By Iris Smith, Ph.D.

Accurately communicating health information to communities and individuals at risk of disease is an important aspect of public health prevention.  However, communicating information does not always result in health literacy, which is both the comprehension and usability of the information in making health-related decisions.  The Centers for Disease Control and Prevention also makes a distinction between individual and organizational literacy:

• Personal health literacy is the degree to which individuals can 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.¹

Limited health literacy is the result of poor reading comprehension, linguistic differences, oral communication difficulties and numeracy skills (ability to calculate).  These limitations can create barriers to information processing and understanding of basic health information and services needed to make appropriate health decisions.²

Ensuring health literacy also involves cultural competence, particularly when working with non-English speaking, indigenous or other marginalized populations. Cultural values, beliefs, and symbols also play a role in information processing. Implicit or unconscious bias is another factor in  provider/client communication that may influence diagnostic or treatment decisions and level of care.³ Cultural norms governing behaviors such as eye contact, physical proximity and other non-verbal behaviors can affect the quality of provider/client interaction.⁴   A review of research studies using The Implicit Association Test which requires participants to rapidly pair two social groups with either positive or negative attributes, found that most healthcare providers across multiple levels of training and disciplines have implicit biases against Black, Hispanic, American-Indian and dark-skinned individuals.⁵  This review found that implicit bias was associated with differences in communication (slower speech, verbal dominance, less emotionally responsive and less empathetic responses).  Most of the studies reviewed examined bias toward Black, Hispanic or American Indian individuals, with  few studies examining implicit bias toward other groups known to experience disparities in health outcomes.

Health communications should be accurate, accessible, and actionable to be effective in achieving behavior change.  Determining the health literacy issues in your organization begins with an assessment to identify training needs and resources. General assessment tools, guides, and other resources for improving organizational and individual health literacy can be found on Centers for Disease Control and Prevention Health Literacy Website.

Resources

Register for the Ditching the Discomfort with Data, Part 5 Communicating and Visualizing Data, November 17

Centers for Disease Control and Prevention Health Literacy Website

Farmanova E, Bonneville L, Bouchard L (2018) Organizational Health Literacy:  Review of Theories, Frameworks Guides and Implementation Issues.  Journal of Health Care Organization, Provision and Financing: 55; pg 1-17.

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. https://health.gov/sites/default/files/2019-09/Health_Literacy_Action_Plan.pdf

Maina IW, Belton TD, GinzbergS, Singh A, Johnson TJ  (2018).  A Decade of Studying Implicit Racial/Ethnic Bias in Healthcare Providers Using the Implicit Association Test. Social Science & Medicine, 199; pg. 219-229.