Module 4: Health Literacy
Health literacy is the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions.
To understand health literacy, language and linguistic competence must initially be considered. Language can be defined as the words, their pronunciation and the methods of combining them used and understood by a community. As language is key to communication, linguistic competency involves providing readily available, culturally appropriate oral and written language services to limited English proficiency (LEP) members through such means as bilingual/bicultural staff, trained medical interpreters and qualified translators.
Language and literacy issues in mental health and substance use disorder recovery services include translation, interpretation and services provided in spoken and non-spoken languages other than English and include providing useful materials for native English speakers with varying literacy levels. Translation is the conversion of written texts from one language to another. Keys to effective translation are accuracy, reading level and consistent literal and conceptual meaning. Interpretation is the process of understanding and analyzing a spoken or signed message and re-expressing that message faithfully, accurately and objectively in another language, taking the cultural and social context into account. Keys to effective interpretation are the skill, fluency, speed and comprehension of the interpreter to accurately convey what the client and practitioner intend to say.
Health literacy also involves ensuring health information, in any language it is offered, is not overly technical or only understood by health experts. Healthy People 2030 defines personal health literacy as 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. Organizations should consider their organizational health literacy or 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. The Healthy People 2030 initiative stresses the importance of people’s ability to use health information, not just understand it, so they are able to make informed health decisions.
Providing or receiving mental health and substance use services in another language is a complex and intensive process that involves both technical language, clinical skills and theoretical skills of a given profession. Spoken language challenges range from issues with accents or dialects that make communication difficult to the way that a second language can change clients’ intended expressions. As described by the Centers for Disease Control and Prevention (CDC), the ideas people have about health, the languages they use, the health literacy skills they have and the contexts in which they communicate about health reflect their cultures. For communities of color and immigrants, discussion of cultural dynamics in mental health and substance use services cannot take place without the consideration of the ways in which language intersects with issues of poverty and equity, access to and utilization of care, discussions of individual and institutional racism, and a lack of language competence on the part of organizations and programs. Cultural and Linguistic Literacy are defined in the next Module.
Module Objectives
- The reader will be able to define health literacy.
- The reader will acquire additional resources for their toolbox about health literacy.
- The reader will be able to apply the skills and tools acquired in this module to a case vignette.
Step 1: Let’s Get Started
This step briefly introduces health literacy and provides specific objectives that will move you closer to your goals.
Step 2: Time to Engage
The information in this step is accessible and provides a general introduction to health literacy. You can listen to a podcast on your morning walk, download a resource to help your client or get a short audio summary of an article that caught your eye before fully engaging with the reading.
Webinars
- In the Prioritizing Equity: COVID-19 and Latinx Voices in the Field (61 min) webinar, Latinx physicians in the mental health and substance use recovery field discuss topics such as the pandemic’s impact on the immigrant community, testing, trends and equity concerns in health care, supporting language access and cultural-linguistic appropriateness.
- Dr. Flores Uribe, MD, MPH stated, “Forty-nine percent of our population actually prefers Spanish as their primary language. So, we’re really talking about the majority of our patients having a language other than English that they would either require an interpreter for in order to make an informed decision.” Dr. Luis Seija, M, explains that it is not enough to hand someone’s discharge paperwork and have the instructions for quarantining in Spanish. These are only some of the health literacy challenges that Latinx communities are facing, but there are many other communities who are also facing similar challenges
- The Centers for Disease Control and Prevention (CDC) focuses on the importance of Health Literacy and ways in which the responsibility of implementing health literacy policies are shifting away from patient/client, clinicians, staff and practitioners, and instead to the institution/organization.
- In their presentation about the importance of personal health literacy, health-literate clinicians and health-literate organizations, Rima Rudd, ScD, MPH, (59:55 min) highlights the challenges that exist when reviewing assessment tools that identify health literacy gaps. In addition to this webinar, you will also find more information on the following topics:
- Here are some additional webinars by the CDC that will provide a more in-depth Health Literacy Communication Training that will assist you in creating your own materials:
Relevant Reports
Dr. Hyejin Jung, PhD, MSW, addresses mental health literacy and resources to increase mental health literacy in an in-depth report, Mental Illness to Mental Health: Mental Health Literacy.
Here are the topics highlighted in the report:
- What is Mental Health?
- Theoretical Background
- Assumptions and Behavior Changes
- Techniques and Interventions
- Final Thoughts
- Resources
In a discussion paper, Ten Attributes of Health Literate Health Care Organizations, authors inform readers about the following 10 attributes:
- Maintaining leadership that makes health literacy integral to its mission, structure and operations.
