Real Warriors Campaign:
The Role of Health Literacy in
Supporting a Culture of Support
for Psychological Health
MAJ Demietrice Pittman, Ph.D., U.S. Army
LT Evette Pinder, Ph.D., USPHS
Ms. Lauren Wilson, M.A., Booz Allen Hamilton
Disclosures
• This continuing education activity is managed and accredited by Professional
Education Service Group. The information presented in this activity
represents the opinion of the author(s) or faculty. Neither PESG, nor any
accrediting organization endorses any commercial products displayed or
mentioned in conjunction with this activity.
• No commercial support was received for this activity.
• Contract support for this activity was provided by Booz Allen Hamilton, Inc.
Learning Objectives:
At the conclusion of this activity, the participant will be able to:
1. Define psychological health literacy and describe how low psychological
health literacy can impact psychological health.
2. Identify best practices all healthcare professionals can utilize to promote
psychological health literacy in a constantly evolving Military Health System
through effective communication and knowledge building.
3. Explain the importance of tangible resources for psychological health
literacy, and employ them in clinical practice or the field to improve
psychological health literacy among service members, veterans and their
families.
Agenda
• Understanding Psychological Health Literacy
• Addressing Psychological Health
Literacy: Real Warriors Campaign
Overview, Goals and Framework
• Hear Real Warriors Speak
• Four Ways to Promote Health
Literacy to Audiences
• How To Get Involved with the
Real Warriors Campaign
• Q&A
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Health Literacy
Understanding
Health Literacy
• Literacy as an autonomous set of skills; literacy as applied, practiced and
situated social practice; literacy as a learning process; literacy as text
• Basic competencies: Access, Understand, Process, Apply
•
Health Literacy
Mental Health
Literacy
Psychological
Health Literacy
•
An individual's capacity to obtain, process and understand basic health
information and services needed to make appropriate health decisions
80 million Americans have limited health literacy
•
Knowledge and beliefs about mental disorders which aid their
recognition, management or prevention
•
Used interchangeably in the literature with Mental Health Literacy
5
Health Literacy Determinants
• What are the external
factors that determine
psychological health
literacy?
• How do they affect a
person’s ability to seek
care?
Health Literacy Chart.
*Skills include literacy, numeracy,
speaking, listening, informationseeking, and technology use
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Impact of Low Health Literacy
• Impacts providers ability to provide care—negatively affects prevention and
screening, health-promoting behaviors, history-taking, and explanations
concerning diagnoses and treatment
• Poor health status
• Adverse health outcomes due to a lack of knowledge
• Health disparities
• Adults with Below Basic and Basic health literacy receive information about
health issues from radio and television
• Adults with Basic, Intermediate, or Proficient health literacy get information
about health issues from written sources, including the Internet
• With each increasing level of health literacy, a higher percentage of adults got
information about health issues from family members, friends, or coworkers
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Psychological Health Literacy
• Similar mental health literacy rates found in population–based sample of those
with major depressive disorder (MDD) and suicidal ideation, just MDD and those
with no MDD; In spite of increased professional contact by those with major
depression and suicidal ideation.
• Low literacy was associated with more depressive symptoms
• 75% of those given depression vignette were able to correctly label the disorder;
one third of those given schizophrenia and PTSD vignettes correctly labeled the
disorders
• Military sample, 99% adequate health literacy; 94% 9th grade reading level or
above
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How do gaps in knowledge influence helpseeking behaviors?
• Approximately one-third of service members and veterans indicate they
have not sought treatment because they do not believe it will be helpful.
• Veterans who believe that treatment would help to improve their symptoms are
significantly more likely to both intend to engage in treatment and to have
participated in treatment.
• Those who believe that they would be able to follow health professionals’ treatment
recommendations are more likely to engage in treatment.
• Those who perceive that they are experiencing psychological symptoms,
and perceive a need for treatment are more likely to initiate care.
• In a study of combat veterans, those who recognized a current problem were more
than seven and a half times more likely to be interested in receiving help than those
who did not.
Psychological Health Literacy in the MHS
There are unique considerations to psychological health care within the military
health system that in turn impact efforts to address psychological health
literacy.
• Impacts every stage along the continuum of care
• Psychological health is complex
• Unclear if psychological health concerns impact literacy issues, or vice
versa
• Confusion about available resources
• Negative perceptions of the MHS
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Real Warriors Campaign:
Major Elements Used to
Promote Health Literacy
Campaign Overview
• The Real Warriors Campaign is a multimedia public awareness initiative
designed to encourage help-seeking behavior among service members and
veterans coping with psychological health concerns.
