Building Bridges: Health Literacy Support for Multi-Cultural Communities

Victoria Purcell-Gates, PhD

Victoria Purcell-Gates, PhD

Victoria Purcell-Gates started off her presentation by discussing the relationship between literacy and culture. “Culture is what holds a group of people together,” and it may include beliefs, language, and more. She showed many examples of literacy in practice. If you study these, you can learn a lot about their culture, she said.

Health literacy is an instance of socially situated literacy, she said. It includes reading, writing, speaking, and listening within the social activity of health. Health literacy is the domain of social activity centered around the maintenance of health, physical fitness, and bodily care. It includes reading prescription or shampoo bottles, filling in a medical form, reading health-related magazines, reading bathroom signs, and keeping a dietary journal, she said.

Health Literacy is embedded in social networks. People learn skills faster if they are taught in the context of real-life literacy activity and they are explicitly taught, she said. “Thinking about health literacy this way is going to deepen our understanding. We talk to a lot of other people about our health — not just our doctor,” she said.

Real-life literacy instruction is when teachers engage their students in reading and writing real-life texts for real-life reasons. Classroom examples include:

  • Reading dosage directions to determine how much to take and how
  • Completing an intake form before an appointment to provide important information
  • Googling a health question to learn an answer
  • Reading lab reports to learn about your health
  • Inquiring about prep requirements for procedure
  • Reading pollution index to see if it’s OK to exercise
  • Making a doctor’s appointment online

In order to build bridges with multicultural students, Purcell-Gates urged practitioners and health literacy teachers to learn the health literacy practices in the lives of their students. “You need to get to know your students — their visions and models of health. Then build activities that build on those,” she said. “Spend time in the community — go to community meetings, wash your clothes in the Laundromat, shop in the stores. It takes time to get past your own preconceptions on what you expect to see. It’s like when you travel in another country: You can’t get everything you need from a guidebook. You need to spend time there.”

10 Attributes of a Health Literate Organization

Russell Rothman, MD, MPP

Russell Rothman, MD, MPP

Dr. Russell Rothman discussed the Institute of Medicine’s 10 Attributes of a Health Literate Organization. He talked about how to put these attributes into practice. He listed health challenges in the U.S. “This is true not just for patients with limited health literacy, but for all of us,” he said.

Low quality of care is caused by many factors, including poor health literacy and health communication skills. One aspect of literacy is numeracy. There has been increasing concern about it, he said. Poor health literacy and numeracy are common. Studies have found that literacy and numeracy are associated with health behaviors, knowledge, and outcomes. Examples include understanding food and medicine labels and diabetes knowledge and control, he said.

Dr. Rothman listed some ways we can communicate better:

  • Use low literacy and picture-based materials
  • Individualize education
  • Teach concepts in a simplified manner
  • Use teach-back technique
  • Address cultural issues
  • Use shared goal setting

Studies have found that these strategies improve health outcomes, he said. But they do have limits: They focus on patient-provider communication, and they often don’t consider larger, system-level challenges related to health literacy.

Dr. Rothman listed the Institute of Medicine’s 10 Attributes of a Health Literate Organization and discussed some measures for assessing if an organization has these attributes. An organization can use these measures to address reporting, accountability, management, quality improvement, and research.

We don’t know yet which measures are the most scientifically valid, he said. “It’s a very young field. We didn’t get a lot of specific details about how they will use the measures.” Dr. Rothman closed by offering next steps for evaluating measures of health literacy. He invited the group to share their own measures.

Closing Keynote Panel, Friday, May 9, 2014

From left to right: Michael Villaire, MSLM, Rima Rudd, ScD

From left to right: Michael Villaire, MSLM, Rima Rudd, ScD

Villaire and Rudd reviewed some highlights of the conference. They also looked to the future. Rudd encouraged the group to act on ideas they got from the conference. “There is so much sharing going on, plus so much skill building. There’s so much networking that could lead to partnerships,” she said. “It’s so much deeper than the exchange of business cards.”  Villaire echoed her advice. “We are very interested in ensuring that we take something home with us,” he said. “Make a promise to yourself. Test out one thing that you’ve learned here. And take a look at the LinkedIn Health Literacy Conference page. We’re going to have a support platform there.”

Villaire urged the group to think about how to help people make the transition to the ACA. “People who have not had health insurance before have been given a great gift, but not much of an instruction manual,” he said. “As keepers of information, we have tremendous power and responsibility.”

Rudd noted that this is her 11th year at the conference. “There has been a seismic shift from a myopic focus on individuals to the broader social context,” she said. “The focus is no longer on the deficits of the patient, but on what health professionals can do to improve communication.” Villaire closed with the thought that “we need to be much more collaborative as a health literacy community. Let’s have those conversations.”