Tuesday, March 31, 2020

Health Literacy & Covid 19: virtual seminar series

Health Literacy & Covid 19
Soundbite Sessions
Created by Christina Zarcadoolas, PhD
Health Literacy Lab  http://healthliteracylab.com/

First in a 3 part series of talks meant for those working to communicate Covid 19 to patients and the public. "Health Literacy & Covid19" presented by Christina Zarcadoolas, PhD, expert in public understanding of health & science. The series makes use of knowledge from linguistics, language comprehension and reading, public health, information processing and risk perception and psychology. Each session will be about 45 minutes with time for questions throughout.
Each session will be about 45 minutes with time for questions throughout.

Feedback or ideas for new topics is always appreciated. 
Thank you 

                                                Click HERE to view presentation.

Friday, March 27, 2020

"Flatten the Curve": Covid and Our Math Literacy

Friday’s shelter in place activity for me  - continue interviewing (virtually) people about what they understand and don’t understand about Covid19 information.

As I do these interviews, I am very aware that my work is not part of the critical rescue mission. I don’t have medical training. I can’t drive a bus, or direct traffic, or do much beyond the all too tiny radius of my shelter in place borders.

But I do think there’s bit part I can play in connecting decades of research in health and science literacy with how experts are talking to people about this pandemic.    
My MO - the close inspection and repair of language acting badly. 

 And there is a lot of it going around as the media, politicians, experts and your cousin Al’s ex-girlfriend’s mother’s twitter posts.

On March 21 I wrote about the jargon that is peppered throughout the President’s Rose Garden Briefings. You may recall the love affair Dr. Birx was having with “high through put”. 

One term that's gone viral in the last week is "flatten the curve".

As early as March 10 in one of the first White House Briefings,  Dr. Anthony Fauci used the term ( maybe the first time referring to this pandemic). 

“If you look at the curves of outbreaks, you know, they go up big peaks, and then they come down(gesturing).  What we need to do is flatten that down. That would have less people infected. That would, ultimately, have less deaths. You do that by interfering with the natural flow of the outbreak.”

Again 3/25 in a live Instagram between Fauci and NBA star Steph Curry - the trajectory of the curve start to come down” before he thinks things can go back to normal.

March 27  Pres. Trump started a briefing with,  “We want to flatten the curve,”

As I’ve asked people what “flattening the curve” means, many gesture and talk about the numbers of infected people going up and then not going up anymore.  
              “So we don’t want it to keep going up.”
         “Why is that so important” I ask.
              “So less people get sick and die.”
Invariably people have gestured to me that the (graph) line stops going up.  No curve going on. 

I’m uneasy.  The bigger significance of flattening the “curve”seems to elude people.  And I’m not surprised. 
Working with numbers  (numeracy)  is the degree to which individuals can access, process, interpret, communicate and act on numerical, quantitative, graphical, biostatistical and probabilistic health information needed to make effective health decisions (Golbeck, et al, 2005).   And there is overwhelming evidence that the vast majority of adults in the US do not have adequate numeracy skills  (Woloshin et al. 2001; Lipkus et al. 2001; Sheridan and Pignone 2002).  It’s clear that low numeracy interferes with what people understand from all sorts of health information, and this ultimately influences their health (Morrow et al. 2006; Nelson et al. 2008)

So if so many are using "flatten the curve" why not explain what it means!!! 

I did find one high profile, trusted figure doing just that. Gov. Andrew Cuomo, repeatedly across a number of his daily Covid19 briefings this week has introduced and explained the meaning and significance of "flattening the curve."  

The following is from March 26 (excerpt) using C-Span quick transcripts:

(my highlighting)
“We’ve had a two-prong agenda which we have been pursuing aggressively.  We still are.  Flatten the curve.  So you reduce the flow into the hospital system.  At the same time increase the hospital capacity.  What we are looking for is not a reduction in the number of cases.  We are looking for a reduction in the rate of the increase in the number of cases.  That’s what comes first when you are starting to make progress.  The rate of increase should reduce as opposed to the number of absolute cases.  So that’s what we are looking for.  The optimum is when they talk about the apex of thee curve is not to have an apex.  That’s what the flattening is.  Not to have that spike because the spike is where you would overwhelm the hospital systems.  Try to get down that rate of increase so you can actually handle it in the hospital system.  And that’s what they about by flattening of the curve.