- Integrating health literacy into planning, evaluation measures, patient safety and quality improvement.
- Preparing the workforce to be health literate and monitoring progress.
- Including populations served in the design, implementation and evaluation of health information and services.
- Meeting the needs of populations with a range of health literacy skills while avoiding stigmatization.
- Utilizing health literacy strategies in interpersonal communications and confirming comprehension at all points of contact.
- Providing easily accessible health information, services and navigation assistance.
- Designing and disseminating print, audiovisual and social media content that is convenient and straightforward.
- Addressing health literacy in high-risk situations, including care transitions and communications about medications.
- Clearly communicating the who, what and how of health coverage plans and services.
In a recent call to action, The Harvard Kennedy School: Misinformation Review released Promoting health literacy during the COVID-19 pandemic: a call to action for health care professionals.
Here are some of the action steps they recommend for health care professionals:
- Strengthening their commitment to health literacy across the scope of operations.
- Building and enhancing partnerships with the communities they serve.
- Reinforcing their cross-sector collaborations with public health systems.
- Making every effort to understand and respond to their patients’ unique health-related knowledge, beliefs and literacy conditions.
In the National Academy of Medicine discussion paper Health Literacy and Health Education in Schools: Collaboration for Action, the authors discuss the following key topics:
- Health Education in Schools
- Characteristics of an Effective Health Education Curriculum
- Promising Opportunities for Strengthening School Health Education
- Integrating Youth Health Education and Health Literacy: Success Stories
- COVID-19: Health Crisis Affecting Children and their Families and a Need for Health Education Health Literacy in K-12
Resources
Ithaca College gathered multiple resources for the multiple challenges specific to LGBTQ+ communities during the Coronavirus Pandemic: LGBTQ+ People and Covid-19.
Some of the key topics discussed include:
- COVID-19 and Sexual Health
- People Living with HIV
- Know Your Rights Guide for Transgender People Navigating COVID-19
- LGBTQ+ Families
- LGBTQ+ Elders
Marbles Kids Museum provides an array of resources to support parents, educators and children as they navigate the challenges during the pandemic.
Some of the topics include:
MedlinePlus, now the National Library of Medicine, has resources that will assist organizations with health information in multiple languages.
Psychology Tools designed a free guide, Living with Worry and Anxiety Amidst Global Uncertainty, in response to the COVID-19 pandemic.
Teen Mental Health is a comprehensive mental health literacy learner resource for educators, friends, parents and health professionals.
Teen Mental Health provides assessment tools, multi-language resources and resources related to COVID-19. Here are some of the topics covered:
- What is Mental Health?
- Mental Disorders
- Brain Injury
- Suicide
- Teen Behavior
- The Teen Brain
- Healthy Sleep
- Understanding Self-Injury/ Self-Harm
- Understanding Stigma
- Understanding Stress
- Cannabis
The American Psychological Association has provided two free e-books that are designed to help kids cope with Covid-19:
The COVID-19 Fact Sheets are available in 35 languages. All materials are reviewed by physicians and medical school faculty members at Harvard hospitals.
These fact sheets explain/provides:
- How you can help prevent the spread of COVID-19.
- What you need to know about COVID-19.
- How COVID-19 affects you if you are pregnant or planning to become pregnant.
- What to do if you are sick with COVID-19 or suspect you are infected.
- Information to help 3–6-year-olds understand the important information about COVID-19.
- Information to help 6–12-year-olds understand the important information about COVID-19.
- Information to help 13–18-year-olds understand the important information about COVID-19.
The COVID-19: 24/7 Parenting provides parenting tips and activities for all ages in worldwide languages.
Some of the topics include:
- Parenting Teens
- Keeping Children Safe Online
- Learning Through Play
- Parenting in Crowded Homes and Communities
- Talking about COVID-19
- When Children Misbehave
Step 3: Creating a Stronger Foundation
This list of materials and resources provides a more detailed description of how to apply the tools introduced in Step 2. This step requires you to engage in deeper analysis of the topic through documentaries, research articles, trainings and books. Some of the tools, like research articles and books, may have a cost attached and we recommend that your organization provide them and share them with other team members. Tools like trainings may require you to engage for longer periods of time than the initial resources.
Research Articles
For additional tools on health literacy, check out some of the articles listed below:
- Interdisciplinary Perspectives on Health Literacy Research Around the World: More Important Than Ever in a Time of COVID-19.
