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Beginnings Guides Blog
Health Education
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Sandra Smith, PhD: Posted on Monday, May 13, 2013 8:01 AM
Last time in this space I told Mandy’s
Story about the depressed 8-month old who transformed over the course of
one week of simple everyday interactions.
The story illustrates the scientific
work of Bowlby and Robertson on the stages
children move through when separated
from their mothers due to hospitalization.
Mandy was well beyond the first stage
in a child’s response to separation: Protest.
This stage is marked by wailing and sobbing in confusion,
fear, grief at being
abandoned.
She was also beyond Stage 2: Despair.
The child becomes more hopeless and
apathetic. She withdraws. Like Mandy. This
going quiet is not settling in.
It is giving up and shutting down.
Mandy was well into Stage 3:
Detachment (or Denial). She had suppressed all
emotion, including - maybe
especially, feelings for her mother. She hardly
noticed when her mother left.
She was so withdrawn that she sought no
mothering at all. Now, i would recognize that as a sign
of major psychological trauma.
There are many lessons in Mandy’s
story. More on that next time. s
Reference For a
history of attachment theory and the stages of separation, plus a good
bibliography, see Van Der Horst, FCP
& Van Der Veer, R. (2009). Separation and Divergence: The untold story of
James Robertson’s and John Bowlby’s Theoretical Dispute on Mother-Child
Separation. Journal of the History of the
Behavioral Sciences, Vol. 45(3), 236–252. Published Wiley Periodicals, Inc.
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Sandra Smith, PhD: Posted on Wednesday, March 27, 2013 5:44 AM
I twisted my knee. Before long it is too sore to ignore, so I
check with a
physical therapist at the gym. He says he can fix it and that he
is a
preferred provider on my insurance; his services will be fully covered.
So
I visit him nine times over two months. My knee is better.
But my mind is boggled.
A week after the final scheduled PT session, I get a nine page so-called “Explanation of Benefits” from my health plan. For each visit, there is
a not-a-bill
on which I’m not-billed separately for Exercise Therapy,
Body Movement Therapy,
and Muscle or Nerve Trai.
I’m not sure what that third item is, or if I had it, or why the provider billed $50, the plan
allows $33.46, so I owe $33.46.
The Note says
“3024”. So I
hunt through the pages and find a
section labeled NOTES.
Here is Note 3024 (their caps): SEE THE “REHABILITATION
SERVICES”
SECTION IN THE ALLOWANCE SCHEDULE OF YOUR CERTIFICATE OF
COVERAGE.”
What?
Looking further, I see on the back of each page that if I
disagree
with the payment decision, I can “submit a request for appeal within
180 days of this notice”. It
should be in writing and include copies of my medical records.
Who has their medical records?
I can’t object to the decision since I can’t determine what the
procedure is. I don’t have a clue what the price should be.
I give up and take the stack of papers to my husband; he’s a
lawyer.
After a 15 minutes pouring
over the pile, we conclude that
this
not-a-bill says the services, including the mystery procedure “Nerve
Trai”,
are covered, at least
partly, but the insurer is not
going to pay; perhaps because while the individual deductible has been
satisfied,
the family deductible
has not. But the the employer says
there is no
deductible on our plan... It seems the take home message is, “You
might get a bill.” Hardly and EOB.
More like a “Not-an- Explanation of No-Benefits.
This story would suggest that, despite the PhD and 30 years in
health services, I have low health
literacy. That is, I do not have the capacity to process and understand
information necessary to make appropriate
health decisions. Likewise for my
husband the trial lawyer.
I’ve been impatient with the Plain Language crowd, thinking that
surely we all know about readability and jargon and all that by now.
I am wrong. Really wrong.
Keep at it Plain
Language advocates!
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Sandra Smith, PhD: Posted on Thursday, March 21, 2013 8:09 AM
This is the last in our series
using the SAM Suitability Assessment pregnancy and parenting for low skilled readers who may be new to the healthcare system. For a good cultural fit
match readers’ LLE Leonard and Cici Doak, authors
of the SAM, concluded that most communication errors in healthcare are caused
by cultural gaps between patients and providers,particularly gaps in Logic, Language &
Experience - LLE. For anyone in health communications -that’s everyone in healthcare, it’s an acronym worth remembering.
