Increasing the health literacy of people in poverty, the uninsured, and the most vulnerable populations positively impacts their health, confidence, resilience, and self-reliance. The U.S. Department of Health and Human Services (HHS) defines health literacy as, “the degree to which individuals have the capacity to obtain, process, and understand basic health information needed to make appropriate health decisions.” Ongoing research of the topic shows its multidimensional layers: limited health literacy could be an outcome of major social determinants of health, systemic forms of cultural and racial discrimination, consumer-patient’s conscious and unconscious biases and fears towards the health systems, and/or the quality of the information provided to the consumer-patient.
A report by the Agency for Healthcare Research and Quality (AHRQ) links low health literacy to the use of more healthcare services, more emergency room visits, and a higher risk of death. In 2012, the total cost of limited health literacy to the U.S. healthcare system was estimated at $50–73 billion. And while “addressing the low health literacy problem as part of national health reform” (Vernon et al. 2003) would be ideal, currently, many health improvement organizations across the country are working to increase the health literacy in their communities. Such efforts rely on collaboration and support from the local health systems, and government, public health departments, private organizations, community-based organizations, and community members. To better understand such efforts, we examined the work of three Network for Regional Healthcare Improvement (NRHI) members who are committed to improving health literacy.
Greater Detroit Area Health Council (GDAHC): Utilizing video messages to increase healthcare enrollment and retention.
Through their work with vulnerable population in the Detroit area, the Greater Detroit Area Health Council (GDAHC), a regional health improvement collaborative (RHIC) and NRHI member, identified the need for a resource that would provide easy-to-understand information about enrolling and retaining healthcare coverage. GDAHC partnered with St. Francis Cabrini Clinic – the oldest free clinic in the country – to produce and disseminate such information.
Organized in a series of four videos (three explanatory videos and one PSA), the “Pathway to Health Care” videos are based upon one-on-one presentations that Cabrini Clinic staff was giving to their clients to help them understand and retain their health care benefits. The videos live on both organizations’ websites and YouTube, allowing customers to review them at their convenience. The videos are available in three languages – English, Spanish, and French – and are accompanied by an online PowerPoint presentation in English and Spanish.
The choice of the medium makes sense. In today’s culture driven by visual information, the videos provide additional context to the staff presentations. They also serve multiple levels of accessibility; one does not need to be literate to glean the information within them, translations ensure that material can be understood, and captioning supports those that may be deaf or hard-of-hearing.
The videos, the first of their type in Michigan, are intended for adults who are eligible for health care subsidies through HealthCare.gov or the Healthy Michigan Plan, have health care benefits for the first time, and/or may have literacy challenges. The animation with voiceover is geared toward all levels of literacy, including adults who have reading challenges. The “Pathway to Health Care” videos cover essential topics such as grasping the ten essential benefits of care, preparing for the first doctor’s visit, retaining care through co-pays, and reenrolling annually.
Videos are an effective way to improve health literacy and even more so when they are part of an already established educational process. A recent survey of southeastern Michigan residents, conducted by GDAHC, found that videos are the more preferred way for their community to learn information related to healthcare; not only are they effective, but they are how people want to learn. Between the staff presentation and the website, the healthcare enrollees have an opportunity to make more informed decisions about their healthcare needs, thus building a sense of empowerment and confidence that they do the right thing for their families and themselves.
Health Care Improvement Foundation’s (HCIF): Health literacy through partnerships with community organizations.
Ten years ago, the Health Care Improvement Foundation (HCIF) – a RHIC and NRHI member from Pennsylvania – and Thomas Jefferson University and Hospitals (TJUH) received a grant from the Pennsylvania Department of Health to establish SEPA-READS. This initiative is a regional learning collaborative addressing health literacy in Southeastern Pennsylvania. Over the years, the HCIF expanded their initiative to include 11 clinical partners (nine hospitals/health systems, two clinics), four senior centers, five community-based organizations serving immigrants and refugees, and three statewide partners.
“In 2014, the Pennsylvania Department of Health provided additional funding to expand health literacy activities in the Commonwealth and form the Pennsylvania Health Literacy Coalition (PA-HLC). A major PA-HLC priority to date has been to build an infrastructure for health literacy training across Pennsylvania through strategic partnerships and development of online training modules,” the HCIF website adds. The coalition’s objectives aimed to improve the two-way communication between healthcare providers and their patients. Since its inception, the coalition led by HCIF and TJUH have trained 17,725 providers and educated 1,530 community members. In addition, participating healthcare organizations have made changes to staff and patient education practices, as well as to their websites, signage, and internal policies in order to better promote health literacy.
In a recent presentation during an NRHI event, Susan Cosgrove, MPA, CPHQ, Director, Health Literacy at HCIF, shared an example of the ways through which they connect with their target audience:
HCIF partners, working at food distribution sites during the pandemic, shared an observation that both staff and food receivers were not practicing social distancing. To inform about the importance of social distancing, HCIF created a toolkit that included both information pamphlets and tools such as chalk and tape measure to help staff enforce social distancing. HCIF leveraged existing partnerships and engaged the people who work with vulnerable communities and truly know what is happening on the ground to ensure that the information they produce reached their audiences in a way that recognizes their language abilities, access to communication channels, and health needs. HCIF’s health literacy initiative is deeply connected with their target audience by understanding the community needs and responding in approachable ways.
Common Ground Health: Bringing population’s blood pressure down – one barbershop and hair salon at a time.
Trust might be one of the most important elements of improving health literacy especially among the most vulnerable populations that have suffered from the current system.
Common Ground Health, a Rochester, NY-based RHIC and NRHI member, knew that for the much of population they work with, salons and barbershops are the pillars of trust. “People congregate there, they’re comfortable there, they share their most personal stories there. These places are where long-term and trusting relationships are nurtured,” says Phyllis Jackson, Community Wellness project manager at Common Ground Health and developer of the health literacy curriculum for the organization. They “are ideal places to raise awareness about health disparities in African American and Latino communities.”
Over the years, Common Ground has led different education campaigns through their work with local barbershops and salons. The most recent one is targeting hypertension and controlling high blood pressure. Before that it was education on substance abuse and sexually transmitted diseases; and before that, education about HIV/AIDS.
Currently, there are nine hair salon and barber shop owners who have become community health educators. They were trained to take blood pressure, be proactive to tell clients to see their doctors if the readings are higher than normal, and pass out health-related materials. Another 16 stylist and barbers are peer leaders, who keep their businesses stocked with health literature and condoms.
The blood pressure campaign is supported by Trillium Health and the High Blood Pressure Collaborative, an initiative of Common Ground Health and the Rochester Chamber of Commerce.
Common Ground Health’s partnership work with the barbershops and salons not only improves the health literacy of the Black and Latinx communities but it also empowers those communities by giving them the knowledge and the tools to take their health in their own hands. “I can’t save someone’s life, but I can steer them in the right direction to help extend their life,” says Cassandra McCrea-June, one of the nine community health educators and owner of Diva Defined in Rochester.
There are many ways to improve health literacy and empower communities and individuals in their journey to better health: a video that helps to navigate one’s enrollment in healthcare, a toolkit that includes a tape measure and chalk to create visual markers for social distancing, or a barber who also takes one’s blood pressure. Regional health improvement collaboratives are well positioned to bring forward such community-centric solutions because of their multi-stakeholder multi-sector work and vested interest in creating thriving communities.