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Using email and text messaging in health advocacy

Using email and text messaging in health advocacy

Health advocates and providers can use HIPAA compliant emails or text messaging to advance equitable healthcare for all. These emails or texts allow secure communication between providers and patients and protect sensitive patient information. Additionally, they can help bridge communication gaps and increase access to healthcare services for marginalized communities.


What is health advocacy?

Medical Teacher defines health advocacy as the "activities related to ensuring access to care, navigating the system, mobilizing resources, addressing health inequities, influencing health policy and creating system change are known as health advocacy."

Health advocacy is based on two fundamental principles: 

  • Socioeconomic determinants of health 
  • Health disparities.


What are socioeconomic determinants of health (SDOH)?

The different circumstances in which people live, work, and play are collectively referred to as social determinants of health. These factors significantly impact people's general well-being and health outcomes. They include an individual's socioeconomic status, educational opportunities, community support networks, and environmental quality.

study on the association of social determinants of health with health outcomes states, "Socioeconomic factors influence health behaviors, leading to a compound effect on outcomes."

These factors influence health at the individual and population levels. At the individual level, genetics, lifestyle choices, and access to healthcare services can significantly impact one's health. On the population level, social determinants like income inequality, education levels, and environmental conditions significantly shape overall health outcomes for communities. Ultimately, these influence the distribution of health disparities among different population groups.


What are health disparities?

The NIH defines health disparities as the "differences in the incidence, prevalence, mortality, and burden of diseases and other adverse health conditions that exist among specific population groups in the United States." These differences are often caused by social, economic, and environmental factors, demonstrating the intricate connection between health disparities and outcomes.

The NIH reports that "SDOH affects as much as 50% of health outcomes and socioeconomic factors 47% of health outcomes." Other factors, such as "health behaviors contribute 34%, clinical care contributes 16%, and the physical environment contributes 3% to health outcomes," also contribute to health outcomes. The majority of negative health outcomes fall on individuals and communities who are disadvantaged by these disparities and who are more likely to experience morbidity and mortality from a variety of illnesses.


Can a provider be an advocate for health?

A health advocate can include healthcare providers or organizations committed to addressing social determinants of health (SDOH) and reducing health disparities. Additionally, providers must be HIPAA compliant, protect patient privacy rights, and use secure communication to effectively address health inequities.

Tulane University states, "Healthcare advocates give patients and their families direct, customized assistance in navigating the healthcare system."

Further explaining that "a healthcare advocate's role entails:

  • Helping patients access healthcare
  • Educating patients so they can make well-informed healthcare decisions
  • Guiding patients through their medical care, insurance questions, and administrative and legal tasks."

In broader terms, advocates can protect sensitive health information and promote equity in healthcare outcomes and access. They do this by coordinating their efforts with patients' privacy rights to promote better health outcomes for all.


Health advocacy and patient privacy rights

HIPAA provides a legal framework for safeguarding patient health information. It requires providers to adhere to privacy standards when communicating sensitive data. HIPAA regulates the collection, storage, and transmission of PHI while respecting patients' autonomy and privacy rights.

Providers must obtain patient authorization before sharing protected health information (PHI). They must also use secure communication channels, like HIPAA compliant email, to prevent unauthorized access or disclosure.

Health advocacy efforts can align with patient privacy rights, uphold ethical standards, and foster trust among patients. 

"Patient [advocacy] is a key ingredient of patient-centered health care," The Complex Role of Patient Trust in Oncology says. It strengthens the patient-provider relationship by promoting patient-centered care. The book further explains that this "contributes to and maintains trust between patients, survivors, and caregivers and their health care team."


Addressing health inequities through secure communication channels

Secure communication channels can address these health inequities by facilitating confidential information exchanges between advocates, patients, and healthcare providers.

A secure communication platform, like Paubox, allows advocates to engage with patients across diverse demographic groups, including those from marginalized communities who may face barriers to accessing traditional healthcare services. Paubox will enable advocates to use HIPAA compliant emails and text messaging to bridge gaps in healthcare access. Advocates can provide targeted support and empower patients to advocate for their health needs.

study in Medical Teacher shows that "There is a lack of clarity around how health advocacy is delineated, how physicians' scope of responsibility is defined." This is particularly relevant in marginalized communities, where collaborating among interdisciplinary healthcare teams may be more difficult. 

Using Paubox can assist advocates in adhering to HIPAA regulations while effectively advocating for patient privacy rights and addressing health disparities. It is a simple way for advocates to streamline their efforts in promoting equity and improving healthcare outcomes for all.

For example, a nurse passionate about preventive cancer care may use Paubox to coordinate with local healthcare providers. The nurse could securely share patient information and coordinate screening events through encrypted emails to ensure HIPAA compliance while increasing collaborative efforts. Here, Paubox serves as a reliable platform to streamline communication and collaboration. It allows the nurse to mobilize individual passion for cancer prevention projects and drive positive change in clinical practice.


Personalized communication in health advocacy

Personalized HIPAA compliant emails and texts could help health advocacy efforts through tailored communication and promote patient engagement

It allows health advocates to send targeted information, resources, and support that resonate with individual patients' needs and preferences. Advocates can address patients by name to build trust, embracing the patient-centered approach.

Additionally, personalized emails and texts can promote health literacy, encourage healthy behaviors, and increase access to healthcare services. Providers can send patients personalized appointment reminders and educational materials or offer personalized recommendations.

Sending support emails or texts can help patients take control of their health and promote self-advocacy. Research on patient self-advocacy and satisfaction shows that "patients' illness education and assertiveness positively influenced patients' satisfaction with their physician."

