Health Education: Who’s the Expert Here?

By Randi Kant, MS, MPH, CHES
Evanston, Illinois

After years of working to promote healthy behaviors among older adults, I realize that my definition of health literacy has grown to include an individual’s understanding of the day-to-day health behaviors crucial for good health. These are the lifestyle choices that will hopefully prevent, but at the very least help manage, the chronic diseases that are so common in this country. And in accommodating this broader definition of health literacy, I have looked for the most effective ways to ensure that my clients internalize this knowledge and incorporate it into their daily lives.

As a Wellness Manager, I develop and implement wellness and fitness programming for older adults, many of whom come to us after years of poor eating and a sedentary lifestyle. The majority have been diagnosed with one or more risk factors for a chronic disease, if not a chronic disease itself. Indeed, the older adults I work with seem more likely than not to be coping with obesity, hypertension, and diabetes. Surprisingly though, these individuals often seem to make no connection between their lifestyle choices and the state of their health, much less realize that they have far more control over their health than they could ever imagine.

Part of my job is to provide accurate, understandable information in a variety of formats that enable people to make informed choices and decisions about their health. And it is precisely at that point that I must consider oh-so-carefully how to proceed. Because if I have learned one thing in over 15 years in this field, it is this: telling people what to do does not work. Yet, if you think about it, is this not our standard strategy?

Now consider this: what if we asked questions instead? "What is most important to you?" "What do you want?" "What do you see for yourself?" This approach has the potential to set the stage for a successful, two-way conversation between the health care provider’ and the consumer, or more accurately, between the "experts." For both parties are experts here – the former in the content area and the latter on themselves.

By asking questions, I learn from my clients what I couldn’t possibly know on my own. I know that what I see of a person is but a tiny sliver of all that they are. The assumptions and judgments that we all have the human tendency to make are often proven wrong. Consequently, the information I do present is much more finely tuned to them. Even then, I allow each individual to decide if this information has value. Everyone has a vast reservoir of potential and all the answers they need inside of them, and I choose to see them as such. Deep down though, my goal remains unchanged—for my clients to truly understand exactly how lifestyle choices affect their health and how much control they really have over their health.

A woman in our "Prime Time Sister Circle" program – part health course on exercise, nutrition, and stress management, and part support group – commented recently, "Obesity and diabetes run in my family." "What’s most important to you?" I asked her. "To remain healthy as I grow older", she stated. "Ah," I said. "So what comes up for you when I say that what really runs in your family is the lifestyle choices that lead to obesity and diabetes?" A flash of insight sparked in her eyes as she answered. "That I have control over whether or not I develop diabetes – that it is not my destiny." And with that realization, she can confidently climb back into the driver’s seat of her own health, a clear destination in mind. And I hadn’t told her to do a single thing.

Randi Kant, MS, MPH, CHES, is an Intrinsic Coach ® and Wellness Initiatives Manager for Mather LifeWays in Chicago. For more information, visit the Mather LifeWays Web site at www.matherlifeways.com or email Randi at rkant@matherlifeways.com. Randi was a volunteer editor on this Health Literacy Month project.

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