The $120,000 Cold - Health Literacy in Market Research

Mark Twain once remarked that the difference between the right word and the wrong word is the difference between lightning and a lightning bug. During the height of the Great Recession, I found out just how right he was. The wrong words cost me six figures.

After a massive layoff in January 2009 (my company downsized by 40%), I found myself without a job and without too many viable prospects. No matter where I turned, no one was hiring at my level. Most of the positions I saw listed were entry level ones; a few companies in my field were looking for individuals who had worked 1-3 years. My experience had become a detriment.

As if my own observations were not sufficient on how dire things had become, a friend’s story about how two different PhDs had answered her ad for a barely-above minimum wage office assistant job hammered the message home. Putting it mildly, things were bad. You can understand then why I was so ecstatic when finally, after a series of phone interviews, I was invited to an in-person meeting at a prestigious healthcare organization.

The opportunity was for a Director of Marketing position with a proposed $120,000 salary plus a generous bonus—a sizable step up from an Unemployment Compensation check. It came down to two candidates: one other and me. They were going to have us both come in on the same day for a series of "Stress Interviews," and they would make their selection based on those interviews.

Murphy's Law operating the way it does, however, found me battling a wretched cold. The meeting facilitator, a headhunter from an external recruitment agency, felt that my condition warranted postponing the meeting. "You'll need to be on your game for these interviews, not drowsy with cold medicine," she said. I thanked her and we agreed that I’d touch base with her the following week. Desperate as I was for a job, though, I began to grow paranoid. What if she didn't relay to the company how excited I was to meet with them? Would they think that I lacked a strong enough desire and fortitude if I let the sniffles prevent me from coming in? I decided to reach out directly and email the company. I told them that I was disappointed I wasn't able to meet with them this week, but that it had been recommended that I reschedule when I was healthier.

In hindsight, I should have trusted the headhunter and the interview process. I shouldn't have reached out directly to the hiring company at all. Failing to do that, I still would have done considerably less damage had I only left off the second half of my remark that it had been "recommended" that I reschedule later.

My email was forwarded to the headhunter. She took offense and responded by:

1. Informing me that it wasn't just her recommendation that I reschedule the interview; it was the hiring company’s preference that I come in healthy and operating at peak capacity, and
2. Closing the meeting window without my interview ever being rescheduled.

By default the other candidate won the position.

This was a costly but important reminder of a marketing fundamental: the success of a product, service, or even oneself is often impacted less by its actual value than by one's ability to use the right words to sell it.

The words we use matter, and the wrong ones will cost you. The wrong words cost us all. They cost patients positive health outcomes, and they cost the healthcare system; it’s estimated that their role in poor patient understanding, which contributes to noncompliance issues, costs the healthcare system billions annually. These are just two reasons why thinking about health literacy is so vital. It’s something all healthcare communicators should do. Shockingly, it is seldom thought about in market research for fundamental patient touch points such as medication labeling (instructions for use).

Why is so much patient material still being written with health literacy as an afterthought, retrofitted like so much duct tape holding the machinery of communication together? When these "quick fixes" are added post-market research without specific patient input on the tactics, it's a gamble whether or not those tactics help to enhance understanding.

The faulty reasoning is that clear communication will be achieved as long as a text's readability is at an ideal level (in the U.S. typically written at a 5th or 6th grade level). The problem with this theory is that while readability is a good first step when thinking about health literacy optimization, it alone does not always result in total audience comprehension, and that, after all, is our goal. 

Starting to think about health literacy only after market research has taken place, and solely relying on readability scores to optimize text, are poor communication approaches with unpredictable results. Sadly, there are countless organizations that don't even do that much but rather ignore health literacy entirely. As a member of PMRG’s Health Literacy Initiative, my company, Sommer Consulting, and I are working hard every day to change that. 

While some organizations are doing their due diligence and including health literacy in their market research, it is not nearly as wide spread as it should be. The effectiveness of different plain language and health literacy optimization approaches to enhance understanding should be routinely tested with patients. Since a given communication tactic may not work in a new context despite possibly having worked previously, testing should occur each time new patient material is developed. This is the only way to guarantee that comprehension has been achieved. Assumptions should not be relied upon. They should not drive procedure for something as important as our health.

Will you join me in making #HeLIMaR (Health Literacy in Market Research) a priority? Doing otherwise risks, as George Barnard Shaw said, the single biggest problem with communication—the assumption that it has taken place.