Advocates should encourage patients to ask questions, voice concerns, and actively participate in healthcare decisions to increase overall satisfaction with their care and lead to better health outcomes.

Health advocacy and personalized communication overlap because they can be tailored to include patient demographics. Healthcare providers can quickly adapt HIPAA compliant texts or emails by considering age, socioeconomic level, and health literacy. Patients can receive information that is understandable and relevant to their needs. Patients can then use this information to make more informed decisions about their health.

For example, a primary care physician can use personalized HIPAA compliant texts to address health disparities. They could send educational texts on diabetes management among low-income patients with limited health literacy. 

In this case, the physician recognizes the health disparities associated with chronic diabetes. They acknowledge the influence of socioeconomic status, health literacy, and language barriers on their patients' ability to manage their condition. 

The physician could also collaborate with their clinic's health education team to develop tailored text messages that address these challenges. The texts could include practical tips on healthy eating on a budget, remind patients to take their medication or offer information in various languages.

These text messages must be confidential, accessible, and culturally sensitive. All parties involved should feel comfortable sharing their thoughts and opinions without fear of judgment. Additionally, advocates must be mindful of cultural norms and practices to help prevent misunderstandings or unintentional offenses.

Read also: Personalization in text message-based interventions across different demographics


Best practices for implementing personalized communication in healthcare advocacy

Understand patient demographics: Ask patients about their demographics, including their age, socioeconomic status, health literacy, and language preferences.

HIPAA compliance: Ensure all communication methods, including emails and texts, adhere to HIPAA regulations to safeguard patients' protected health information (PHI).

Personalized communication: Send personalized emails or texts based on patient demographics, health conditions, and communication preferences.

Simplify language: Use clear language to improve understanding and avoid medical jargon, especially for patients with limited health literacy.

Cultural sensitivity: Respect cultural differences and preferences when communicating with patients from diverse backgrounds.

Timing and frequency: Consider the timing and frequency of messages to maximize effectiveness without overwhelming patients. A helpful Paubox tip is to determine any relevant information you could share via email every few weeks.

Two-way communication: Encourage patients to respond and ask questions. Patients should take an active role in their healthcare, which could lead to better patient engagement.

Provide resources: Offer additional resources, like educational materials, links to reputable websites, or access to support groups.

Patient feedback: Use patient feedback to continuously improve communication strategies.

Training and education: Train healthcare providers and staff on best practices for personalized HIPAA compliant communication and patient engagement.

Evaluation and monitoring: Regularly evaluate the effectiveness of personalized communication strategies using patient feedback and outcomes, then adjust the strategy if needed. 

Collaboration: Use HIPAA compliant emails and text to collaborate with other healthcare providers, educators, and community organizations to leverage resources and expertise in delivering personalized communication solutions.


Common challenges and considerations in communications for health advocacy

When implementing secure emails or texts, healthcare advocates often face technological limitations, workflow disruptions, and user adoption hurdles. If not addressed proactively, these challenges can affect advocacy efforts and compromise patient privacy. Advocates must identify these obstacles and find potential solutions.

One prominent concern is the persistent threat of phishing attacks, which are malicious attempts to trick people into giving up personal and online account information to access and exploit more valuable and sensitive systems.

For example, an email sent to healthcare professionals may appear to come from a reputable healthcare provider or government agency, even claiming to offer important updates on mental health legislation or resources for advocacy efforts. The message could contain a link prompting recipients to "click here" to access the information.

However, providers who click on the link would be redirected to a fraudulent website designed to mimic the appearance of the legitimate organization's login portal. Once users enter their credentials to access the supposed updates, cybercriminals capture this sensitive information and gain unauthorized access to the organization's network.

The attackers may exploit the compromised accounts to disseminate malware, steal additional data, or launch phishing attacks targeting the organization's contacts.


The consequences of potential phishing attacks in health advocacy

Falling victim to a phishing attack could potentially lead to HIPAA violations. More specifically, if cybercriminals gain unauthorized access to any protected health information (PHI), like medical records or personally identifiable information, it could result in a HIPAA violation.

HIPAA violations can result in costly fines, legal penalties, and reputational damage. Depending on the extent of the breach and the sensitivity of the compromised information, the organization may be required to notify affected individuals, government agencies, and the media.

HIPAA fines can range from $100 to $50,000 per violation, with an annual maximum of $1.5 million. The fine will depend on the severity of the breach, whether it was due to negligence or willful neglect, and whether the organization promptly corrected the issue. 

The organization could also face civil lawsuits from affected individuals. The financial and reputational impact of these consequences can be severe and potentially threaten the viability of the organization's advocacy efforts.

Considering these consequences, health advocates should implement robust cybersecurity measures, including using a secure communication platform like Paubox that offers inbound email security features. Advocates can train staff on phishing awareness and use advanced threat detection solutions.

Go deeper: How do email phishing attacks impact HIPAA compliance?



Why tailor communication messages to patients' demographic and literacy levels?

Personalized messages improve understanding and engagement, especially for patients with limited health literacy or language barriers.


What strategies can advocates use to reduce workflow disruptions in HIPAA compliant communication?

Strategies may include careful planning and integration of communication tools into existing workflows to minimize disruptions. Advocates can also consider providing staff with training on how to use communication tools effectively and ensuring that all team members are aware of HIPAA regulations to prevent potential breaches. Additionally, regular audits and assessments help identify areas for improvement and ensure that workflows remain efficient and compliant. 


What resources are available to help health advocates navigate HIPAA regulations?

Resources include:

Additionally, professional associations and advocacy organizations may offer resources and support specific to health advocacy activities.

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