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Talking Touchscreen: Reaching the Hard-to-Reach Patient

Talking Touchscreen: Reaching the Hard-to-Reach Patient

EVANSTON, Illinois—Patients with low literacy have often been excluded
from assessments of self-reported health outcomes, but that may change thanks
to a new multimedia tool called the Talking Touchscreen.

The Touchscreen, which is being tested in three Chicago cancer centers,
may finally allow researchers to identify the factors influencing health
outcomes in this understudied and vulnerable population, Elizabeth A. Hahn,
MA, told ONI in an interview. Ms. Hahn, one of the Touchscreen’s developers,
is a research assistant professor at the Institute for Health Services
Research and Policy Studies, Northwestern University, and director of
biostatistics at the Center on Outcomes, Research and Education (CORE),
Evanston Northwestern Healthcare, both in Evanston, Illinois.

Few studies have assessed the prevalence or impact of low literacy in the
health care setting, according to Ms. Hahn. But the available evidence
suggests that about half of all patients have impaired literacy, and that low
literacy has tangible health consequences.

"Patients with low literacy are considered to be vulnerable and at risk of
having poorer health outcomes," she said. Studies have found, for example,
that individuals with low literacy are diagnosed with cancer at a later
stage, are more likely to rate their health as poor, and have higher health
care costs.

However, the reasons for these associations remain uncertain because this
population has generally been left out of studies assessing self-reported
outcomes, Ms. Hahn said. "In fact, in most research studies, literacy is
explicitly listed as an inclusion criterion," she said.

Some researchers have used face-to-face interviews to work around literacy
barriers. But this approach has problems of its own, she observed, most
notably the need for resources and the potential for introducing bias.

"We don’t really know if the problems facing patients with low literacy
are the same as those in patients who can read because we don’t have enough
information about them," Ms. Hahn said. So the primary motivation in
developing the Talking Touchscreen, she said, was to find a way to include
these patients in future research or "any kind of health outcomes assessment
in hopes of learning more about these patients and ultimately being able to
do something to improve their outcomes."

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