Logic refers to a way of
thinking about health, illness, treatment. Because of their
specialized training, healthcare professionals have a special way of thinking.
For example, to a clinician who sees 30 sick people per day, illness is normal,
another day at work, the usual routine.
But to those 30 sick people, their illness is exceptional, a major source of physical, emotional,
spiritual and financial stress for a whole family, a reason to miss work and
suspend the usual routine. The clinician’s routine challenge may be the
patient’s life changing event. Consider, too differences between Western and
Eastern medicine, between medical specialties, between medicine and public health, between medicine and
health promotion. A challenge for all health communicators is to understand and
match the learner’s logic about your topic.
Language refers to a way
of talking
about health, illness, treatment Of course, logic and language
overlap. To a professional the problem may be hypertension exacerbated by obesity; to the patient the problem is bad blood making it hard to walk up the
stairs. In the West, we describe epilepsy as a disease - abnormalities in brain
cells that cause seizures. Elsewhere, epilepsy is described as blessing - a sign that the person may be
a shaman; “the spirit catches you and you fall down”. Other language issues are
less subtle.
 English is the language of the
healthcare system.If you are not proficient in English, you will struggle at
every level. And even if you are, you may still struggle when simple English
terms like stool and screen, minor and routine take on a whole new medical meaning. Or when simple concepts like walking and pus
or go home take
on a whole new vocabulary like ambulation
and discharge.
Latin and Greek are the
language of medicine. Terms are long and technical, so a natural short hand emerges. As public relations director for a hospital that specializes in heart
surgery, I encountered more than one family who objected to hearing staff refer
their loved one as “the cabbage in 206”. They were using shorthand for coronary
artery bypass, thinking and talking about the patient as his procedure and
location.
Experience refers to
participation in events as a basis of knowledge A clinician lives in the
hospital or clinic. S/he is intimately familiar with the technology. S/he is in
charge and in control. Everything is organized for his or her convenience and
efficiency. His or her status comes from specialized knowledge. In many cases, the patient has no
experience and very limited knowledge. That means no basis on which to judge quality, weigh options, or interpret
instructions. At that same hospital, two patients who had open heart surgery by
the same surgeon on the same day were re-admitted two weeks later. Their doctor had
told them to “take it easy.”
Both complied. One ran 3 miles instead of his usual 5. The other never
got off the couch.
Who is responsible for
bridging the gap? Federal, state and local laws,
Medicare and Medicaid regulations, and accrediting bodies clearly state it is
the healthcare providers’ duty to communicate in a way the patient and family
can understand. SAM says Superior health education materials match the readers
LLE and present images and examples that are realistic and and positive.
Beginnings Guides are intended for a broad national audience. It’s
intent is to be as culture-neutral as possible. We chose cover art by Laurel Burch in which our testers saw whatever was important to
them.
Last words on SAM: Only
readers know for sure
SAM is an at-your-desk review. It cannot tell you that your
information is easy to understand and use. Only the intended learners can tell you that they learn
easily from your document. SAM helps you get your materials to the point where
they are ready for Reader Verification Interviews. More on that next time. |
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Sandra Smith, PhD, MPH: Posted on Friday, January 25, 2013 7:50 AM
In this Part 10 of our series using
the SAM - Suitability Assessment of Materials - to evaluate Beginnings Guides, we address layout,
the architecture of the page. Like the architecture of a building, layout makes
a page inviting or intimidating, easy or physically demanding to navigate,
memorable or nondescript. SAM
names eight factors that substantially influence the suitability of health
education materials by making the process of reading painless or not. We will
take them in order. But first, I will add one essential item that SAM leaves
out and that all page design should respect
Reading
gravity rules layout Reading demands physical skill,
concentration and time, all of which may be in short supply. The information
architect must ensure that none of the reader’s effort and time are wasted, or
worse, sacrificed to design.
