Incorporating diversity into channels and platforms like Emmi, Wolters Kluwer Health's patient-facing personalized education tool leveraged by providers, payers and partners, is about empowering and encouraging patients to be part of their healthcare decision-making, said Evan Heigert, brand and creative director overseeing patient engagement across Wolters Kluwer Health.

While diversity "always creates a richer story," Heigert said, he focuses his user experience and creative teams on building trust with minority communities by making sure they can identify with the health communications they receive or access.

When it comes to something like healthcare, "it's very important to build trust and to develop a representation of our patients so they feel seen and heard," he said, noting they may have had mistrust or been underrepresented in healthcare.

Increasing diversity is not just a one-and-done to check the box on health diversity, equity and inclusion. Educational materials – whether printed or multimedia – need to be created with an intentional effort toward DEI to strengthen relationships between providers and patients.

Revitalizing maternal health education

To address cultural misconceptions or mistrust of various medical establishments head-on, such as with maternal health, Heigert's team recently updated Wolters Kluwer Health's childbirth program, one of their most highly utilized patient education programs.

They modernized the visuals and representation of the figures, but a key change was the voice used for the copy. It was very clinical in explaining what would happen throughout the process, Heigert explained.

"We reversed that to be a bit more from the patient perspective and encouraging and empowering language," he said.

"Regardless of what their background and their health history has been, they deserve respected and personalized care at all time, and so just encouraging that language so they feel in control and able to address and ask questions, whereas in the past they may have really poor experiences in the healthcare space." 

When they measured how the revitalized maternal health program was received, patients reported positive patient feedback from the survey at the end of the program. They reported feeling like they are more represented and the language is more approachable, he said.

"Over the past 18 months we've put a strong focus on creating new programs with more personalization and more focus on diversity, equity and inclusion," and have seen a 30% increase in start rates for those programs over that timeframe versus older programs, he said.

On the provider side, patient engagement videos and outreach calls generally result in measurable outcomes, according to a representative for Wolters Kluwer Health in a follow-up email. 

After employing EmmiJourneys, a personalized post-clinical support version of Emmi featuring omnichannel content, Memorial Hospital in Gulfport, Mississippi found:

• 50% higher likelihood of attending follow-up appointments with primary care providers within 21 days of discharge.
• 26% fewer avoidable emergency department visits.
• Fewer ED visits were further associated with lower costs, potentially up to nearly $89,000 per 1,000 patient discharges.
• Between 27% and 65% lower 30-day readmission rate, depending on whether patients engaged with only some or all of the Emmi programs prescribed to them.

A look back at programs from five to 10 years ago reveals "they're certainly not addressing as many experiences as should be addressed," he said.

The Wolters Kluwer Health creative team now reviews their library of content, highly utilized patient education programs and information programs specifically targeting minority communities annually. Members look for opportunities to audit visuals and language (tone and voice artists) and either recreate those programs or change certain attributes of them to make them more inclusive.

"It's something you have to learn and develop and evolve over time, and we have certainly seen that in the work we've done," Heigert said.

While Wolters Kluwer Health's in-house editorial team works with a patient advisory board to gather feedback on patient-facing education programs, as well as with provider and peer clients, medical deputies and third-party consultants, employing key tactics can help any in-house creative team implement DEI in their patient-facing materials.

Building trust through universal design

Reflecting diversity, ethnicity, gender, sexual orientation, family structure and ability level also leads to greater medical accuracy with information that's being delivered to patients, Heigert explained.

One example is sharing information on what measles may look like by "showing that in both a lighter and darker skin tone so you can actually see the representation and the manifestation of that disease accurately based on different experiences," he said.

Creative teams can also use a "show and say" approach in illustrative, text-on-screen and audio formats.

An example of this is evolving the voice of Emmi – historically a white woman who delivered information in a very empathetic way. "But it was limiting in terms of the audiences we were talking to," he said. 

They found over time that "it's true that patients are going to trust a voice that comes from their community inherently more than someone that's speaking to them from the outside." They increased their roster of professional voice artists to represent a broader and more diverse set of voices. 

"With so much content out there, it's impossible to customize every piece of content to address every patient," but patient-facing materials can showcase "a number of perspectives over time," he said.

Enabling access for all abilities and modalities

As digital interactions become the norm, providers and others must deliver access to patient information across a wide variety of audiences.

"The digital interactions are increasing at such a rapid pace. Back in the day, it used to be that you'd go and talk to your doctor and have this face-to-face conversation, and if you don't understand something, you can ask questions. 

"That's still what we are trying to enable, is better question-asking of patients, but we understand that just the access to that digital information is so important and delivered in a variety of ways," he added.

Providing the greatest range of approaches to content delivery and the tools that allow people with other abilities to be able to access it is where equity comes into play, he said. 

Some simple techniques that all providers can implement in patient-facing communications are adherence to Web accessibility standards, known as WCAG 2.0, closed captioning, enabling script readers that turn text into audio for all content and making sure content is available in a variety of formats, including print.

Closing the health literacy gap

Creating thoughtful patient engagement content can also address the growing health literacy gap in the U.S.

Patients have a lot of information at their fingertips, and along with that comes misinformation. 

Heigert said the U.S. Department of Education found that 80 million people have low health literacy, and more than 65% of those come from minority communities. 

"Our north star, our guiding light, is to be able to deliver evidence-based information in a way that is empowering and engaging for those patients," he said.

His advice to providers and payers on how to address topics for their patients or members? "You have to find that balance between accuracy and evidence-based information, but also being engaging and understandable for that patient," he said.

Aim for language that's approachable and empathetic to their situation, and that ultimately empowers them to make a decision, he advises. Tricks of the trade include using language that is nonclinical as much as possible – poop instead of stool, weed instead of cannabis – "things that are understandable," because it's very important to be clear and precise with patient information, he said. 

The communications industry standard is to target the fourth or fifth-grade reading level. "And that's not to dumb down information, that's just to make it as clear and simple for a patient to understand across education levels. But also, it's empathetic in the sense that you don't know where their mindset is at the time that they are receiving this information," he said.

He also advises using visual metaphors to explain complex topics. A simple example is speaking to a birthing partner on what to expect before a birth by using the example of a water balloon. It can burst and gush water, or a little can emerge at a time, as when a water balloon is just slightly pierced. 

"Explaining that experience as well as showing the visual metaphors helps a patient kind of internalize that and personalize that for whatever their reality is," he said.

The cutting edge is patient-first

Heigert advises that when looking at advanced technologies for patient communications, like augmented reality and artificial intelligence, start with the patient needs and challenges, then look at the technology options for how to deliver the content in an impactful way. 

"The caveat in any conversation around technology is that we first approach it from a patient perspective, understanding their needs and their abilities to access content and deliver that in a variety of ways so they can access it," he said.

Wolters Kluwer Health uses a combination of audio and visual content, including texts, voice calls and web-based videos with options to self-select for personalization to communicate with patients about relevant health information.

In addition to diversifying voiceovers, Wolters Kluwer also uses voice-assisted technologies to drive content through applications such as Amazon's Alexa or Apple's Siri, Heigert said.

"One of the trends that we have seen in the industry is by and large those AI voices have a very white voice," so the creative team is looking at how to bring in their diverse voice talents of different backgrounds to apply AI-driven patient information delivery. 

As far as the future for engagement with patient information, "personalization and representation go hand in hand … We can meet them where they're at," Heigert concluded. 

Andrea Fox is senior editor of Healthcare IT News.
Email: afox@himss.org
Healthcare IT News is a HIMSS publication.