- Sentell, T., Vamos, S., & Okan, O. (2020). Interdisciplinary perspectives on health literacy research around the world: More important than ever in a time of COVID-19. International Journal of Environmental Research and Public Health, 17(9). https://doi-org.proxy-remote.galib.uga.edu/10.3390/ijerph17093010
- Critical health literacy and the COVID-19 crisis
- Abel, T. & McQueen, D. (2020). Critical health literacy and the COVID-19 crisis. Health Promotion International. https://doi-org.proxy-remote.galib.uga.edu/10.1093/heapro/daaa040
- Caught in the Middle: Spanish-Speaking Bilingual Mental Health Counselors as Language Brokers
- Delgado-Romero, E. A., De Los Santos, J., Raman, V. S., Merrifield, J. N., Vazquez, M. S., Monroig, M. M., Bautista, E. C., & Duran, M. Y. (2018). Caught in the middle: Spanish-speaking bilingual mental health counselors as language brokers. Journal of Mental Health Counseling, 40(4), 341–352. https://doi-org.proxy-remote.galib.uga.edu/10.17744/mehc.40.4.06
- Navigating Language Brokering in K–12 Schools
- Tuttle, M. & Johnson, L. V. (2018). Navigating language brokering in K-12 schools. Journal of Mental Health Counseling, 40(4), 328–340. https://doi-org.proxy-galib.uga.edu/10.17744/mehc.40.4.05
- Mental health risk factors associated with childhood language brokering
- Rainey, V. R., Flores, V., Morrison, R. G., David, E. J. R., & Silton, R. L. (2014). Mental health risk factors associated with childhood language brokering. Journal of Multilingual and Multicultural Development, 35(5), 463–478.
Trainings
Mental health and substance use recovery organizations, especially youth-focused organizations, may find themselves working collaboratively with teachers for the overall wellbeing of clients/patients.
Here are some tools that you can suggest to teachers who are on the frontlines when it comes to working with youth. Teach Mental Health provides a free self-guided training for educators, given that teacher training programs rarely address mental health literacy. Here are the seven modules that you will find throughout this self-guided training:
- Module 1: Introduction & Background
- Module 2: Stigma & Mental Health
- Module 3: Human Brain Development
- Module 4: Understanding Mental Health, Mental Illness & Related Issues in Young People
- Module 5: What is Treatment?
- Module 6: Seeking Help & Providing Support
- Module 7: Caring for Students & Ourselves
Step 4: Your Turn
This step encourages you to apply what you have learned through a case vignette. We recommend that you explore the gaps present within the vignette and implement any new skills acquired through this module. Consult with others on your team to explore the multiple ways to address the issues, especially as you take your role within your organization and your experience, skills and worldview into account. We provide reflection questions from the following perspectives: individual learning and beliefs, organizational learning and systemic. You can use the questions to have discussions with others and think through all the facets that are relevant to your work.
Case Vignette
Two months into the COVID-19 pandemic in the U.S., basic health information about the virus was not yet available in Korean. A prosperous suburb of a major city had seen a mass migration of South Korean individuals to the area. It was common to see only Korean businesses and signs in the Korean language along a long stretch of the highway. In normal times, the Korean population was under-resourced but managed to move forward socially and economically.
The pandemic had changed that. Korean businesses were shuttered and uninformed on how to receive credible health information and practice safe measures during this time. Rumors and superstitions about the virus were commonplace. In addition, the Korean community was in fear given the racially charged political rhetoric that blamed Asian individuals for the virus. Korean families feared violence and prejudice and the community felt isolated and unsafe.
The local health agency had previously put out COVID-19 health information in English, but that information was not available in Korean at a level which the community could use. One staff member had attempted a literal translation of health information, but the ineffective translation simply made the climate of mistrust and fear worse than before.
Reflection questions
- Asian Americans went from being stereotyped as a “model minority” to be being blamed for the pandemic. What do you imagine that feels like? (Individual learning and beliefs)“Model Minority Stereotype” ‒ A prevalent and misleading assumption that depicts Asian American and Pacific Islander (AAPI) people as uniformly well-adjusted, attaining more socioeconomic success than other minority groups through strong work ethic, conforming to social norms and excelling academically. The fact is the AAPI community is highly diverse across subgroups in rates of socioeconomic, health and mental health challenges. The social and familial pressure created by this deceptive stereotype can prevent community members from seeking mental health care.
- Access to health information that is adequately translated and interpreted (reading level, accuracy and cultural and linguistic nuances) is vital, and even more vital during emergencies. How might your organization provide usable information to English language learner populations? (Organizational learning and change)
- How can health organizations address racism and prejudice that either prevents health equity or is a significant stressor detracting from positive health? (Systemic change)