We read from the top left corner of
the page and work our way across and down; left to right and back again to the
bottom right corner. Page design
should facilitate this efficient pattern and avoid disturbing reading
rhythm. In testing, on average 67
percent of readers showed good comprehension of information that complied with
reading gravity compared to 32 percent of readers of the same information on
pages that required them to work against reading gravity. Learn more and see
Reading gravity explains many of the
suitability factors for layout.
Position
illustrations adjacent to related text. SAM says photos or other graphics
should be placed adjacent to the text that they explain. Ideally the text is to
the left of the graphic (so you read it, then see the explanatory graphic) and a caption is immediately
below the graphic. Otherwise, the illustration becomes a distraction and
interrupts reading.
Make
it easy to predict the flow of information That means the content follows a
logical sequence and is presented consistently. and the usual progress of pregnancy. Each of the six booklets uses
the same section heads and text addresses similar subjects in consistent order
(e.g. Your Baby’s Growth and Development). Warning Signs are always located on
the back cover; they change by stage of pregnancy; no searching is required. Use
visual cues to direct attention to key content
For example, Beginnings Guides highlight key messages by displaying them in bold
type
in a box with 10% cyan( light blue) screen. Research suggests the light
screen attracts the eye without interfering with comprehension. A cell phone
icon alerts the reader to a condition that warrants a call to the doctor.
Keep
the page clean Simple design works best for readers.
A cluttered page looks hard to read, and most likely is. Testers may say the over-designed page
is more attractive, but
Keep
color in a supporting role Color attracts the eye. Use it to lead
the reader to key content. Or to lure the eye up to the “fallow corner” at the
upper right. Check to make sure the color does not pull the eye against reading
gravity like it does below.
Keep
lines short - 30 to 50 characters and spaces Remember the reading eye moves from
left to right and back again. At the end of the line, the eye returns to its
starting place and drops down to the next line.
Unless something is in the way.
Then it has to search for what is next,and be lost to the distraction.
Keep
high contrast between type and paper. When
contrast is low, reading is difficult. For comprehension, black type on SAM
says use non-gloss (matte) finish. Glossy paper carries a reflection which can be distracting. However, other testing showed no difference in
comprehension. A coated stock repels fingerprints and is more durable.
Beginnings Guides get a Superior rating for
complying with all these factors most Material with fewer than three factors present or
that just looks uninviting or hard to read is Inadequate. |
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Sandra Smith MPH, PhD: Posted on Thursday, January 03, 2013 2:35 PM
the SAM instrument. It will
complete the review of graphic elements begun in captions.
Today we consider lists, tables, charts and forms.
Lists
can facilitate learning if they engage the reader to interact with the
information, make choices, and take action. To meet this goal, the purpose
of the list must be made
immediately clear through a headline or subhead
(see Road Signs) and
brief instructions, as needed.
Example: Beginnings Pregnancy Guide (Page 65) includes a list of what to
take to the hospital or birthing center for childbirth. This is important
content to increase confidence and reduce anxiety, especially for the
many women for whom childbirth is their
first hospital experience.
“Pack you bag” is a clear simple
headline that clarifies the purpose of the
list. Two short introductory
sentences tell when to pack and indicate the
list includes “all you will
need.” Check boxes are included to
encourage
interaction. The list is
broken up with a subhead: “Pack for
baby”,
indicating the next
appropriate action.
Provide
instructions step-by-step Explanations and directions are
essential. When presenting how-to
information, a bulleted list is easier and quicker to read and use than
a
paragraph. An example clarifies
the instruction and instills confidence.
When preparing instructions, think
through who will use the information and how will they use it. Where are they
likely to be when the want and need the information. What might they be doing?
Who might be with
them? What might get in the way? What might be confusing? What format
will be most accessible?
Focus on what-to-do. Be specific. Omit all reference to what not to do (it is equivalent to static).
Example: Every pregnant woman
wonders how she will know she is in labor
and what to do when labor begins. Beginnings Pregnancy
Guide (page 72-73 ) presents step-by-step instructions under the headline “Are you in labor? Walk to find out.” Steps are numbered and presented in
logical order: 1.Notice contractions. 2. Walk 3. Time your contractions. 4. Call your doctor. Key
information is highlighted: “True labor
contractions get longer, stronger
and closer together” . Instructions for
calling include who to call, when to
call, what questions to anticipate, what
to say, what if you get an answering service, what if you cannot call; and
finally, what to expect at the hospital.