The passage still has other complex concepts requiring rather sophisticated numeracy skills - we shouldn't assume most people accurately understand  “apex of the curve” and even “reducing the rate.”

But Cuomo is a master at explaining what he’s talking about – in communicating with a real sense of the audience. We need much more of this at all levels – from experts, media and all the rest of us talking Covid19.  

Some references on numeracy

Zarcadoolas, C. and Vaughon, W. (2014).  If numbers could speak: low numeracy skills and the digital revolution. In H. Hamilton and Chou, W- Y. (eds.), Routledge Handbook of Applied Linguistics and Health Communication, New York, NY, Routledge.

Monday, March 23, 2020

It Will "Go Away": Trump's Magical Thinking

 The first time I heard Trump’s explanation of what will happen with the virus I truly thought I misheard. (March 11).  

           "It will go away. Just stay calm. It will go away... Be calm.                  It's really working out.

And then tonight he repeated this phrase more than once.

Talking about needing to open up the government.
           “We’ll be watching this closely. Can’t keep it closed for                         years….This is going to go away. We’re going to win the                     battle.”
It sounded so peculiar, so child-like to me. 
“Teddy bear went away.”  

Let’s unpack Trump's utterance.
 (The virus) will go away.
      Noun        verb    adverb

There is no actor or agent acting on the virus.
Nothing seems to cause the virus to “go away.”

The virus goes away of its own volition.
Human agents don’t show up here.

I guess, like locusts.  The virus just goes away.

Trump Cons, Cuomo Connects; Trump fails in talking to us

 When he first came into office critics and pundits had a field day (and continue to) with Trump’s limited, how shall we say, verbal repertoire - his limited command of spoken English. 

I'm a linguist by trade and I long ago grew weary of this spectator sport – hearing his overused superlatives (incredible, fantastic, perfect, huge); his word invention (Mexicans “criming here, criming there); his lack of any self-effacing or humble referents (“stable genius”, I know more about Isis than the generals do.); or his dizzying circular statements, "Well, I think these people always hit me with eminent domain, and frankly, I'm not in love with eminent domain. But eminent domain is something you need very strongly.”

Now in the grip of the Covid19 pandemic, I’ve found the bandwidth once again to listen to Coronavirus Task Force Meetings,  only to hear Trump dragging the spoken word through the mud in the service of overtly bigoted, xenophobic and ego-wounded remarks delivered with passive anger to the American public.  

One particular briefing reminded me of  an astute observation one of my grad students made back in 2017.  I was giving a grad seminar at my university on the linguistic characteristics of Trump Speak. Me focusing on the 3-5 grade readability score of most of his language; his haiku-like stream of non sequiturs – sort of like a comedy routine, minus the laughs. No lack of great language samples in my powerpoint.  

And then a student hit the nail of the head. “Trump is just a bad storyteller. Nothing holds together. Ever.”

Why is it so important right now, when we’re exposed to and trying to consume so much new and often contradictory information about Covid19?
  • Humans take in and process best in chunks, in short stories.

Listen to this story.
                            The King died.  The Queen died.

We’re far more likely to remember and relate to the following story much more.
                            The King died and then the Queen died ....of grief.

It’s well studied and proven that a well constructed story ( no matter the length) yields better comprehension and recall.  We simply learn through stories (Thorndyke; Van Dijk

Or as Ira Glass (NPRs This American Life)  sums up the power of story nicely. No matter how boring the facts are, with a well told story “you feel inherently as if you are on a train that has a destination.”

Good teachers, and good politicians know that a good story builds emotional and intellectual connections and can certainly persuade more than any straight facts.