• The campaign is an integral part of the Defense Department’s overall effort
to eliminate the stigma that was identified in the 2007 Mental Health Task
Force Report and encourage help-seeking behavior for invisible wounds.
• By using the campaign as a vehicle, the Defense Department/MHS seeks to
reach audiences at all levels of health literacy by using a diverse range of
outreach tactics to increase knowledge and awareness of psychological
health and treatment.
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Campaign Goals
• Educate and reduce misperception, promote psychological health literacy
• Foster a culture of support for psychological health by promoting the
belief that seeking help is a sign of strength and educating audiences on how
to access care
• Restore faith in the Military Health System (MHS) and promote confidence
of treatment effectiveness
• Improve support systems for service members and their families
• Empower behavior change through the promotion of self-efficacy
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Campaign Framework: Health Belief Model
Individual Perceptions
Modifying Factors
Age, sex ethnicity
Personality
Socio-economics
Knowledge
Perceived
severity
of problem
(e.g., demotion,
Perceived
susceptibility
of problem
(e.g., TBI, PTSD,
combat stress)
Likelihood of Action
Perceived benefits
of specific action
(e.g., improved relationships,
successful career)
VS
Perceived barriers to taking
action (e.g., sign of weakness,
lack of leadership support)
Likelihood of
behavioral change
substance abuse)
•
•
•
Cues to action
Education
Symptoms
Media information
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Formative Research
• Service members want proof. Personal examples of service members who
have received psychological health care, support or treatment and are
maintaining a successful military career.
• Service members want success, either in their military career or postservice. Quotes include “I’m back with my unit;” “I’m still in command;” “I
needed help. I got help.”
• Service members want to see themselves. Profiles represent a variety of
services, rank (enlisted and officers) and age as well as representation of both
active duty and National Guardsmen and reservists.
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RealWarriors.net – Digital Resources 24/7
Live chat with Masters level trained health
resource consultants
Order or download psychological health
promotion materials online
Contact the Military Crisis Line
Watch video profiles and PSAs
Read informational articles targeted to
different audiences
The website is designed to provide
tools and resources that are
understandable to audience members
at all health literacy levels.
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Online Articles
• More than 130 articles on a wide variety of topics
related to resilience, recovery and reintegration
to increase health literacy of audiences
• New articles added several times a month with
tailored content for active duty, Guard & reserve,
families, veterans and health professionals,
on a variety of topics including:
• 6 Apps for Staying Mission Ready
• Taking the First Steps to Get Help for Articles provide clear, easy-to-read
Psychological Health Concerns
information on seeking care and
benefits of treatment, to increase
• Treatment Options for PTSD
psychological health literacy.
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Social Media Engagement
On social media, we share
contact information for 24/7
resources (DCoE Outreach,
Military Crisis Line) to help
connect service members to care.
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Find Real Warriors on the App Store!
The Real Warriors app is an online photo-sharing service that
offers peer support for warriors, veterans and military families.
• Upload photos and salute others.
• Check out the wall from any device at realwarriors.net.
• Access 24/7 resources.
• Download the Real Warriors app for free on the App Store,
available for iPhone, iPad and iPod touch.
• Responsive site: https://realstrength.realwarriors.net/
Mobile apps and resources give easy access
and real-time support to users of all levels of
psychological health literacy.
19
Partnership Network
• The campaign partners with a variety of
federal, military, not-for-profit and
local organizations to help spread
campaign messages and materials to
service members, veterans and military
families worldwide.
• Campaign partners share the campaign’s
mission and provide a support service,
program or resource directed towards
service members, veterans, military
The partnership network is critical to
families or health professionals.
promoting campaign resources and
improving psychological health
literacy for military stakeholders.
20
Real Warriors Speak
By sharing their stories, these individuals prove through example that
reaching out leads to successful outcomes, including maintaining a
successful military or civilian career.
21
Real Warriors Profile: 1st Sgt. Aaron Tippett
Video will be embedded upon approval of presentation.
22
4 Ways Real Warriors Campaign
Promotes Health Literacy to Audiences
1. Utilize content hubs for easy access to information.
• Use a website to host a variety of educational resources, such as articles and psychological
health resources
2. Reach remote audiences with digital platforms.
• Post social media messages that refer audiences to resources on interactive websites or mobile
apps (e.g. RWC social media channels)
• Use mobile apps to connect service members living in remote areas to 24/7 support resources
(e.g. Real Warriors app, DCoE’s PTSD Coach)
3. Share tangible resources with your audiences.
• Distribute print materials to service members, veterans and their families that highlight tips,
tools and resources
4. Use videos of real stories or testimonials to dispel myths, promote resources and show
success.
