Health Literacy & Community Assessment Models

Defining Health Literacy

• individuals can obtain, process, understand, an communicate health information needed to make informed decisions

• knowledge, motivation, and competences to access, understand, appraise, and apply health information

  • to make judgements and take decisions in healthcare, disease prevention, and health promotion to maintain or improve quality of life

digital health literacy

• digital skills and ability to search for, understand, use, and evaluate health information on digital media

• actively participate in health information exchange and interaction

• use the obtained information to address or solve health problems

Sorensen’s 4 operational competencies of health literacy

• accessing - ability to seek, find, and obtain health information

• understanding - ability to comprehend accessed health information

• appraising - ability to interpret, filter, evaluate and judge the credibility of health information

• applying - ability to communicate and use information to make informed choices

Health Literacy Stats

• 88% of adults have substandard rates of health literacy

• older population (65+) have the lowest levels of health literacy

• 42% of those who reported poor health have below basic knowledge of health literacy

• low health literacy creates up to 238$ billion in annual healthcare costs in the US

• every $1 invested in health literacy yields 25$ in systemic savings

National action plan to improve health literacy

• accessible information: deliver accurate, actionable health and safety content

• healthcare system reform: improve care communication, access, and informed decision-making

• education integration: teach health and science concepts from early childhood through university

• community support: expand adult education, ESL instruction, and culturally tailored health services

• Policy and partnerships: build cross-sector alliances, issue guidance, and update health policies

• research and evaluation: advance research to test and refine health literacy interventions

• scale proven practices: expand the adoption of evidence-based health literacy strategies

Health literacy as SDOH

• organizational health literacy - degree which organizations enable all individuals to find, understand, and use information and services (helps them make health-related decisions and actions for themselves and others)

  • leadership and universal precautions - clear communication into leadership, strategic planning, and workforce training to apply health literacy across all patient care without stigma

  • access and community engagement - partner with patients and local communities to design services, create plain-language print and digital content, and ensure transparent accessible care environments

patient and interpersonal barriers

• anatomical knowledge gaps - patients often lack basic anatomical understanding

• cultural incongruence - deeply rooted religious or community beliefs collide with biomedical models

• linguistic and translation risks: replying on family members due to a lack of professional interpreters leads to misinterpretation, privacy breaches, and safety risks

• shame and concealment: intimidation and fear of appearing unintelligent cause patients to nod along and conceal

provider assessment and communication barriers

• 6 to 1 overestimation - nurses estimated ~68% of patients have adequate health literacy, whereas formal testing reveals only 22% actually do

• educational proxy fallacy: using formal grade completion as a proxy is unreliable

  • 40% of high school graduates still demonstrate limited health literacy

• jargon and curricular deficit

  • medical terminology dominates clinical dialogue and there is minimal health literacy training in nursing curricula

systemic barrier

• lack of institutional support: healthcare organization advocate for patient education in policy without dedicating time tracking or support structures

organizational barriers

• time constrains: high patient to nurse ratios force rapid explanations

• translator shortages: facilities frequently lack 24/7 professional interpreter access and low literacy materials

informational barriers

• health misinformation - deficits in public health communication invites community misinformation that spread rapidly

• unreliable internet sources - patients turn to search engines and social media, exposing them to misleading marketing and false cures

digital health literacy barriers

• “digital native” fallacy - device familiarity in younger populations does not equal ability to critically evaluate online health information

• platforms and usability barriers - technical lockouts, software conflicts, and complex navigation interfaces prevent efficient access to digital health tools

AHRQ - Health Literacy Universal Precautions Toolkit

• structures services so everyone can easily understand and act on health information

• core actions

  • simplify communication and confirm patient understanding

  • ease office and system navigation

  • support patients in improving health

Evidence-Based Clinical Communication Frameworks

• Teach back (chunk and check) loop

  • explain 1-3 concepts and ask the patient to restate instructions in their own words, clarify missteps, recheck and document in the EHR

• Ask me 3 program

  • empower patients to ask

    • what is the main problem

    • what do i need to do

    • why is it important for me to do this

• the LEARN model

  • listen to perceptions

  • explain nursing view

  • acknowledge differences

  • recommend options

  • negotiate a mutual plan

• Osborne’s Communication Rules

  • use private spaces

  • fit facing the client

  • maintain eye contact

  • 5th grade level materials

  • ask open ended questions

Community as a Partner Model (CAPM)

• developed to illustrate public health nursing as a synthesis of public health and nurses

• definitions of the four concepts that are central to nursing: person, environment, health, and nursing provide

  • framework for the community as a partner model

• developed by Elizabeth Anderson and Judith McFarlane

Community Assessment Wheel (CAPM)

• represents people who make up the community: demographics, their values, beliefs, and history

• 8 subsystems - influence each other not separate

  • physical

  • environment

  • education

  • safety and transportation

  • politics and government

  • health and social services

  • communication

  • economics

  • recreation

• Most understand all subsystems and assessment of people

• normal line of defense (solid line) - level of health of the community (eg. high rate of immunity, low infant mortality, middle-income level,)

• flexible line - buffer zone representing a dynamic level of health resulting from temporary response to stressors (flooding, unwanted adult bookstore)

Community as Partner Model cont.

• degree of reaction - amount of disequilibrium or disruption that result from stressors crossing community’s lines of defense

  • eg. mortality/morbidity rates, unemployment, or crime statistics

• stressors - tension-producing stimuli that have potential of causing disequilibrium

  • can originate outside or inside the community

  • penetrate flexible and normal lines of defense - disruption in community

  • inadequate, inaccessible, or unaffordable services

Community Assessment

• comprehensive evaluation of the status of a community based on interactions between people, health, and the environment

• important for finding ways to improve health status of a risk populations and conducting outreach activities

• allows for community’s strengths, weaknesses, assets, and deficits

• examine, psychosocial, biological, and sociocultural influences of the environment

• identifies vulnerable populations, determines unmet needs, and document community resources - used to set goals, plan programs for interventions, and evaluate outcomes

• informal

Windshield Survey

• used to learn about neighborhood in which their client live

• descriptive way of understanding what appears to be physical expression of community - through a windshield of car

• observe 8 subsystems: economic, physical, educational, safety/transportation, health/social services, communication, politics/government, and recreation