Trump is a master twitter ( if we’re using sheer volume as the metric) but he cannot tell a good, coherent meaningful, memorable story.

What’s Trump missing:  
·    A story narrator has to connect with the listener and work to keep the listener’s attention – Trump can’t do that.
·    A narrator chooses a point of view that advances the characters and plot.  Trump’s narrator is always, always, first person “I”.
·    A story needs a compelling character or characters, who develop over time. A character the listener cares about.  Trump is the only character Trump is interested in.
·    A story needs a plot – a beginning, middle and end. A logic. There’s very little logic in Trump’s discourse.  He can’t create a narrative thread because he’s too intent on getting in his jabs – the name-calling and smack talk that hijacks the flow. Faulkner can weave a detoured story, Trump simply can’t.
·    Building a story, even a short one, requires time and skill.  Trump doesn’t have the attention span to thread the story (for stark contrast listen to Rachel Maddow on any night – a quintessential story teller). And he’s too busy ready to do verbal battle with every allusion or questioner in his path.
·    A good story has a resolution, some closure. We listen for the ending.  Trump’s stories all end the same way.  I am perfect, a genius.  They END.

Trump Example:
Here’s one recent example if you need convincing:
(Context) Over an hour into his Corona Task Force briefing March 22 2020, Trump is asked “Mr. President, did you sell stock?” (in reference to some legislators who dumped stock after a closed coronavirus update meeting).   Yea it’s a poor question but Trump’s response is an example of Trump’s stories going off the rails. (forgive the format - it's how CSPAN posts transcripts). 

He rifts about being rich. He wanders.  There is no destination (we want to get to). 

And his failure to communicate convincingly and memorably is now in sharp contrast to a master communicator -
Governor Andrew Cuomo.

This excerpt from one of Cuomo's daily corona virus briefings: 
( a quick story about his thoughts about how bills get passed)
Cuomo Example 
"Also the federal funding, they're working on another coronavirus bill - I was in Washington for eight years. This should not be the usual sausage making of pork barrel. When you do a piece of legislation in Washington, most legislators, it becomes the expression, "sausage making," it becomes "pork barrel." It goes through the political process, and the political process says everybody should get some money. Which dilutes the funding, gives it to communities and governments that don't really need the funding and doesn't even address the need, it's one of the reasons people are suspect of government spending, right, because it winds up pork barrel. Every Senator is going to say, "I want money for my state." Every congressperson says, "I want money for my local district. I want to be able to go home with a little package that I can hand to my local government." That's not what this is about in this case. This is about addressing a need and getting funding, precious funding, to people and places that need it. And the rule here should be, money follows the need. It's that simple. What places need it? Self-serving, but New York State has 15 times more cases than any other state right now. Fund the states, fund the places that need it. Follow the number of cases, and use need as the basis for funding. It's common sense. It would be respected by the people of this nation, and the alternative to politicize this funding process is intolerable."

And today, talking about the human stress of social distancing: 

"We are going to have time. And the question is how do we use this time positively?"…"Finding the silver lining, the positive. Life is going to be quieter for a matter of months. Everything will function. Life will function. Everything will normal operations, there won't be chaos There's less noise. You know what, that can be a good thing in some ways. You have more time. You have more flexibility. You can do some of those things that you haven't done, that you kept saying, 'Well I'd love to be able to, I'd love to be able to.' Well now you can. You have more time with family.

"For myself, this young lady, Cara, is with me. She would never be here otherwise But I'm now going to be with Cara literally for a few months. What a beautiful gift that is, right? I would have never had that chance. And that is precious, and then after this is over she's gone, she's flown the nest. She's going to go do her thing, but this crazy situation is crazy as it is, came with this beautiful gift. So one door closes, another door opens. Think about that. Realize the timeframe we're expecting, make peace with it and find a way to help each other through this situation because it's hard for everyone. And the goal for me - socially distanced but spiritually connected. How do you achieve socially distanced but spiritually connected?"

What a nice destination.  No train wreck here. 

All transcripts obtained as “quick transcripts”