Home What is Health Literacy?
What is Health Literacy?
by Andres Muro
El Paso Communtiy College/Community Education Program
Health literacy is the ability to understand, access and use health related tools and services available in a given location. Some people may think of health literacy as simply the ability to decode health-related text. However, this is a narrow definition. Rather, healthy literacy has to do with the social and cultural practices that individuals and groups may engage in, in the process of understanding, accessing and using health related tools and services.
Health literacy is contextual and dependent on the location of individuals in a community, or the space they occupy. Social status, age, gender, marital status, ethnicity, geographical space, number of children, people that a person relates to all impact health literacy. Below are examples of some health literacy situations and practices;
- A child may need to distinguish between a tube of toothpaste and one of hemorroidal cream, or between a toothbrush, a nailbrush, and a brass brush.
- A mother may need to read a medicine bottle and understand indications and counter-indications
- A family may need to get to the emergency room in a hospital by using personal transportation, or the public transit system
- A person may need to order a prescription through a pharmacy's automated answering service. This would require access to a touch-tone phone, the ability to understand the language in which the information is given, and familiarity entering information through a touch tone phone service.
- Individuals may be able to go to the supermarket and recognize products that they wish to purchase and the aisle where the products located.
- Other individuals may be able to recognize household cleaning products that are safe to individuals or the environment.
- Some people may know that baking soda and diluted hydrogen peroxide are inexpensive alternatives to toothpaste and mouth rinse.
- A person may be able to recognize plants and animals that are safe to consume in the wilderness, and how to prepare them.
- People may find treatment for a specific health condition by locating a specialist in a highly bureaucratic and complicated healthcare maze.
- A person may seek non-traditional health services from a healer from a particular culture rather than an allopathic doctor.
Some of the above examples of health literacy practices are tied to people's ability to decode text, while others are not. In fact, a person's ability to decode text is not an indicator of a person's ability to understand, use, and access a healthcare tool or service.
A highly educated person (academically) may not be able to walk into a supermarket, purchase a variety of healthy foods, and prepare a several course meal for an entire family. On the other hand, many mothers with little formal education can quickly perform this task. Another very educated person may not know what to eat in the wilderness or how to safely prepare food, while a person with no formal education may be able to readily do so. Also, formal education does not guarantee that people will practice healthy behaviors and lifestyles. Similarly, people with lack of formal education may seek questionable health treatments and place themselves or their families at risk.
Every year, highly educated people die from cancer, heart failure, complications of emphysema and AIDS. In many cases, these illnesses could have been prevented. At the same time, immigrants with little formal education may seek health services from curanderas (healers), and use alternative health treatments. These treatments and services may be beneficial in some cases, but in others, they may not. In addition, poor, educationally disadvantaged people may live in substandard housing, consume contaminated water and other products, and use septic practices.
The examples above should give a sense of the variety of social and cultural behaviors and practices that constitute health literacy. Health literacy clearly means different things to different people in different communities. Even within the same community, health literacy implies different things.
What Entities Do Health Literacy Work?
Over the past 20 years, medical/health entities have progressively increased their focus on health literacy. Specifically, these entities include: hospitals, health clinics, pharmaceutical companies, health insurance providers, and entities that focus on specific issues such as the American Cancer Society, the American Diabetes Association, the American Heart Association, Planned Parenthood, HIV/AIDS awareness organizations, blood banks, and others. These entities have focused on health literacy in order to make their services more accessible to people seeking them, or to bring awareness of a specific health issue to the community at large. Health literacy efforts have consisted of:
- Modifying the level of language of print material to make it more accessible to readers.
- Developing health related literacy materials that are culturally sensitive to readers.
- Developing print materials in the native language of prospective readers.
- Hiring multilingual staff to communicate with people who speak different languages
- Training staff about cultural sensitivity in interacting with people
This focus on health literacy has been important in improving the quality of services provided to people that seek them. It has also facilitated the dissemination of health information to communities. Unfortunately, managed health care has complicated the bureaucracies mediating access to health care. This has increased the need to find mediators that can help the public to navigate health care mazes.
While the focus of the medical/health community on health literacy may have improved information about and access to health issues and services, many people are being left behind.
