The interview partners
Prof. Dr. Patrick Da-Cruz is Professor of Business Administration and Healthcare Management at the Faculty of Healthcare Management at Neu-Ulm University of Applied Sciences (HNU) and Academic Director of the MBA program Leadership and Management in Healthcare. Before joining the HNU, Mr. Da-Cruz worked for renowned strategy consultancies in the pharmaceutical/healthcare sector and in management positions in companies in the healthcare industry in Germany and abroad.
Hanno Wolfram worked in the pharmaceutical industry for more than 20 years, including in sales, as HR Manager, Managing Director Switzerland and Area Manager Europe. Based on this experience, he founded the consulting agency Innov8 and has been involved in consulting, change and implementation projects in numerous countries for 25 years. He is a book author, coach and lecturer at the HNU.
How would you define digital health literacy?
Hanno Wolfram: It starts with health literacy as such. Being health literate means being able to understand relevant information and to evaluate and use it appropriately for your own health. The adjective “digital” only adds an everyday triviality: nowhere is more information accessed than digitally. In this respect, the adjective “digital” seems superfluous.
What significance does health literacy have for modern health management?
Hanno Wolfram: Only those who have health literacy are in a position to make meaningful and value-enhancing contributions to their own health. This applies equally to the prevention and treatment of illnesses. Making the right decisions in terms of disease prevention requires considerable knowledge and insight. A lack of health literacy, on the other hand, often leads to individual misjudgements and wrong decisions. For me, this explains some of the bizarre aspects of the healthcare system and a considerable part of the economic inefficiency. If we in Germany have an average of 9.6 consultations with a doctor per year and the Swedes only 2.1, this also appears to be an indicator of a widespread lack of health literacy.
A key problem today is the competition between well-founded knowledge and emotionally formed opinions in the minds of undiagnosed and diagnosed patients.
What are the challenges in acquiring digital health literacy?
Hanno Wolfram: The central source of valid health literacy is the visit to the doctor. Unfortunately, speaking medicine is not sufficiently emphasized, neither in training nor in remuneration in everyday practice.1 It would be easy to teach and acquire health literacy in the GP practice.
According to studies, however, around 80% of the information that reaches a patient during a consultation is no longer remembered at home, and only around half of the information is understood by patients. The doctor's consultation is therefore obviously not currently a place where health literacy is acquired.
The biggest challenge in assessing the quality of information bears the name of what is still the market-leading search engine. For a quarter of a century, “googling” has been an established method practically everywhere, including for finding answers to health questions.
The problem is that search results are generated algorithmically. The results correspond more to the result expected by the respective user and less to medical validity. Search and retrieval algorithms follow existing trade secrets and only a few comprehensible criteria. This is another reason why commercial advertising and simple links are very close together. Evaluating the relevance and validity of the statements found for one's own health is difficult, for many people impossible. The closest content that is supposedly correct or fits in with one's own image is therefore assumed to be the correct answer. It is not for nothing that “Dr. Google” is one of the most colorful enemy images of health professionals.
However, since it is unlikely that Google will change its business model in favor of free users, the only option is to turn away from Google and establish digital services that provide valid, reliable and, in the best case, certified answers to questions about one's own health. There are certainly valid answers, but the sources are little known. As they usually have no commercial background, the expected convenience for Internet users is just as often lacking.
1 Wichtige Infos leichter verstehen | Stiftung Gesundheitswissen (in German)
How are barriers to the acquisition of health literacy overcome?
Hanno Wolfram: One key way in which patients can acquire health literacy is by using artificial intelligence such as ChatGPT or Microsoft Copilot. The AI provides a clear full text answer to the relevant question. The option to ask more detailed questions, cite sources or provide further details is an integral part of ChatGPT, alongside the plain text answers. No one has to choose the right content from a selection of Internet links. Becoming more health literate seems to be much easier with the “Copilot”.
As a rule, the answers are provided with a reference and indication of origin. So if artificial intelligence is used more for health topics, the health literacy of users will increase immediately. In my opinion, any shyness or even questioning of AI is out of place in this context.
All you need to be able to do is formulate questions in complete sentences. This is known as “prompting”. A call therefore goes out to all healthcare professionals and their assistants to quickly gain their own experience and then instruct patients to do the same.
Perhaps physician assistants will also be part of the solution in the future? Everyday life and the future areas of application in practices will show. This new job description creates scope for much more than the continuation of previous medical practices and their partial delegation.
If the aim of a practice is to improve the health literacy of patients, declining patient contact numbers should be a valuable parameter for measuring the achievement of this goal. A decrease in the number of contacts with the same patients leads to more time for everyone. With the end of budgeting, increasing health literacy should also contribute to an increased fee volume for doctors.
How can digital technologies be used to improve the health literacy of the population?
Hanno Wolfram: Our healthcare systems are currently still largely tailored to the treatment of patients. Disease prevention is clearly underdeveloped in our comprehensive health insurance system.
So-called DiGAs are certified digital services that can be prescribed and reimbursed. They are subject to considerable costs and prevent widespread use.
For patients, there is the former Federal Center for Health Education (BZgA). It was only recently reorganized as the Federal Institute of Public Health (BIÖG). The name itself, with an umlaut, raises doubts about its widespread use in the future. https://www.bioeg.de/
www.netdoktor.de is another valuable source for learning how to deal with your own illness and thus become more health literate.
Social media and patient forums are rather unsuitable sources for acquiring serious knowledge.
Conclusion:
Unfortunately, there are currently only a few and mostly hard-to-find offers for the development of individual health literacy. Physician- and pharmacist-induced health literacy is not yet the focus of efforts. There is still a lot of room for improvement and good ideas for making a complex topic simple.
In any case, health literacy needs much more than a constantly guilty conscience in everyday life or rice cakes.
Thank you very much for the interview!
The content and statements presented in the interviews reflect the perspective of the interviewees and do not necessarily reflect the position of the editorial team.
