Authorities overestimate patients’ health literacy

I’m impressed by how much we struggle with seemingly simple health decisions when faced with sorting through too much information.

Buying sunscreen: It’s a simple task, right? Most of us do it every year about this time. And among actions we can take to reduce our risk of cancer in general and skin cancer specifically, this choice is fairly important.

So my colleague was surprised to hear this snippet of conversation as she contemplated her annual purchase at her local drug store:

“There are over 30 different kinds of sunscreen here. What’s the difference?”

“I don’t even know what SPF means. Broad spectrum is good, right?”

“Yeah, and I wonder whether this whole thing isn’t a lot of marketing hype — you probably get the same thing whether you pick one rated 30 as one rated 100+.”

“You know what, forget it. I’ll get the cheap one and be done with the whole thing.”

His friend could have said (as I am apt to), “Hey, look those questions up on your phone — that’s what it’s for” and spent a good five minutes going from site to site to get his questions answered.

Or they could have gotten distracted by the rumors of toxicity – “You know, I’ve heard there is a poisonous chemical in them all anyway” – and abandoned the whole plan. An informal poll of Real Simple readers found that this was the most commonly held excuse for not using sunscreen. Notions that there are poisonous chemicals in sunscreens or that sunscreen contributes to a vitamin D deficiency have been countered by strong scientific evidence. Yet, like resistance to vaccines, such popular myths provoke responses that are inured to countervailing evidence.

The guys in the store might have had a car full of sweaty, excited kids on the way to the beach, concerned about the smelliness and stickiness of the different brands, and just turned their attention to cosmetic marketing claims, as opposed to the health-related ones.

The cheap stuff was probably just fine. At least they got some sunscreen, maybe used it a couple times over the course of the summer, perhaps prevented a bad burn or two and then summer was over.

This type of sunscreen decision is replicated hundreds of times by individuals in the course of a week as we view similarly diverse arrays of products with health, convenience and cosmetic claims competing for our attention. Think yogurt, Gatorade, running shoes, breakfast cereal …

Given the ubiquity of such products and the swirl of marketing and science-based or non-science-based information surrounding each, I’m wondering three things:

  1. What do health authorities/professionals assume about the level of knowledge we bring to these decisions as part of our contribution to our health?
  2. What do we expect of ourselves?
  3. How are we doing at maximizing the wisdom behind our choices?

With regard to the assumptions others make about us: Authorities consistently overestimate our literacy about specific technical health topics like the meaning and relative importance of sun protection factor. They overestimate both the sophistication of and patience for search strategies we use for in-the-moment information. More important, however, is the common assumption that objective, non-commercial public health messages are getting through to us. I’d guess that most of us are probably not making good use of marketing or scientific information that could guide our choices.

With regard to our expectations about our ability to make good choices about such products: This kind of forced, moment-of-purchase choice probably makes some of us anxious when we find ourselves making a decision based on the picture on the label or relying on price as a proxy for quality. But for many of us, what little we know (or think we know) — the rumors, the semi-remembered news articles — provides us with just enough confidence to believe our knowledge is sufficient.

With regard to how we are doing? We’re probably “standing knee-deep in the river, dying of thirst,” in the glaring midday sun with SPF 4 sunscreen slathered all over.

Jessie Gruman is the founder and president, Center for Advancing Health. She is the author of Aftershock: What to Do When You or Someone you Love is Diagnosed with a Devastating Diagnosis. She blogs at the Prepared Patient blog.  

Jessie passed away on July 14th, 2014 after a long illness.  Condolences to her family and loved ones, with sincere appreciation for articulating the voice of the patient on this site.

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  • azmd

    I think the real problem is that we have lots and lots of people interested in doing research and publishing the results, since there are significant incentives for pursuing those activities. For example, it is practically impossible to get into medical school any more if you haven’t “published something,” and the ACGME dings residency training programs if their faculty are not actively involved in “scholarly actitivies” such as research and publication.
    As a result, our system generates an avalanche of medical information, some of it of dubious validity.
    The process of curating all this information and presenting it effectively to patients is not nearly as highly valued as generating it is, as we can see by the fact that it’s not an activity that is reimbursed by insurance companies, nor is it considered to be something you can put on your c.v.

  • SteveCaley

    There is a principle that accurate and well-based knowledge is codified and perpetually scrutinized by dispassionate groups of well-educated persons – a “college” of some sort that is bound only to their mutual admiration of fidelity to Reality.
    It makes no money. Advertising makes money.
    Mr. Flexner’s passion for the Sciency Side of Medicine wound up, a century later, with the imprinted behavior of excreting medically-related data in order to “succeed” in academia. One’s pyramid rises higher, one’s horizon broadens, the higher one can sit upon one’s collective excreta.
    People seeking guidance through the morass of advertising are, once again, led by those with an agenda and a mule to sell.
    Combined with a populace generally benumbed by an educational system which never challenges them to form an independent opinion – but rather ranks people on their ability to color in ovals on a piece of paper or a computer screen – they generally respond with anxiety and an appeal to guidance from a benevolent authority when confronted by uncertainty.
    That is the way we, our society and civilization, likes to be. I’m sure that the cultural anthropologists will note that “This kind of forced, moment-of-purchase choice probably makes some of us anxious when we find ourselves making a decision based on the picture on the label or relying on price as a proxy for quality.” They puzzle, and look up from their virtual clipboards – “Why?”

  • Karen Ronk

    I don’t think that the problem is not making good use of scientific research. I think the problem is that there are so many conflicting studies on various products/treatments that it becomes impossible to come to a clear conclusion.