Health literacy - IROHLA: How photo stories can help older people talk to their doctor

In an effort to support and empower older adults in their doctor-patient communication the University of Groningen (RUG) has developed innovative health communication tools under the form of one-page photo stories. These are presented as part of the IROHLA project, an EU-funded project aimed at improving health literacy in the ageing population in order to build sustainable health systems.

Approximately half of Europeans have difficulties to grasp medical information[1]. In the context of an ageing population and economic pressures, improving older people’s skills to access, understand, appraise and communicate information in relation to their health is crucial. The IROHLA project identifies, validates and presents a set of best interventions which constitute a comprehensive approach to addressing the health literacy needs of the ageing population in European countries.

One of the findings of the IROHLA project was that narrative forms of health communication can improve health literacy. This is how author Ruth Koops van ‘t Jagt chose to work on photo stories together with cartoonist Ype Driessen. The stories depict recognizable real-life situations – people who have difficulties talking to their doctor for example, with the idea to make users aware of and reduce possible difficulties and barriers in doctor-patient communication. Through their step-by-step scenarios and role models the photo stories portray solutions and strategies to these barriers. They are highly accessible, simple and lively and they aim to increase older patients’ self-confidence. 

 “Health literacy will improve older people’s health management, result in more effective and sustainable health services and curb the increase of health services costs” said Dr Jaap Koot from the University Medical Centre Groningen.  “Most of all, health literacy contributes to active and healthy ageing and increased healthy life expectancy. The more people are informed the better they will be able to care for themselves”.

The photo stories are among the first to use short, one-page stories as a health communication tool in the Netherlands and Europe, although similar but longer stories exist in Latin and North America, South Africa and Mediterranean countries. They have been translated into English, German, Italian and Hungarian and are currently being evaluated in the Netherlands and in Germany, where they are compared with traditional brochures.

For the future, Ruth Koops van’t Jagt “would like to further study the effectiveness of photo stories in other contexts (e.g. self-management of diabetes, psycho-social care for adolescents), in other cultures and in other media formats”, she said. “And to explore whether this tool can be implemented into training and educating professionals.”


Note to the editors

IROHLA - “Intervention Research on Health Literacy among ageing population” is a European project under the FP7 programme that aims at formulating guidelines for policy and practice based on best interventions for improving health literacy levels among older people. The project is coordinated by the University Medical Centre Groningen (the Netherlands). It incorporates 20 consortium partners from 10 European countries from science, public health, civil society and business communities, amongst them the Brussels based organisations EuroHealthNet and AGE Platform Europe.

At its conference on 17th November 2015, the Consortium will present a policy brief for the European Commission and for Governments in the Member States on how to incorporate health literacy into health systems. It will provide guidance to develop new interventions in the area of health literacy, and many concrete best practices, tools and instruments for practitioners in Europe.

One photo story example is available here.

Their author, Ruth Koops van 't Jagt, completed a BA in psychology studies and a BA and MA in Dutch Language and Culture at the University of Groningen (the Netherlands). She is now working on a PhD in Health Communication at the same University. 

For more information, contact Ruth Koops van 't Jagt at 


[1] Rowlands G, Protheroe J, Richardson M, et al. The health information gap: the mismatch between population health literacy and the complexity of health information. An observational study. London: British Journal of General Practice