dr Deena Chisolm joins Dr Mike in the PediaCast Studio this week to talk about health literacy. How do parents, teens, and children consume and use health information in the 21st Century? Can parents ignite a spirit of self-discovery in their teens? What electronic tools are teens using today? What tools SHOULD they use? We talk benefits and pitfalls of self-directed health education in our digital world!

Guest

Dr Deena Chisolm
Principal Investigator
Center for Innovation in Pediatric Practice
Nationwide Children’s Hospital

Topic

Health Literacy: What Teens and Parents Need to Know

Links

Transcript

Announcer 1: This is PediaCast.

[Music]

Announcer 2: Welcome to PediaCast, a pediatric podcast for parents. And now, direct from the campus of Nationwide Children’s, here is your host, Dr. Mike!

Mike Patrick: Hello, everyone, and welcome once again to PediaCast, a pediatric podcast for moms and dads. We are coming to you from the campus of Nationwide Children’s Hospital in Columbus, Ohio. I’d like to welcome everyone to the show.

It’s Episode 201, so we’re embarking on our second set of 200 shows. It is February 29th, 2012, which means it’s a leap day, so we’re getting an extra day of the year and an extra PediaCast.

I also want to say Happy Birthday to all the leap babies out there. I actually have an uncle who is one of those, Uncle Bob Taylor, so I want to give a little shout-out to him. I think he deserves it because he only gets to celebrate a birthday on the actual day once every four years. But then again, you get to tell people that you are a quarter of your real age, so sometimes as you get older that comes in handy. So happy birthday to all the leap babies out there today.

01:24¬

Also, this show, interesting topic we have for you today: “Health Literacy: What Teens and Parents Need to Know.” To help me talk about that, we have Dr. Deena Chisolm. She is a Principal Investigator with the Center for Innovation in Pediatric Practice here at Nationwide Children’s. We’re going to talk about what is health literacy, where do folks get consumer health information, and in particular, how do teenagers get and use health information.

For those of us, at least who have teenagers, back when we were kids, there wasn’t the internet and there weren’t all these vast resources to get information, so we’re going to talk about how teenagers are using technology today to understand more about their bodies and about health in general, what are the pros, what are the cons. We’re going to cover all of that.

02:15¬

I do want to remind you, if there is a topic that you would like us to discuss or you have a question, comment, anything, just head over to pediacast.org. You can click on the ‘Contact’ link to get a hold of us that way. You can also email pediacast@gmail.com or call the voice line at 347-404-KIDS. That’s 347, 404, K-I-D-S.

I also want to remind you that the information presented in every episode of PediaCast is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals, so if you do have a concern about your child’s health, make sure you call your doctor and arrange a face-to-face interview and hands-on physical examination.

Also, your use of this audio program is subject to the PediaCast Terms of Use Agreement, and you can find that over at pediacast.org.

03:02¬

All right, let’s turn our attention to our studio guest today. Dr. Deena Chisolm is a Principal Investigator with the Center for Innovation in Pediatric Practice at the Research Institute at Nationwide Children’s Hospital. She’s also an Assistant Professor of Pediatrics at the Ohio State University College of Medicine and an Assistant Professor of Heath Services Management and Policy with the Ohio State University College of Public Health.

Dr. Chisolm’s research focuses on measuring and improving the effectiveness, efficiency, and equity of pediatric health care. In particular, she is interested in the use of information technology to improve the health literacy of at-risk youth.

Welcome to PediaCast, Dr. Chisolm.

Deena Chisolm: Thanks. Great to be here.

Mike Patrick: Great. Great to have you. Let’s just start out with what is meant by the term ‘health literacy’.

Deena Chisolm: Well, the official definition that’s used in Healthy People 2000 and in most of our national research really says that health literacy is an individual’s capacity to obtain process and understand health information and to use that in making health care decisions, and it’s really related to being able to understand both spoken and written words and numbers.

04:13¬

That’s the real formal definition, but really more specifically, we’re talking about how people can find information, how they can understand information, and how they can use that information to make good decisions about keeping themselves healthy or managing their illnesses.

Right now, the National Research says that between 25% and 50% of people in the U.S. have some limitation in their health literacy, some limitation that makes it harder for them to use health information in their lives, and that those limitations are more common in older populations, in populations where English isn’t their first language, and in minority populations, but it is a problem across all populations.