• Share stories of Real Warriors to help audiences understand that reaching out is a sign of
strength
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Ways to Get Involved with
Real Warriors Campaign
• Encourage service members, veterans and families to visit
www.realwarriors.net
• Use the campaign’s print, video and online products in your outreach efforts
and display materials in high traffic areas. Order or download free materials
at www.realwarriors.net/materials
• Learn more about the campaign Partnership Network by visiting
www.realwarriors.net/partner
• Encourage others to share their stories of success by emailing
shareyourstory@realwarriors.net
• Join the conversation at facebook.com/realwarriors and
twitter.com/realwarriors
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Questions?
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Campaign Contact Information
• Join the Real Warriors Network: Sign up online to receive updates at
www.realwarriors.net/emailupdates
• Media inquiries: media@realwarriors.net or call 877-291-3263
• Requests to share personal story: shareyourstory@realwarriors.net
• Partnership Program inquiries: partners@realwarriors.net
• Website: for technical issues/comments/feedback email webmaster@realwarriors.net
Presenter E-mails
• MAJ Demietrice Pittman: demietrice.l.pittman.mil@mail.mil
• LT Evette Pinder: evette.d.pinder.mil@mail.mil
• Ms. Lauren Wilson: Wilson_Lauren2@bah.com
26
References
•
Baur, C. (2014) Health Literacy as a Framework for Transformation. Presented at the Legacy Health Literacy Conference March 7, 2014.
•
Beckman, N.D., Dewalt, D.A., Pignone, M.P. et al. (2004) Literacy and Health Outcomes: Summary, Evidence Report/Technology Assessment No. 87.
http://www.ahrq.gov/downloads/pub/evidence/pdf/literacy/literacy.pdf.
•
Blue Star Families, Department of Research and Policy. (2014). 2014 Military Family Lifestyle Survey: Findings and Analysis. Washington, D.C.
•
Brown M.C., Creel A.H., Engel C.C., Herrell R.K., & Hodge C.W. (2011). Factors associated with interest in receiving help for mental health problems in combat veterans returning from
deployment to Iraq. Journal of Nervous and Mental Disease, 199(10), 797-801.
•
Edmunds, M. (2005) Health Literacy a Barrier to Patient Education. Nurse Practitioner, 30(3), 54.
•
Goldney, R., Fisher, L., Wilson, D. & Cheok, F. (2002) Mental Health Literacy of those with Major Depression and Suicidal Ideation: An Impediment to Help Seeking. Suicide and LifeThreatening Behavior, 32(4), 394-403.
•
Jorm, A. F., Korten, A. E., Jacomb, P. A., Christensen, H., Rodgers, B., & Pollitt, P. (1997). “Mental health literacy”: A survey of the public’s ability to recognise mental disorders and their
beliefs about the effectiveness of treatment. Medical Journal of Australia, 166, 182–186.
•
Kutner, M., Greenberg, E., Jin, Y., Paulsen, C. (2006) The Health Literacy of America’s Adults: Results from the 2003 National Assessment of Adult Literacy.
http://nces.ed.gov/pubs2006/2006483.pdf
•
Lincoln, A., et al., (2006) Impact of Health Literacy on Depressive Symptoms and Mental Health-related: Quality of Life Among Adults with Addiction. Journal General Internal Medicine.
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•
Nielsen-Bohlman, L., Panzer, A., and Kindig, D. (2004) Health Literacy: A Prescription to End Confusion. http://www.nap.edu/catalog/10883.html
•
Reavley and Jorm, (2011) Recognition of mental disorders and beliefs about treatment and outcome: findings from an Australian national survey of mental health literacy and stigma.
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•
Spoont M.R., Nelson D.B., Murdoch M., Rector T., Sayer N.A., Nugent S., & Westermeyer J. (2014). Impact of treatment beliefs and social network encouragement on initiation of care by
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•
Sorenson, K., et al. (2012). Health literacy and public health: A systematic review and integration of definitions and models. Bio Med Central Public Health 12:80.
•
Stecker T., Fortney J., Hamilton F., Sherbourne C.D., & Ajzen I. (2010). Engagement in mental health treatment among veterans returning from Iraq. Patient Preference and Adherence, 4,
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•
United Nations Educational Scientific and Cultural Organization. (2005). Education for All Global Monitoring Report. http://www.uis.unesco.org/Library/Documents/gmr06-en.pdf.
•
Weiss, B. et al. (2005) Quick Assessment of Literacy in Primary Care: The Newest Vital Sign. Annals of Family Medicine, 3(6), 514–522.
•
Weld, K., Padden, D., Ricciardi, R., & Bibb, S. (2009) Health Literacy Rates in a Sample of Active Duty Military Personnel. Military Medicine. 174 (11), 11:1137-1145.
Obtaining CME/CE Credit
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