Pushing back against a top-down approach

How has your background shaped your work?

After my GP training, I spent eight years at Bristol University, doing teaching and research in primary care, before becoming a GP partner. So I’ve always been interested in communicating health-related issues to students and the public.

To make sure resources meet people’s needs, it’s important that app developers and information producers involve specialists and clinicians too. That clinical input is often missing. But being a doctor doesn’t mean the health content I develop should be shaped by what I think. I’m more a facilitator of the creation process and always involve people with lived experience as integral team members.

Too often, I see organisations and health professionals developing health information in a top-down way. I try to push back against that. I want to do things differently.

Why did you make the switch to health communicator?

In my consultations, I found many people came to see me because of anxieties about things they could address simply for themselves, while others left it far too late, such as those with cancer symptoms.

I realised I could only do so much in my surgery one-to-one. So I became interested in what I could do to help people make better-informed decisions at scale. I started working with the Self Care Forum, initially writing health leaflets.

During one project, developing content for university students, a group of participants asked ‘Could you make us an app?’ At the time, I literally had no idea what an app was! I had this old phone with basic features! Of course, I know now – but I still come at my work from a non-techie perspective, and actually I think that improves the products.

We’ve now developed 10 apps, including a self-care app for students (which has had over 100,000 downloads), plus others on topics including self-harm and suicide, eating disorders, young carers and incontinence. They all tend to be for groups that have pressing health and support needs but might be reluctant to seek help in more traditional ways.

What is the most important principle for you when developing health content?

I always start by working to understand who I’m creating communications for, and then involving people with lived experience and practitioners working with them. Only they can provide expert knowledge of that community.

As GPs, we’re trained to use the acronym ICE (ideas, concerns and expectations). So when I meet a patient, I’m trying to find out what they think is going on, what they are worried about, and what they want. When it comes to health content, similarly we ask what results people would like to see from our product. That’s our starting point for exploring the options.

In the end, properly listening to people saves you a lot of time – because you know what you need to focus on. Otherwise you might think you’ve done a good job telling someone why they don’t need antibiotics for their cough when actually they want to know if they might have throat cancer. So investing that time initially is crucial.

What trends are you seeing in health communication?

There’s a big move towards quality certification. There’s just so much content out there, people don’t know what to trust. People also need to know where their data is going and privacy is really important.

It’s not just patients – integrated care boards get approached by so many digital information providers and they don’t have the capacity to look into each one.

That’s why standards like the PIF Tick (from the Patient Information Forum), DTAC (the NHS Digital Technology Assessment Criteria Framework) and ORCHA (the Organisation for the Review of Care and Health Apps) are so important. 

What’s the biggest misconception you see about health communication?

That health content is only about delivering information. People don’t just need information – they need reassurance. For example, the NHS website provides a fantastic amount of information. But it can be a bit sterile because it’s not talking to particular groups – it’s trying to cater for everyone.

In contrast, if someone thinks ‘This is written by someone who really understands where I am’, it opens up those receptors. They are far more likely to engage with the content than if you’re trying to ‘inform’ them.

Engaging content is not about us telling someone what to do, with that power imbalance. It’s about us being on that person’s side, working together as equals. We’re there to give them information, guidance and advice, but ultimately people will make their own choices and decisions.

What’s on the horizon for you?

We have a couple of apps at the idea stage – a health, safety and wellbeing app for Irish farmers and an app supporting students in transition from school to university and university to work life. Funding is always an issue. Each app is usually supported by several charity and NHS partners. Now we’re coming to a stage where I’d like to grow and get some more staff on board.

Three tips from Knut:

  1. Health content is not always a numbers game. Check whether a better goal is to get the information spot-on for a small group of people
  2. Work alongside your audience, whoever they are. This is an essential first step in developing content. Only they can tell you what they actually need.
  3. Check if your health content is empowering your audience. Is it helping the person facilitate their own journey, or is it simply teaching them facts?
Dr Knut Schroeder
1450 1395 Articulate Health
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