05:03¬

Mike Patrick: Sure, so the idea being if you have poor health literacy, then it’s going to be harder to respond to educational materials because it just goes over your head and you don’t really understand it or have an interest in understanding.

Deena Chisolm: That and even more, because you have to think about all the ways in your health care that you are bombarded with information. You have to be able to make a decision about, do I understand how to follow the instructions on this medicine bottle, do I know how to fill out this insurance form when I’m trying to access health care.

Mike Patrick: Sure.

Deena Chisolm: We easily think about health education, but it’s a much broader use of skills to be able to navigate the health care system.

Mike Patrick: Yeah. Now how has 21st-century technology changed the way consumers interact with health information?

Deena Chisolm: Well, it’s kind of interesting. If you think back, well, I can’t quite think back, but if someone could think back to the early 20th century, most of your health information came from one of two places: either you got it from your doctor or you got it from a trusted friend or family member.

06:08¬

If you wanted to know, ‘What’s going to happen during my pregnancy?’ you ask your mother or your grandmother. If you wanted to know how you get the baby to stop crying, you asked a neighbor or a friend who has just gone through the baby stages, or maybe you asked a doctor, even though that wasn’t even the most common situation at the time.

But as new media have expanded our ways of communicating, now people get health information from radio and from TV and from websites and from social media and from smartphone apps.

Mike Patrick: And from podcasts.

Deena Chisolm: And from podcasts!

What that means is, you have more immediate access to information. If I want to know something about how to treat a cold sore at 3 in the morning, I can get out of bed and go to my computer and look it up.

It also, though, means that there’s a lot more information, and the quality of that information is inconsistent. So there’s a lot more to be done in terms of sifting through mountains of information in hopes of finding the right information to help you with your health.

07:10¬

Mike Patrick: All right.

Now, this interest in finding information is not new. Folks have been, as you say, wanting to find out information about their health care for a long time, and I did come across an article that you had written that talked about Utah in the late 1800s.

In July of 1889, there was an issue of “The Salt Lake Sanitarian”, which was a Utah magazine covering health trends of the era, and they proclaimed that baldness was a result of inadequate scalp sunlight exposure, which we can laugh at today, but back then, they were seriously trying to prevent baldness by saying that men should wash their head once a week and they should wear hats and really avoid sunlight exposure in order to, or I’m sorry, that need more sunlight exposure, so they were trying to figure out a way that hats could get more sunlight in. That’s why they had the ventilated hat.

08:12¬

Fast-forward to today when Google reveals that there’s over 300,000 internet resources dealing with baldness prevention. We really have come a long way.

Deena Chisolm: We really have. And some of that is the challenge of health information: some things that we used to say are wrong because we’ve learned new things, some things that we used to say were wrong because they were always wrong, some things that we used to say are questionable because maybe it was hat manufacturers who were involved in putting the information out there.

Mike Patrick: Yeah. Yeah.

Deena Chisolm: So there’s a lot of different ways that information can be not the best information or change over time, and particularly now where information is saved forever, whether digitally, books, whatever, people getting the right information and the most recent and the most current information to make decisions remains another challenge in the process.

09:08¬

Mike Patrick: Yeah. And even the information that doctors have, there’s certainly things that we recommend today and talk about today that tomorrow we’ll find out really wasn’t the best advice. So it’s even evolving that not only the consumer has to be geared into health literacy but as practitioners we need to be geared into it as well.

Deena Chisolm: Definitely.

Mike Patrick: Let’s talk a little bit about teenagers specifically. In what ways are teenagers interacting with health information technology?

Deena Chisolm: Pretty much all the ways that they interact with all the other technology that’s out there.

A national survey done by the Pew Internet & American Life Project, they do a national survey every year to see how people interact with the internet, their data says that about 90% of teens are using the internet and about 50% of them are using it everyday.

That research also shows that about a third are using the internet for health, diet and fitness information. One out of every three kids is looking for information about how to make themselves healthier online. So they are seeing this as a resource.

10:19¬

One of the things that’s interesting is that 20% or one in five are using the internet to find information about health-related topics that it’s hard to talk to your parents or your doctor about, things like depression or substance use or sexual health. So people are using that as a way of getting information in a way that doesn’t expose them to embarrassment or other potential trouble, so they’re using that as a support system for information.

Mike Patrick: And this would include not just Googling and internet searches but also social media stuff like on Facebook and Twitter and really the whole gamut of what we think about as being online now.