In the US, there are millions of people that simply do not seek or use health services. Literature in hospitals and health clinics may be more accessible, and staff may be more linguistically and culturally sensitive. Yet, if people do not seek health care, the most sensitive materials and staff will not help them. The poor, the educationally disadvantaged and poor immigrants are among the people that do not seek health services. Reasons for them not seeking health services include:
- People may simply not know that there are health services available to them
- Many poor immigrants come to the US to improve their economic conditions, but, contrary to public perception, they do not want to become financial burdens on their host country by seeking free health services.
- Immigrants may use curanderas, herbalists and other alternative and questionable health providers. This is especially true along the US-Mexico border where immigrants can go to Mexico to obtain treatment.
- Immigrants along the US-Mexico border may also obtain medicine from drug stores in the less regulated Mexican market.
- In some other countries health services are scarce or non-existent. Some immigrants are not used to seeking health services from established providers in their native homes.
- In some cultures, the only person that can touch a woman's body is the spouse and women cannot be examined by doctors.
While many of the poor, the educationally disadvantaged and immigrants do not seek health services, they participate in other areas of the community, such as churches, community centers, and educational programs. In fact, any of these places are ideal to facilitate health literacy education.
Specifically, the educationally disadvantaged enroll in adult basic education, GED, ESL, and literacy classes to learn or improve their language communication skills, to obtain a high school equivalency certificate or to obtain employment. Traditionally, most of these programs have focused on teaching language skills in decontextualized fashion. However, experts are slowly realizing that bringing content into the classroom makes instruction more effective as well as more beneficial to the students. One of the content areas that can be incorporated into adult education is health. From this perspective, adult education providers can become leaders in promoting health services among people who traditionally do not seek them.
Why Should Adult Education Programs Provide Health Literacy Education?
The short and obvious answer to the above question is that it is the right thing to do since access to adequate health care is a human right. Moreover, from an economic perspective, health literacy education should have a positive impact on all aspects of society. The majority of learners who enroll in adult education do not complete programs. Research suggests that learners resist traditional instruction provided in most adult education programs, become frustrated, and drop out. However, newer pedagogies have shown that incorporating content into language instruction that is relevant to the students has a positive impact on retention and completion of classes. Of course, this is provided that teachers are well versed at incorporating content into language instruction.
Ultimately, combining health education with language instruction should increase retention in, and completion, of adult education classes. Furthermore, health education may have an immediate impact on the well being of students and their families. Prevention of, or solutions to, health problems that students or family members may have, can lead to better attendance, retention, and completion. Overall, healthy adults miss less work and school, while healthy children miss less school. In addition, healthy individuals can focus much better on given tasks, than people who are ill and/or in pain. Finally, adults that are unfamiliar with the health care system may not seek primary care and regular check-ups for themselves or their families. Consequently, they may end up seeking treatment for full-blown illnesses or major health complications that could have been prevented. Financially, primary care is much less expensive than the treatment of full-blown illnesses.
Barriers to Adult Education Programs Providing Health Literacy
The overwhelming barrier to adult education programs providing health literacy education is financial. While both health entities and educational entities can play a significant role in addressing health care, there is an unequal distribution of funding. Health entities have more monies than educational entities. In fact, adult education is the most underfunded field in the United States. Yet, adult educators can have a tremendous impact in reaching out to students with health literacy information. Unfortunately the budget allocated for adult education to focus on health literacy is, so far, non-existent.
Another barrier, which is directly tied to funding, is teacher training. Combining health education with language instruction requires extensive training of teachers. Unfortunately, most adult education teachers work part-time, in what is considered the least paid profession in this country, and have virtually no paid time to devote to professional development. Adult education teachers often juggle two to three part time jobs. In addition, actual funding to pay for professional development is very limited.
A final barrier is the resistance from students to non-traditional instruction. Students have expectations of what adult education should look like. Most anticipate learning discrete language skills taught in decontextualized fashion. When instruction does not meet the expectation of the students, they experience cultural shock and they resist. Instead, they request what is familiar to them, although, it may not work. Students' acceptance of new pedagogies is directly related to skill and training of the teacher. Well trained, experienced teachers can successfully combine health content with language instruction. Inexperienced teachers may meet more resistance.