A photo shows a woman walking with hands on pregnant belly, noticing her contractions.
Test
essential instructions with a few representative learners with no prior
experience and little knowledge of your topic. Invite them to read your
instructions and tell, or better show you what they would do. You will find
out quickly if the
directions are too brief to use the graphic or follow the
directions
independently in likely circumstances. For Beginnings,our standard
is that the learner can find and follow the
necessary instructions in the middle of the night while throwing up.
Beginnings
gets a Superior rating on the SAM for providing step-by-step
directions
with examples that build self-efficacy. Graphics--lists, charts,
tables,
forms-- presented without explanations are not suitable in health
education
materials.
NEXT: Typography: type sizes, fonts,
caps, color |
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Sandra Smith, PhD : Posted on Thursday, November 08, 2012 6:51 AM
I had an
extraordinary hour- long conversation with about 35 medical residents and attendings in an inner city teaching hospital last week. I was invited to present not-a-lecture
on health literacy at their Grand Rounds*. I met them in their beautiful auditorium, which was
elaborately equipped and designed for lectures.
I decided to model what I teach. I took on the role
of a home visitor. I resolved to empower this “family” to move toward their best possible desired outcome
by asking
reflective questions that would lead them to formulate their response to health
literacy in their institution and their practices. As home visitors point out,
this is scary; who knows what might happen?
I set my intention to be fully present with them,
especially if things got dicey. I reminded myself to avoid “duct tape moments”. Those happen when a visitor needs duct tape on her mouth to
resist giving advice, answering questions families can answer themselves, or telling them what to do.
Thinking
together I told the physicians I would like to engage them in
a reflective conversation. The intent of the discussion would be to think
together about what health literacy means to them, their hospital, and their
patients; about how would they know if they were addressing health literacy
thoroughly and well; what's
supporting them and what's in the way or missing. By the end of the hour, if we
were good, they would name action steps that they are willing and able to take
next week. They were game.
One ‘burning question” from the group was What IS
health literacy? So we started with the story of my Dad’s fall in the
driveway last summer and my family’s experience with him in the ER and the hospital (not their
hospital). I asked them to listen for three perspectives of health literacy. 1)
“Low health literacy” as
clinically defined (inability to understand (read) basic information needed to
make health decisions); 2) health literacy as a personal and community asset
that people use to manage their health and healthcare and to build healthy
communities; and 3) “hyper health literacy” - a term I coined to describe
extreme levels of medical knowledge and familiarity with healthcare documents
which can leave health professionals unable to communicate effectively with
those outside the professions. Doctors feel
disrespected and unappreciated, too The physicians were engaged, participative,
thoughtful, reflective, and at times, defensive. Generally a tough, stressed,
brilliant group. It was not an easy conversation. The doctors revealed feeling
unappreciated. “They treat us like waiters. They say, ‘I want this and this and
that,” one attending said. “The respect is gone,” said another.
Some thought my dad had low health literacy and
probably could not read well since he did not know if he had a kyphoplasty* and
did not know whether his testosterone and prostrate had been checked. (He’s an
avid reader - but not of medical journals) A few defended the doctor for asking Dad to repeat what
happened, although he had told the story many times already that day, his
injuries made it difficult to talk, he was on a pain cocktail, and it was
recorded in the chart, which the doctor did not read. “We hear something new each time, she said.” Fair enough. How could you do it
differently to save the patient some of the difficulty and save yourself some
time?
The Chief Resident chided me for not being more
assertive. He said when the doctor burst into the room late at night, woke us
up, pointed at me and asked Dad, “Who is she and what is her relationship?”, I
could have stood up and asked him who he was and what was he doing there. Good
point. It reminded me of quote attributed to Melvin
Belsky, M.D: It’s not enough for the doctor to stop
playing God, you have to get off your knees. Next time.
