2.3 Beyond written material
As explained in section 1.6, many researchers argue for more effective patient education and focus on different strategies to achieve this, such as better oral communication between patients and health care professionals, training for health care professionals and developing non-written means of communication. Perrin argues for the need to make health information available other than via the written word. He explains that some people do not view written information as credible and prefer to obtain their health information through other means. Health information alone is not sufficient for individuals with low literacy skills who often feel powerless to make changes in their lives. Looking at the issue from a different perspective, Perrin presents alternative forms of health communications such as community development approaches and participatory health education (Perrin, 1998).
Community development approaches
Since low-literate individuals often get more of their health information from people surrounding them rather than from health experts, it makes sense to look at community groups and how established community networks, which already include hard-to-reach patients, can become involved in health literacy efforts. The literature suggests that health care professionals must change their role and act more as facilitators, working in partnership with others in the community to provide health information. There is a need to investigate community dynamics and to tap into existing community networks, peer groups, social support networks, etc. A US study conducted in 1994 showed that using a peer-helper approach and community volunteers was a more effective way to reach out to older, low-literate women regarding health than using traditional and educational approaches (cited in Roberts, 1998, p.18, see endnote).
Participatory health education
On occasion, literacy and public health programs have facilitated the participation of low-literate individuals in the process of reflection, discussion and action concerning health issues. This education process works from the bottom up, with the active participation of literacy students or patients within a group process. They identify the health issues that concern them, they explore them, they develop the content and the methodologies for sharing information, and they take action in the community. Health specialists play a different role, not as experts but as human resources who share knowledge with the group. This participatory process enables students/patients to gain confidence and to take more control over their health and their lives.
Drama
Another alternative way to transmit health information, raise awareness and communicate messages is through drama or popular theatre. Drama can represent an effective way for hard-to-reach patients to express their difficulties with the health care system and to investigate strategies to improve their situation.
Unfortunately, the Perrin paper does not present Canadian case studies of these alternative forms of health communication. Few concrete examples can be found in the literature. Our hypothesis is that while these are not very common, they do exist (please see more in Section 3).
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