Developing Collaboratives to Incorporate Health Education into Adult Education
Traditional adult education programs teach discrete and decontextualized language skills in artificial learning environments (the classroom). Students go from their real lives into the classroom, and try to put reality on hold for a period of time, while passively receiving information from teachers. Students are supposed to check their emotions, personalities, moods, and daily problems at the door, sit in a desk, and absorb whatever the teacher throws at them. When the students leave the classroom, they are unable to apply the information into their real lives. Essentially, students learn that there are two types of languages uses. One is the language that they use in the classroom, and to pass tests. The other is the language that they use for everyday activities. Research has shown that students resist this type of approach, become frustrated, and drop out.
In their daily lives, most people read, write, and speak in communities. They interpret songs, read magazines, newspapers, prescriptions, job applications, manuals, forms, notes from coworkers, children's school work and many other things. They may write letters to relatives, notes to coworkers, grocery lists, and may fill out various types of forms. They may converse with relatives, doctors, nurses, supervisors, employees, neighbors, and employees of various entities.
From a community based perspective, adult education activities should be connected to the literacy practices that students may engage in, or may need to engage in, in a given community. In other words, adult education should bring community literacy practices into the class, and take the class into the community in order to immerse the class with meaning. Specifically, for health education, this means forming collaboratives with existing health entities. Often times, adult education teachers fear that incorporating health education into the class requires that they become experts in health. This is, in fact, far from the truth. Rather, they need to seek experts that can facilitate health information. Their job is to develop language acquisition activities using the health information facilitated by the experts.
The above requires that adult education programs identify health entities that exist in a given community. Often times, health entities receive funding to facilitate health information to hard to serve populations. While these agencies may have the information that needs to be provided, they may not know how to reach the target population. At the same time, adult education providers may have already recruited the same target population into classes, but they may not have valuable information that the students will benefit from. Therefore, partnerships between health entities and adult education programs are a must. Following is a list of health entities that may exist in most Communities and can facilitate health information.
- Community/City/County/Public Hospital: They usually have an education department that facilitates literature and make presentations about health services and how to access them.
- Private hospitals: While they may discourage the uninsured from seeking services, they often want to have a good image. They have human relations' offices and they may provide literature, grants, and donations of cash, equipment, or other resources.
- Department of Human Services/Welfare Office: They will make presentations and facilitate information about accessing Medicare or Medicaid and other existing health services in communities for the poor. They will help students enroll in Medicaid, Medicare programs.
- Community/City/County Health Department: They educate communities about household hazards, antiseptic practices, infectious diseases, contamination, and availability of vaccination.
- Community Health Clinics: They will make presentations about their services, how to access them. They will facilitate literature, about health problems affecting a given community. Health clinics in poor communities sometimes operate as community centers. They may refer students to classes, or facilitate adult education classes in their facilities.
- Planned Parenthood: They will make presentations and facilitate literature about family planning, sexually transmitted diseases, and reproductive health. They will also provide counseling and help people access health services at reduced or no cost.
- United Blood Services: Can make presentations and facilitate literature about donating blood, and safety of blood donation and transfusions.
- American Cancer Society, American Heart Association, American Lung Association, American Diabetes Association, Center for Disease Control, Environmental Protection Agency: These are national entities that often have local representatives. They have a lot of literature about diseases, how to prevent them, and how to access services. They may perform basic health tests for students such as blood pressure, cholesterol, and blood sugar. They may refer people at risk to health entities, and they can facilitate information about programs for poor people to access health services.
- Community Voices: These are organizations founded by the Kellogg Foundation. They exist in some communities and provide minimal cost primary health insurance coverage for the uninsured.
People can access information about these entities in their communities in their phonebooks. Local public libraries may also have directories of health and other resources. People may also find information by typing the name of the entity and the name of their community in their web browsers. They can also type the name of the entity and find information available nationwide. The American Cancer Society, American Heart Association, American Lung Association, American Diabetes Association, Center for Disease Control, Environmental Protection Agency have extensive web-sites with a lot of health related information.
Often times, immigrants may be afraid to seek health services for fear of deportation. Health entities, however, are not in the immigration business and are willing and able to assist poor immigrants. In fact, some of their funding requires that they do this.