11:00¬

Deena Chisolm: Exactly.

Mike Patrick: Yeah. Now what are the benefits then, do you think, of all that information out there?

Deena Chisolm: Well, the benefits of it are, as I said before, one, the immediacy, that you can get to things quickly. You don’t have to wait until you can make an appointment with your doctor and get in.

Another benefit is the privacy. Sometimes you want to ask a hard question, you don’t want to have to look somebody in the eye when you ask them. At least to get the initial information, you can do that in a way that’s personal and private.

And there are a lot of features that are available in some of the online/internet-based systems that really do engage patients in their health care: letting them track their symptoms online and make graphs of their breathing abilities when they have asthma or graphs of their glucose levels when they have diabetes, things that let them participate in online chats with other teens with diabetes so that they can not feel alone when they’re dealing with these life issues.

12:07¬

Mike Patrick: Yeah, that’s great. All these things, really, there’s just so much benefit to as long as you can get to the right place and find the right information and not be led astray with falsehoods.

Deena Chisolm: And that’s the challenge, really, because if we do believe that the data says that 25% to 50% of people have a limitation in their literacy, but those people are still online, those people are still looking for information. The question is, are they understanding what they’re finding, and are they finding the right materials for their particular problem?

Mike Patrick: And that leads us into the pitfalls of all of this. What are the major pitfalls?

Deena Chisolm: Well, the major pitfalls are the fact that there’s a lot of information out there and not all of it is good, for a number of reasons.

Some of it is biased because it’s put out there by a pharmaceutical company that’s focused on selling you their product, not focused on educating you.

Some of it is biased because there is a set of inappropriate information that somebody just wants to share. Some people just want to give people wrong information. There are whole websites that are out there to support bad activities. ‘How do I purge when I have anorexia?’ There’s a whole community of websites to support people with those sorts of problems.

13:23¬

Mike Patrick: Yeah.

Deena Chisolm: So sometimes the Web can push bad health behaviors just as much as it can push good health behaviors, so there needs to be monitoring and there needs to be support of knowing what to find and how to find the stuff that’s actually going to make you healthier, not sicker.

Mike Patrick: Yeah. And I think, kudos to Nationwide Children’s Hospital for being able to put out a podcast like this where we really try to get information into the hands of folks that’s evidence-based, because there really are, as you were mentioning, a lot of places where parents get bad information because something happens to someone’s child and they wants answers and they want a reason, but it’s not necessarily what the science behind it says.

14:11¬

We talk about immunizations and autism, and sometimes associations get made that aren’t backed up in science and in the literature, and it’s not a conspiracy of trying to hide these things but it gets out there and then parents trust that. And I guess that’s the battle that we in the health care field fight everyday, and not just for teens but for parents, too.

Deena Chisolm: Definitely. It’s a challenge that the internet is the best and worst of multiple worlds at times because everybody can get their ideas out there but those ideas are not always backed up by science.

Mike Patrick: Yeah. Tell us a little bit about your research looking at health literacy, in particular with teens who have asthma and diabetes.

Deena Chisolm: We recently completed a research project that was funded by the Eunice Kennedy-Shriver National Institute on Child Health and Human Development. That grant was funded to look at how teens with asthma and diabetes use the internet to help with managing their diseases and finding health information.

15:17¬

We recruited teens from Nationwide Children’s Hospital. We measured their health literacy and their attitudes towards using health information technology and we followed them up for three months and looked at how they actually used the internet.

What we saw was that teens with a chronic condition like asthma or diabetes were more likely than the average teen to be looking for health information online, which wasn’t a surprise. But we found that the lower-literacy teens and the higher-literacy teens were just as likely to be looking for that information, which goes back to our concerns about people being able to find and understand the information that they need.

But one of the things that was interesting is we found that the higher-literacy teens were more likely to want to be regular users of online health information. So regardless of literacy, everybody’s looking, but the higher-literacy were more likely to say, ‘I want to use this as a regular tool for my disease management.’

16:17¬

We also found, when we asked them, just flat-out asked them, “What do you like or not like about online health information websites?” what they liked were websites that were teen-focused, that had chat rooms, that had games, and that had constantly updating information.

So as Nationwide Children’s Hospital or as other health educators think about how we engage use through the internet, those are the sorts of features we need to make sure were included.

Mike Patrick: Sure. So if we have a better understanding of what these teenagers want, then we can design a product that appeals to them, and the by-product of that is to get good information into their hands.