What do you
want and how will you know you’ve got it? The doctors said they would know they are addressing
health literacy fully and well when patients are more compliant; and they
acknowledged that an informed patient might reasonably choose not to comply.
Another sign: patients would ask more questions. Good one.
Things
supporting them in addressing health literacy were good training and good policies. In the
way, no surprise, was limited time with patients. More troubling was some
attitudes about patients. A young
woman resident said, "they are just irresponsible, you give them info and
they leave it on the bed". The group suggested several reasons why
that might happen - they thought they were going to get the same information
from the pharmacist; they were overwhelmed with info and instructions; no one
discussed the information and its importance with them. One physician complained that his
patients search the Internet and come in with information. He considered that a
time consuming problem, rather than a sign of an engaged patient, Moving to
Action The reflection lead the doctors to name steps they
will take in the next week to address health literacy. For example, instead of
asking the patient to repeat their story for each provider, they might read the
notes and say something like
"I understand this is what happened... “ and ask for specifics as
needed. At discharge they might
talk with the patient about how they will apply instructions to cope and recover at home. They might encourage patients with a new diagnosis to make a
list of questions for the follow-up visit, and then be sure to ask them for it. A simple suggestion was to look the
patient in the eye when talking with them. My best lecture could not have
generated this collaborative action planning.
The Power of
Reflection to engage people, bring them to their own solutions, and move
them to actions that they are willing and able to take. These doctors showed
that they are response-able
for health literacy in their institution. Hear me applauding.
Notes & Reference The reflective process described here is part of
TED* - The Empowerment Dynamic described by David Emerald. Visit powerofted.com/. Order the book The
Power of TED* or the new TED* and Diabetes. s *Kyphoplasty
is a surgical procedure designed to stop the pain caused by a spinal fracture |
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Sandra Smith, PhD, MPH : Posted on Tuesday, October 16, 2012 1:26 PM
This continues our discussion of what makes materials easier or
harder to read, of
Materials. We are using the instrument to assess the suitability of Beginnings
Road signs reduce anxiety,
aid learning Working through information on a tough subject is like driving a
rental car in unfamiliar territory. You need road signs to know where you are
now, and what’s ahead. Without them, it’s easy to feel anxious, get confused
and go a long way in the wrong direction. Road signs enable drivers and readers
to more easily find what they are looking for, and arrive there focused and
prepared.
Road signs in information -- on paper or on screen -- are
headlines and subheads. They alert the reader to expect what’s coming next and
prepare her to think about (process and understand) the announced topic.
Without good subheads, the reader is likely to bypass the information or
miss the point.
Subheads break up a sea of
type A text-heavy page
can be intimidating and discouraging to anyone, and especially those
unaccustomed to reading by learning. Judicious use of subheads, in bold type,
make a page look
more readable, an essential first step toward being read.
A good easy-to-read sentences contain one thought. An easy to
read paragraph contains two or three thoughts about the same topic. A subhead
announces what is coming in the next one to three paragraphs. Put a verb in it. A
good subhead is more than a label. It should be a short basic sentence. You can tell your subheads are useful
if, when the reader takes in only
the headline and subheads on a page, she gets the most important points.
Sometimes you will need levels of heads and subheads. Note that this section
starts with a subhead, in bold type, on its own line, with no punctuation. Then
this paragraph starts with a secondary subhead. The topic is still subheads, but now we are talking about a different aspect of
subheads. The second-level subhead
is in bold type, but inline with the text and using a period to separate it
from the text.
Be consistent. On the
road, drivers expect freeway signs to look different from state highway signs
and local street signs. If
they were inconsistent they would be distracting, less informative, harder to
learn from. Navigating through a page is equally aided by consistency.
SAM says at least half of
topics must have a road sign.
Beginnings Guides gets
a Superior rating since nearly all topics are announced just before the reader
gets to them.
Guide.
Starting on p 86, the text leads the parent/reader through an exploration of
their new baby’s body. The
previous paragraphs’ subheads are “Get to know your baby” and “Do not give Baby
your cold”. So now the reader understands why she would explore the baby’s body
and, we hope, she has washed her hands, and is ready for the next section:
“Explore Baby’s body”.
