Primary health care is normally the first point of contact with the health care system, often through a family physician. It is at this stage that promotion and education efforts are undertaken and one of the outcomes for any health care system is increased knowledge about health and health care among the population served. Health remains vital to supporting families, building stable neighborhoods and reducing poverty. Income and education inequality, standard of living and quality of the physical environment and culture impact health outcomes resulting in health disparities.
Health literacy forms a core component in the effect that these social determinants have on health outcomes. Health literacy covers an individual’s ability to find, understand, evaluate, and use health information, to engage the services needed to make appropriate health decisions and navigate the health care system. It focuses on an understanding of prescriptions, hospital admission policies, health insurance and financial eligibility information. Understanding and comprehension influence an individual’s health care decision-making and therefore the overall health outcome.
In situations where English is not the mother tongue of the individual there are gaps in understanding and comprehension leading to poor compliance and health outcomes. This proposal focuses on the role of society and culture amongst families that speak limited English at home. An examination of the role of these factors in the development of health literacy will assist in formulation and implementation of strategies to minimize the disparities in the health of this population. Abstract Health is an important part of human development and affects overall quality of life.
Many factors play a role in health outcomes, one of which is health literacy. Health literacy encompasses however is not restricted to understanding and comprehension of written and oral communication of health information. The majority of health practitioners are English speakers and hence communication is in this language. It is known that a large percent of the population are not native English speakers. The language barrier therefore limits understanding and low levels of literacy can result amongst this population group.
This grant focuses on examining the role of social and cultural factors amongst this group in development of health literary and the disparities in health. The role of social and cultural factors in health literacy development amongst non-English speaking families Background and Significance The UN estimates that 7% to 47% of the population in individual Organization for Economic Co-operation and Development (OECD) countries lack functional literacy skills (cited in Nutbeam, 2008). In the United States it has been reported that approximately 90 million people have inadequate or marginal literacy skills (Kirsch, 1993).
There are many forms of literacy of which health literacy is one. Health literacy is defined as “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. ” (cited in Hicks et al. , 2006). Health literacy is therefore a key component bridging the gap in the communication, understanding and comprehension of information that influences the health care decision-making of individuals. Studies have shown that health knowledge is associated with health literacy (Bohem et al.
, 1995; Hicks et al. , 2006). Health knowledge can be affected by gaps in education, the complexity of the health care system, culture and society. In addition, language barriers, the skills of health professionals, and medical terminology, are some of the factors which lead to poor health literacy among the population. Low health literacy can both directly and indirectly affect health outcomes (cited in Nutbeam, 2008). Low literacy can lead to medication errors, increased hospitalizations and mortality, poor self-management of chronic health conditions and unnecessary spending (Kuruvilla et al.
, 2006). Indirect effects are related to low socioeconomic status, a factor normally associated with adverse health effects (cited in Nutbeam, 2007). Improving the quality of health communications, and greater sensitivity among health professionals to social, cultural and language barriers can mitigate the impact of poor literacy. However for a greater effect, the focus should be on the health literacy of individuals. Need Statement A 1993 report from the National Centre for Education Statistics showed that a majority of Americans have adequate or marginal literacy skills.
The report also revealed that a large proportion of individuals in the United States speak a language other than English. The target groups for this project are the parents and children in the community whose first language is not English. Amongst non-native English households, there is a need for information on: the role of the social and cultural factors on health literacy; the relationship between health literacy and health disparities; and an examination of strategies to improve health literacy.
In order to meet this need, the grant program proposes to survey stakeholders of the target community, linking with health care practitioners to reach parents and children with the aim of understanding the factors that affect their access to health care, prevention and management of diseases. Objectives This research proposal can make a difference in health literacy in non-native English speaking communities. Improving health literacy has the potential to assist in compliance, prevention and management of diseases.
Awareness by community members and health care practitioners with respect to communication of health information in a way that makes it understandable to this population group will be heightened and a result will be minimisation of health disparities. By offering culturally sensitive, accessible services, health outcomes can be improved. Therefore the aims of this proposal are to: • examine the role of the society, culture and the media in transmitting health related knowledge to these families • develop strategies to improve health literacy and reduce disparities
Activities The research activities are: • survey the community to identify non-native English speaking families • determine the methods of acquisition of health related information by members of these families • examine the effect of the methods of communication on health literacy and health disparities • to hold seminars and conferences and focus groups to gather information, discuss, and inform stakeholders – families, community groups, schools, health care practitioners • staff training in the use of literacy measures
• modification of the Health Activity Literacy Scale (HALS) measure to produce a shorter version (the choice of measure is discussed in the Appendix) • validation of the brief health literacy screening assessment • use of assessment tools for identifying persons with health literacy needs • identification of appropriate key contacts at each health care institutions and community and build relationships • implementation of education programs for non-native English speakers, health care practitioners and other stakeholders • development of various forms of communication of health related information – website development
Personnel The personnel requirements and their roles will be: • Principal investigator – management of project, supervision of staff, administration of seminars and education programs • Senior person versed in the use of literacy measures – modification of measure, validation and testing • Bilingual research assistants (2) – to assist with surveys, focus groups and seminars • Programmer/Web developer – development of plain language website and software • Secretary – administrative duties • Statistician – a consultant will be required for statistical analyses