Health Literacy Program with Centene Foundation for Quality Healthcare

Our Health Literacy Communications Tools and Resources Toolkit is now available below:

English Language Toolkit

NHHF is pleased to partner with the Centene Foundation for Quality Healthcare on its Health Literacy program.

The Patient Protection and Affordable Care Act of 2010, Title V, defines health literacy as the “degree to which an individual has the capacity to obtain, communicate, process, and understand health information and services in order to make appropriate health decisions.”[1]

The U.S. Department of Health and Human Services (HHS) Healthy People 2030 updated the health literacy definition to include personal health literacy and organizational health literacy. HHS provides the following definitions:[2]

• Personal health literacy is the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.
• Organizational health literacy is the degree to which organizations equitably enable individuals to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.

Health Literacy and Hispanics

The U.S. Department of Health and Human Services (HHS) released a document in 2010 titled National Action Plan to Improve Health Literacy, citing that certain populations are most likely to experience limited health literacy, which includes racial and ethnic groups other than white, people with less than a high school degree or GED, and non-native speakers of English.[3]

The Hispanic population accounts for 19% of the population in 2020 (62.3 million) and is slated to account for 28% of the population (111.2 million).[4] Data from the National Assessment of Adult Literacy confirms that Hispanics have the lowest levels of health literacy among racial/ethnic groups. 41% of Hispanics have “below basic health literacy” compared with 25% American Indian/Alaska Native, 24% non-Hispanic Blacks, 13% Asian/Pacific Islander, and 9% non-Hispanic Whites.[4] Implications of inadequate health literacy often leads to poor health outcomes, less use of preventive care, higher rates of non-compliance with medications and recommendations, and increased health disparities regarding access to health care.[5], [6], [7] Other implications are the increased likeliness of using the emergency room, also that these patients will return to the emergency department within two weeks of that visit.[8]

Language and cultural barriers often play a role in health literacy.  It has been noted that cultural beliefs impact the relationship and communication between patients and medical providers, which affects the patient’s capacity to comply with the physician’s instructions and recommendations. Other factors such as poverty, education level, race/ethnicity, age, and disability status, play a role in health literacy.[9]

Tools Used by Professionals and Communities to Improve Health Literacy

 Due to the impacts that health literacy has on health outcomes, it is essential to increase community and healthcare providers’ access to health literacy tools.  Cultural sensitivity and improved health literacy are needed to improve the Hispanic population’s access to health services to help address and control chronic diseases. Enhanced health literacy can impact a patient’s ability to live a healthy lifestyle, prevent obesity, and utilize preventive screening services. Health care professionals in the U.S. are required to offer language translation services to patients with limited language proficiency (LEP) to any LEP group that is either 5% or 1000 persons of the population (whichever is less) that they serve, failure to do so can result in the loss of eligibility to receive federal funding of health service. Health practices need to be proactive in addressing low health literacy in their patients and the populations in which they serve.  There are some easily implemented ways that providers can make a direct impact with their patient’s health literacy levels such as “simplifying communication; confirming comprehension for all patients to minimize the risk of miscommunication; making the health care system easier to navigate, and supporting patient’s efforts to improve their health.”[10]

There are various approaches health care providers can use to improve health literacy. Evidence-based strategies on interventions come from simplifying and improving written materials, using video or other targeted approaches, and improving patient-provider communications. The Agency for Healthcare Research and Quality (AHRQ) created a health literacy universal precautions toolkit for providers to assist in creating a health literacy plan.[10]

In response to the need for improved health literacy within Hispanic populations, NHHF and Centene Foundation set out to create a useful and impactful health literacy toolkit for both patients and health professionals.  HispanicHealth.info is a website designed by NHHF to share resources with patients, providers, and community members. These resources include information about health concerns and disparities specifically relating to the Hispanic population. Our goal is to provide information and references from trustworthy sources and partners so that we can mitigate the disproportionate effects faced by the Hispanic community. While the Health Literacy Toolkit is in its piloting phase (until March 2022) HispanicHealth.info will house and become the platform for which the public will have access to the toolkit.

[1] United States. Affordable Care Act: Title V - Health Care Workforce: Subtitle A- Purpose and Definitions. 2010,https://www.hhs.gov/sites/default/files/v-healthcare-workforce.pdf. Accessed 11 May 2021.  

[2]Health Literacy in Healthy People 2030. (2020).https://health.gov/our-work/healthy-people-2030/about-healthy-people-2030/health-literacy-healthy-people. Accessed 11 May 2021. 

[3] U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. (2010). National Action Plan to Improve Health Literacy. Washington, DC: Author.

[4]United States Census Bureau. Hispanic Population to Reach 111 Million by 2060. (2018). https://www.census.gov/library/visualizations/2018/comm/hispanic-projected-pop.html Accessed 11 May 2021.

[5] Kutner, M., Greenberg, E., Jin, Y., and Paulsen, C. (2006). The Health Literacy of America’s Adults: Results From the 2003 National Assessment of Adult Literacy (NCES 2006–483). U.S. Department of Education. Washington, DC: National Center for Education Statistics.https://nces.ed.gov/pubs2006/2006483.pdf. Accessed 11 May 2021.

[6] Garbers, Samantha, and Mary Ann Chiasson. “Inadequate functional health literacy in Spanish as a barrier to cervical cancer screening among immigrant Latinas in New York City.” Preventing chronic disease vol. 1,4 (2004): A07.https://pubmed.ncbi.nlm.nih.gov/15670438/. Accessed 11 May 2021.  

[7] Cheng, E.M., Chen, A. & Cunningham, W. Primary Language and Receipt of Recommended Health Care Among Hispanics in the United States. J GEN INTERN MED22, 283–288 (2007).https://doi.org/10.1007/s11606-007-0346-6. Accessed 11 May 2021.

[8] Leyva, Melissa et al. “Health literacy among Spanish-speaking Latino parents with limited English proficiency.” Ambulatory pediatrics: the official journal of the Ambulatory Pediatric Association vol. 5,1 (2005): 56-9. doi:10.1367/A04-093R.1https://pubmed.ncbi.nlm.nih.gov/15656706/. Accessed 11 May 2021.

[9] Office of Disease Prevention and Health Promotion. Health Literacy. (2020).https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-health/interventions-resources/health-literacy. Accessed 11 May 2021.  

[9] Velasco-Mondragon E, Jimenez A, Palladino-Davis AG, Davis D, Escamilla-Cejudo JA. Hispanic health in the USA: a scoping review of the literature. Public Health Reviews. 2016;37(1). doi:10.1186/s40985-016-0043-2 

[10] Brega AG, Barnard J, Mabachi NM, Weiss BD, DeWalt DA, Brach C, Cifuentes M, Albright K, West, DR. AHRQ Health Literacy Universal Precautions Toolkit, Second Edition. (Prepared by Colorado Health Outcomes Program, University of Colorado Anschutz Medical Campus under Contract No. HHSA290200710008, TO#10.) AHRQ Publication No. 15-0023-EF. Rockville, MD. Agency for Healthcare Research and Quality. January 2015. https://www.ahrq.gov/sites/default/files/publications/files/healthlittoolkit2_4.pdf. Accessed 11 May 2021.