Then, uh-oh, a label for a subhead. In this case the label
functions on its own to tell parents where they are in the exploration. Body
parts are labeled consistently and the discussion moves logically from head to toe. Second level subheads
are sentences that highlight things to notice. Under “Eyes”, the second level subheads are “Baby may
have blood spots”, “Baby might look cross-eyed”, “Baby may cry without tears” and “Yellowish discharge from the corner of the eyes is normal”. Each of these announces brief
information about something that mothers said they worry or wonder about.
To make information easier to read, lead your reader through the
text with good subheads.
Next: A new section on
graphics starts with the Cover |
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Sandra Smith, PhD, MPH: Posted on Thursday, September 20, 2012 10:38 AM
of Beginnings
Guides to promote maternal health literacy. So the Guides need to
fit the audience, US pregnant women including those
with low resources and limited literacy, and to facilitate use of health
information and services. In Part 3 addresses two
additional factors that determine the literacy demand of information,
writing
style and sentence construction.
Writing
Style is Conversational Easy-to-use health information uses a
conversational tone. Read aloud the information you are reviewing It should sound like something you
would actually say to a person sitting with you. Some clinicians may pan a
conversational style as “unscientific” or “unprofessional”, a reflection of professional
training that rewards multisyllabic latinized
terms in long complex sentences like this one as
demonstration of deep knowledge.
But that is not the point here.
The point is to make the information
easy to understand, personalize, and apply in
real life. Conversational tone is familiar and expected, so quickly grasped
and not intimidating. Rather it invites reflection and interaction.
Conversation nearly always uses the
active voice: “ Jason hit the ball” is active. I can see
the action in my
mind’s eye. “The ball was hit” is
passive; it creates an incomplete mental
picture. It does not engage the
reader.
Conversation uses short simple
sentences, and sometimes incomplete sentences. No
embedded information. In the
first paragraph above, the third sentence intentionally contains multiple
phases and embeds mostly irrelevant information about professional training
demonstrating that long involved sentences and extraneous facts slow reading
and reduce comprehension. So instead of
“Patients are advised to take vitamins daily”; say it the regular way:
“Take your vitamins every day”.
Beginnings
Guides get a Superior rating for using conversational style and simple Sentence
Construction: Context first The way the sentence is built makes a
big difference in comprehension. Readers recall the last thing they read, that
is, the end of the sentence. Starting with what the reader already knows,
provides context and increases understanding.
Start with the context - the part the
reader already knows: “While you are pregnant....”;
end with new information:
“...your uterus is big enough to hold the baby. Right after birth, it shrinks
to the size of a grapefruit.” (Beginnings Pregnancy Guide Book 6 page
77)
If I state the new information first, the reader is likely to miss
or forget it.
SAM gives an Adequate rating to
materials that present the context first half the time. Beginnings Guides get a
Superior rating for consistently providing context before new information.
Next:
Vocabulary & Road Signs |
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Sandra Smith, PhD : Posted on Wednesday, August 29, 2012 7:07 AM
* surgical
removal of some, or all, of the foreskin (or prepuce) from the penis; the most
common surgical procedure in the US.
The American Academy of
Pediatrics published a new policy statement on circumcision this week In Pediatrics. If you just read the
abstract and the headlines, this jumps out:
Evaluation of current evidence indicates that the
health benefits of newborn male
circumcision outweigh the risks and that the
procedure’s benefits justify access to this
procedure for families who choose
it. In other words, health plans should
cover circumcision.
Private insurance typically covers circumcision, so we’re
talking about Medicaid, which covers 41% of births.
Circumcision costs $400-600. I
have not heard parents clamoring for this service. Have you? In fact fewer parents have been
choosing circumcision. Reported
US rates:
1965: 85%,
2006: 56%,
2009 33%.
The Task Force strongly
recommends the development of educational materials for providers to enhance
practitioners’ competency in discussing circumcision’s benefits and risks with
parents. Let’s exercise some critical health
literacy skills to consider the content
of such
discussions. (How to present the content is another discussion)
The Policy Statement refers
readers to the Technical Report but there is no bibliography or list of studies considered. The
report simply mentions prevention of urinary tract infections,
acquisition of
HIV, transmission of some sexually transmitted infections, and penile cancer.
