Thursday, February 23, 2012

WHERE TO BEGIN? Figuring Out What You Don't Even Know That You Don't Know?

It is pretty easy to feel comfortable with what we know. It is equally comfortable (especially in an insatiably curious person) to be comfortable asking lots of questions about a topic that we are aware we don't know enough or have enough knowledge (aka a 'Wiki dip' to answer a question).
But how do we get an inroad to asking a question when we haven't yet thought about it? When we don't even know that we need to know about it?  It is a huge challenge. The only approach I have come up with thus far, is to intentionally expose yourself to diverse experiences - stream a video on a topic or area you know little about; read a book (or even a blog!) on a topic that you stumble upon; go visit an art exhibit on a style that doesn't grab you; visit countries and work on gaining a different perspective.
So here'a health literacy example, I came upon while delivery a community engagement workshop that highlights 'knowing.' In our Philadelphia Ujima Network, we have the honor of training lay health ambassadors. These women and men are the informal opinion leaders and experts on health in their community based groups(faith based, social service, educational, etc.) Our training sessions happen on Saturday mornings and we have highly interactive sessions to learn things like "Know Your Numbers and Your Health." In one of these sessions, we were discussing heart health risks and hypertension. As I spoke to the group, I became aware that 1) they knew many people with hypertension; 2) they had heard 'a lot' about it; 3) they were aware that it was a very prevalent condition (HTN). But here is where they didn't know what they didn't know.
Because of health outreach successes of others, almost every knew that high blood pressure was associated with the reading of 140/90. But here was the gap. What hadn't been conveyed effectively was that this number represented the 'admissions ticket' to a diagnosis of hypertension,  instead of the audiences' interpretation on this number. Most of the group believed that controlled blood pressure MEANT a bp of 140/90 (or 'near that, 150/100'!). When I clarified that the target BP control range (at least) was 120-134/70-84, many were shocked. "How can you have that blood pressure if you have High Blood Pressure?" one asked.  "By taking medications," I responded. It was new news to the group - something they didn't know (that they needed to know), that good control of BP had readings that were the same as someone who didn't have High Blood Pressure. We didn't even get to the lower numbers needed if you also had Diabetes.
It made me wonder, from a literacy perspective - do we confuse people by accepting the common phrase of High Blood Pressure instead of Hypertension? (e.g. If you have High Pressure (this condition), how can it be low  or normal?)
Every opportunity to teach, we open ourselves up to the gift of learning.
Stimulating questions of the unknown, reminds me of the saying that when you learn a little about a topic, it is not too dissimilar to lighting a match in a huge auditorium - you become aware how little you know and how much more you need to know.
Gaining experiences that engage us in the uncovering of what we don't know and haven't yet thought of asking about, increases the number of matches we hold!

Health Literacy
•Ask Me Three
click here
•Teach Back Technique in Removing barriers to safer care. Health literacy and patient safety. Help patients understand. Manual for clinicians. Weiss, B. AMA Foundation
•Institute of Medicine (2010) Safe Use Initiative and Health Literacy: A Workshop. National Academy Press. Washington, DC.
READ MORE: A very interesting blog to read more on Knowing and Not Knowing:  
Atherton J S (2011) Doceo; Knowing and not knowing [On-line: UK] retrieved 23 February 2012 from #ixzz1nFFYq2B6  Under Creative Commons License: Attribution Non-Commercial No Derivatives


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