Deena Chisolm: Exactly.

17:01¬

Mike Patrick: That’s a challenge.

Deena Chisolm: It is definitely a challenge.

Mike Patrick: Because the people in charge of the pocketbooks don’t always hear what we’re saying, right?

Deena Chisolm: That is very true. The other thing is that the people in charge of the design aren’t usually 15-, 16- and 17-year-olds, they’re 40- and 45- and 50-year-olds. We need to make sure that we’re engaging the youths not just in using the system but in designing the systems so that we’re meeting them where they are, because we don’t always know what goes on in their minds, at least I don’t always know what goes on in the minds of teenagers, so you have to have them at the table.

Mike Patrick: Yeah. And they’re not health care workers, either.

Deena Chisolm: No.

Mike Patrick: But we’re trying to change that. Just this podcast is one example of that. And I will say, the folks here at Nationwide Children’s are cued into that and we’ve got some great, great products that are coming out and lined up. But certainly it’s still a challenge and there’s not as many resources as there should be out there.

Deena Chisolm: Definitely.

Mike Patrick: What projects are you currently working on right now?

Deena Chisolm: Right now, we are starting a larger study that is sort of a follow-up to the asthma and diabetes study, and that study is being done in Central Ohio and Southeastern Ohio. We are looking at health literacy of teens and parents when the teen has a chronic disease or a special health care need.

18:21¬

We’re looking at how the teens’ health literacy and the parents’ health literacy is associated with their readiness for transition from pediatric care to adult care. That’s a real challenge for a lot of families because you get used to the pediatric doctor and the pediatric setting and the parent managing the condition, but as children age, they’ve got to take on responsibility.

Health literacy is a key tool for them to be able to do that, so we’re looking at how health literacy is associated with readiness for transition in a population of teens with special health care needs, and then also looking at how health literacy is associated with use of health care services, cost related to health care services, and satisfaction with health care services.

19:07¬

That study is funded by the National Institutes on Minority Health and Health Disparities. It has a focus also on looking at rural health as well as urban populations. And we are just getting started.

Mike Patrick: Great. And then you also have some stuff going on with HIV risk behaviors in terms of sexual activity and drug use and following teenagers to find out how they get the right information into their hands to protect themselves against HIV.

Deena Chisolm: Right. We have a study that is funded by the National Institutes on Drug Abuse that’s being done with us and in partnership with the University of Pittsburgh. We are recruiting adolescents from our Adolescent Medicine Clinic and doing questionnaires on all sorts of health behaviors, particularly those related to HIV and sexually-transmitted diseases.

And what we’re really trying to look at by following them over time is looking at how risk behaviors develop from one another, what is the path of development of risk behaviors over time, and to look at what are the factors that are associated with a higher-risk profile or a lower-risk profile. So we’re looking at things like religion or spirituality, school performance, family routines, family support, peer support.

20:27¬

But what we really want to do is to be able to say, ‘A youth who comes in at age 14 with this risk profile is likely to have this risk profile by the time they’re 17 if we don’t intervene in a specific way between those periods.’

Mike Patrick: So if you can understand, and this is important for parents, too, because if you can understand early risk factors, you may say, ‘Well, that particular thing’s not a big deal,’ but if we know that leads to the next step and to the next step and we can intervene at the ground level, we’re going to have more of an impact in their lives in the future.

21:00¬

Deena Chisolm: Right. That links back to the health literacy and technology piece because we know that that is a key source of information in this population, so how do we integrate that into everything else we’re doing for risk reduction to get the teens healthy.

Mike Patrick: Now that flows into our next question. We’ve talked about health literacy and what it is and how kids get it. I guess the next step here is, how is that important? Why do we want kids to have enhanced and improved health literacy?

Deena Chisolm: You know, the key point that we’re looking at is patient engagement. A watchword in all of the health care reform and other health literature is the idea of ‘patient-centered’ care, the idea that it’s not just the doctor telling the patient what to do and the patient doing it but the patient being part of the health care decision-making process, or the parent when we’re dealing with smaller children.

But to really be an engaged and empowered patient, you have to understand what’s going on with your body. You have to know how to get information, you have to know how to ask questions, you have to know how to follow up on questions when you don’t understand the answers that you get.

22:11¬

Disease management, self-management has always been a part of health care. There’s always been an expectation that when you go home you’ll take your medicine and call back if you have another problem or things like that.