Let’s look at three of these:
Urinary tract infections
(UTI) are rare, usually limited
to the first year of life (usually the first
month for boys), much more common
in girls (but no circumcision is recommended for girls).
While it is may be
correct to say that UTIs are 10 times more common in uncircumcised boys, that
is not informative and is misleading. The numbers are tiny; 0.1% - one tenth of
one percent or one in one thousand
circumcised baby boys get a UTI vs. 1.1% of uncircumcised boys. So the
best possible preventive effect is a 1% reduction in risk. One study estimates it would take 195
circumcisions (about $10,000) to prevent one urinary tract infection, which
would be readily
treated with antibiotics. hmmm...
HIV The World Health Organization declared
three years ago that circumcision should be
part of any strategy to prevent HIV infection in men in parts of the world where
less than 20 percent of
boys are circumcised. Notably,
there are six African countries where men are more likely to be
HIV+ if they've been circumcised. On the other hand, Scientific American
reports 3 randomized
trials in different settings consistently showed a 55 to 65% reduction in new HIV
infections among
newly circumcised African adult males. However, that
conclusion relies on the (big) assumption that all the subjects in different
countries, cultures and religions had similar sexual practices;
and controversy remains over how circumcision protects. It seems
logical that if circumcision
was that effective against HIV, the epidemic could
not survive as it has in the US.
Also worth
asking: Why does uncircumcised Europe have lower HIV and STD
rates than more circumcised
USA? hmmm...
While the policy is not about women, it seems worth mentioning that a randomized controlled
trial into male-to-female transmission showed women were 54% more likely to be infected by
a circumcised man than by an “intact”
man. Circumcised or not, you still
have to use a condom!
Penile cancer is rare, even among uncircumcised men. 1570 new cases are expected in 2012, and 310 deaths. Risks appear a bit
lower for men circumcised in childhood and a bit higher
for those circumcised
as adults. hmmmm
The
American Cancer Society concludes:
In the end, decisions
about circumcision are highly personal and depend more on social and religious
factors than on medical evidence.
This is essentially what
AAP said; the policy is about covering the cost through health insurance
coverage.
It seems to me
this policy presents nothing new for practice, but shores up the industry built
up around circumcision and now waning as fewer parents elect circumcision. That
money
would be better spent on primary care for mothers.
Next
time. What to tell Parents? |
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Sandra Smith, PhD: Posted on Monday, July 30, 2012 11:52 AM
We’ve gone social! We started Tweeting in January
2011. We’re also on
parenting and health literacy is on Twitter. Social media
allows us to monitor and contribute to related online discourse and resources. Beginnings WebMother Simone Snyder
follows 1490 tweeters to keep us up to the minute on the latest developments in
several fields!
have a combined following of over
100,000. An additional 190+ follow posts directly by phone or email. You can also just
check in at your convenience.
I am happily surprised by the range of
interest. Beginnings followers include individual parents and grandparents,
physicians, nurses, nutritionists, SIDS specialists, injury prevention experts,
health coaches, child advocates, nine March of Dimes programs around the
country, several United Ways and Head Starts, literacy groups in the US and
Canada, child care organizations and women’s clinics. Major organizations tuned in to our work include the Maternal Child Health Bureau, CityMatCH, American Association of Maternal Child
Health Programs, Early Intervention Family Alliance, Child Health USA, Tulane
MCH, HelpMeGrow, Text4baby.
How
to follow us and participate in the conversation
You can expect 10-15 quality posts a week on topics ranging from Health Literacy, Maternal Child Health, to tips for home visitors and expecting parents.
Twitter To follow Beginnings Guides click here or search for @BeginningsGuide. To follow The Center for Health Literacy Promotion click here or search for @HealthLitPromo.
FacebookTo Like Beginnings Guides click here or search for Beginnings Guides. To Like The Center for Health Literacy Promotion click here or search for Center for Health Literacy Promotion.
Linked
In To set up an account click here. To connect with Sandra Smith, PhD on LinkedIn click here.
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