But as health care has grown more complex, there’s even more things patients are expected to do at home: expected to give themselves injections, expected to track symptoms, higher-end clinical activities up through things like dialysis at home. Telehealth is being used so that health care can be managed in your home through telephones and webcams and the internet.

As we’re growing the expectations of what patients are doing at home, they need to have the tools to do those things successfully, so that’s where health literacy comes in is making sure patients have the tools to support their illness, to support their wellness, and to interact with the health care system successfully.

23:07¬

Mike Patrick: Having a couple of teenagers at home myself, if you just tell a teenager, ‘Hey, this is what you need to do,’ I think, and as they’re gaining independence, the natural response is, ‘I don’t have to do that,’ or ‘I don’t want to do that.’

When they have a better understanding of exactly why, and even to the point that they know as much about their disease as their physician knows about it because they’ve used these tools, then they start to take ownership of the issue and then they’re going to be more engaged and more compliant, which, from the health professional standpoint, there’s a reason we want them to take their insulin in this fashion, so if they understand it and grab onto the importance of it, then they’re more likely to be compliant.

Deena Chisolm: Right, exactly. Teens are not going to do the ‘Because I said so’ means of communication as well as ‘Because I want to,’ and that’s really what we want to do in engaging them is to get them to the point where they’re not doing things because somebody told them to do it but because they understand how important it is to their health.

24:15¬

Mike Patrick: Yeah. How can we then enhance health literacy? We talked about we can have better websites that are more what teens are looking for, but what are other ways that we can enhance health literacy for teenagers?

Deena Chisolm: When we think about health literacy from a research perspective, we try to think about it from two angles.

We think about, one, how do we increase the individual’s capacity to be health-literate, how do we make them understand information better. And then from the other side, we look at how do we make the information that we’re providing easier to understand by anybody of any health literacy level. So we try to balance both of those approaches.

On the individual side, one thing is just promoting general literacy. Higher general literacy is associated with higher health literacy. Supporting reading at young ages and supporting the education system in how they do health-related education is a big part of growing a population of health-literate teens.
25:21¬

But at the same time, we have to use the tools that we have available to us, so multimedia, using videos, using sound, using games, using things that engage people so that they’re more willing to commit the time to learn it because it’s fun and interesting and because it targets people who learn by reading versus people who learn by seeing versus people who learn by hearing, using all of those tools at one time to maximize the effect of any of the education we’re trying to provide.

Mike Patrick: So if you know all the different learning styles and have resources available for that, people are going to gravitate toward their own natural learning style and what interests them. But you have to have it available.

26:01¬

Deena Chisolm: Exactly.

Mike Patrick: This brings up the obstacles to enhancing it. How are we doing with the access to technology for teenagers, especially those at-risk and in lower socioeconomic situations?

Deena Chisolm: Interestingly, the general access is not as bad as it was 10, 15 years ago. Most teens, a vast majority of teens have access to the internet on a semi-regular basis. The challenge is that ‘semi-‘ part of the regular.

Like I said, the National Surveys are saying 90% of teens use the internet, but many of them only can do it when they go to the library, and they can only go to the library after school a couple of days a week, or they can only use it at school but that’s only during these hours, or they can use it at home but they’ve got dial-up and it’s too slow to be able to do anything interesting or fun.

So that’s the challenge is to make the access more regular, more consistent and higher-quality, because people aren’t going to really sit down and do good research when they’ve only got a half an hour on the computer and they’ve got to spend the first 20 minutes checking their Facebook. You don’t get the impact until you have more consistent access.

27:17¬

Mike Patrick: How does that happen? We’re going to solve the world’s problems today.

Deena Chisolm: Solve the world’s problems today.

I think that there’s a lot going on in terms of expanding spectrum for internet access: creating low-priced packages for relatively high-speed internet, doing more with having the schools have after-school hours where you can get on the computers, having the libraries expand their computer access, I spent a lot of time in public libraries and every time I’m there every computer has somebody at it and there’s a line, looking at how we can increase the availability of the resource because people clearly want it there.

28:00¬

It’s a work in progress. We’re not there yet. But we’re growing.

Mike Patrick: Yeah. And I think that, when I had mentioned before about the bean counters and the people who make decisions not necessarily to be on board with education, I think it’s because there’s not necessarily profit that you can see right away with this kind of thing. You’re spending money on education, but you don’t get that immediate bottom line.

But if you look further out and you see the health of the individual and the savings that that can come across through to society over time, you have to have someone with vision.

Deena Chisolm: Right. It definitely takes vision and it definitely takes a willingness to work across silos, to work across fields. Health care can’t do it.

Health care gets people for a visit here or a visit there. We need to look at what is happening in the education system, what is happening in community organizations and rec centers and churches and other places that get access to use more consistently then we do. We can’t just live in our little health care box and think we’re going to create health literacy in the little bits of time that we have patients here.

29:12¬

Mike Patrick: Yeah. Just from Nationwide Children’s Hospital’s point of view, education is an important part of the mission of this organization. Just as some examples of things that we do, I know myself, working through the emergency department and our urgent care centers, we have an entire library of patient education materials that we send out. If someone comes in with strep throat, we have literature that’s printed out that they go home with.

But then the next question becomes how many people actually take the time to read those and how many go on the trash and would folks engage in a different way if they had a website, they had information about strep throat. Would that be better or would it be better to listen to a podcast on the way home about that condition? What ways are people going to interact with their information? I think there’s a lot of research potential in how people want to get information that way.

30:10¬

Deena Chisolm: Definitely. And Children’s has a lot going on in its focus on literacy, from the Reach Out and Read program, which is focused on promoting general literacy in preschool and school-age children, up through our Nationwide Children’s Hospital website that has a whole section dedicated to general health information for families who are looking for it, to some innovative things that we’re doing, using tablet computers for patient education in the waiting room that have interactive quizzes and opportunities to see surgeries that you’re going to be going through so that you can get an idea about what’s going to happen, that sort of thing.

We’re continually finding new ways to try to engage families, because we know no one way works.

31:00¬

We also have a really exciting program that is called Mediglyphs which uses pictograms, little pictures of a little character doing different things so that you can see him do the things while you read the directions beside it about what’s supposed to be done, again to capture people who learn in different ways or understand in different ways or aren’t as English-proficient.

Mike Patrick: Right, and we have a whole family resource center and a parent education center with tons of resources for folks that are on campus and have questions and are interested in learning more.

So these are some of the things that Nationwide Children’s is doing. What can parents do to encourage teenage health literacy?

Deena Chisolm: Well, first of all, encouraging literacy encourages health literacy. From the earliest ages, we always support the idea of encouraging reading, reading to and reading with your children, and reading in front of your children so that they know that that’s something that grown-ups do.

32:01¬

We also think that it’s important to talk about health information together, whether you’re looking for health information online, doing that together so that you can see what sorts of things the youth is looking at, discuss what may or may not make that information reliable.

Also being in visits with teens. It’s interesting because sometimes a visit is with the parent, sometimes it’s without, but being able to ask good questions or to promote asking good questions or support asking good questions so that you learn as part of the health care process.

And really starting to transition things. As teens go from being 12 and 13 to 14 and 15, maybe they start making their own doctor’s appointments or calling in their own prescription refills or doing some of those things that they start to develop the literacy and the comfort with making their own health care decisions so that as they move on to college or move on to their own professional lives, they’ve already done a few of those things with somebody holding their hand.

33:04¬

Mike Patrick: Right. I think it’s interesting how folks who seem to be more in tune with health literacy and want to learn more about their condition, and it’s really rewarding then to see them going into careers in the health fields to help others because they had such a passion for it.

Deena Chisolm: Yeah.

Mike Patrick: One of our guests a few months ago, Dr. Maya Spaeth, she’s a plastic surgeon here at Nationwide Children’s, the reason that she got interested in it is she had a thumb surgery and had to have microsurgery to fix her thumb, and then that led to her interest in microsurgery and she’s now a plastic surgeon here doing those same things. That’s kind of cool to see that circle.

What about younger children? Are they also interacting with health information technology? If so, in what ways?

Deena Chisolm: They are interacting, but we really don’t know as much about it. There’s not been a lot of research done on how preteens or even younger children are using health information online, so right now we don’t really know what’s happening in that population. That is a place where we need to do more research.

34:13¬

Most of the educational material is targeted to parents when the children are school-aged or younger. But at the same time, there are still health decisions that a 10-year-old makes in terms of what they eat or where they go or whether they play with a dog that they’re allergic to, so there’s really still opportunities for building health literacy starting at a young age.

Mike Patrick: What are some of your favorite sites to give to teens and parents in terms of looking up information? If we were going to say, ‘OK, these are trustworthy sites,’ what are some that you like yourself?

Deena Chisolm: I like WebMD. It is not a fun, teen, cool site. It is a good informational site, and sometimes you just need straight good information.

35:07¬

Mike Patrick: Yes.

Deena Chisolm: Another straight good information site is NetWellness.org. That is actually a service that is run by Ohio State University, University of Cincinnati, and Case Western Reserve and it is designed to provide health information.

They have ‘Ask-a-Doc’ where you can email a question and they’ll post your question and the answer for the community if you want it to be shared or they’ll respond directly. They have a lot of special sections on things like minority health and sexual health and different areas where they tell you what’s the latest and greatest news in health information for that.

The CDC has a whole section on teen health and information specific to teen health that is very useful.

36:01¬

There is just a lot of good sites that are out there, depending on condition-specific or general health.

Mike Patrick: Some other ones that I’ve come across, HealthyChildren.org is another one, and that’s actually published by the American Academy of Pediatrics and a part of their website. It has lots of helpful information for parents.

And of course, specific disease sites. The American Heart Association…

Deena Chisolm: The American Diabetes Association.

Mike Patrick: Yes. Cystic Fibrosis Foundation. American Lung Association. Those all obviously have trustworthy information, too.

We’ll put a link in the Show Notes over at pediacast.org to WebMD, HealthyChildren.org, NetWellness.org and the CDC teen wellness, we’ll put all that out there so it’s easy for people to find them.

Deena Chisolm: And I’ll send you a few other ones, too.

Mike Patrick: OK, great, and we’ll add those to the Show Notes as well. KidsHealth.org is another one that’s got lots of great information in it, too. We’ll have all that over at pediacast.org.

37:02¬

We really appreciate you stopping by and talking to us about health literacy.

One of the things that we have a passion for here at PediaCast is families spending time together that doesn’t necessarily involve everybody staring at the same screen and not communicating with one another. So we like to play board games in our house. Every guest that comes into the studio, we just ask, if you remember from when you were a kid or if you play games with your kids now, what’s your favorite board game?

Deena Chisolm: Connect Four.

Mike Patrick: Oh, yeah. That is a fun one. That’s great. And you know, the funny thing about Connect Four is, as a kid, it was so much fun when you were done with the game and you let all those go.

Deena Chisolm: Yes.

Mike Patrick: And the falling and clanking. That’s great. I haven’t played that game in a long time. I think we do have it at home. We probably ought to get the dust off of it and play it again.

Deena Chisolm: I don’t have it at home. I have Scrabble at home. And then I’m one of those people who loves the party games.

38:00¬

Mike Patrick: Oh, sure.

Deena Chisolm: So Pictionary and other games like that that you play with groups of people and act a little crazy.

Mike Patrick: Yeah. Now if you like Scrabble, do you do Words with Friends?

Deena Chisolm: I do not do Words with Friends. I have several friends who are trying to convince me to do Words with Friends, but I don’t need one more thing to take up my time. I know if I started it would be very bad.

Mike Patrick: Yeah. I was not clued into this whole Words with Friends culture until just a couple of weeks ago, so now I’ve got a game going with my wife and my son and my daughter and then you’re just on your spare time. But it can become addicting. I could definitely see that that could be a problem if you spend too much time with it.

Deena Chisolm: I fear it. I’m not going to try it.

Mike Patrick: Right. That’s probably smart.

All right, well, Dr. Deena Chisolm, we appreciate stopping by the studio to talk to us about health literacy.

I do want to remind you once again, if there’s a topic that you would like us to talk about or you have a question or a comment for the show, just head over to pediacast.org and click on the ‘Contact’ link. You can also email pediacast@gmail.com or, again, call the voice line, 347-404-KIDS. That’s 347, 404, K-I-D-S.

39:12¬

I also want to remind you to spread the word about PediaCast. Probably the best way that you can do that is the next time that you go to your doctor’s, whether it’s for a well checkup or a sick office visit, just make sure you let your doctor know about the program by Nationwide Children’s Hospital. It’s evidence-based and just trying to get good information into the hands of moms and dads. So if you could help us spread the word about the show, we’d really appreciate it.

And until next time, this is Dr. Mike saying stay safe, stay healthy, and stay involved with your kids. So long, everybody!

[Music]

Announcer 2: This program is a production of Nationwide Children’s. Thanks for listening! We’ll see you next time on PediaCast.

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