The Latinx community is extremely vulnerable to COVID-19. This heavy burden can be attributed to the inequities in the social determinants of health, such as income, education, housing, and health care access (Despres, 2020). If we dig a bit deeper, we will also find that health literacy impacts these social determinants. Health literacy is defined as the degree to which an individual has the capacity to obtain, process, and understand health information and services to make appropriate health decisions (CDC, 2020).
Low health literacy is linked to higher risk of death, and higher utilization of expensive services, such as emergency room visits and hospitalizations. Studies have shown that people with low literacy have a lower likelihood of getting flu shots, have a harder time understanding medical labels and instructions, and a greater likelihood of taking their medication incorrectly compared to adults with higher health literacy (Bennett, Chen, Soroui, et al., 2009). People with low health literacy may also have trouble reading a thermometer, trouble managing their conditions, such as diabetes, or know the early symptoms of a stroke or heart attack.
People of all ages, races, incomes, and education levels are affected by limited or poor health literacy. It is especially important to point out that populations susceptible to low health literacy include older adults, immigrants, minitories, and low income populations (NNLM, n.d.). In the United States, nine out of ten adults struggle to understand and use health information that is unfamiliar or complex (CDC, 2020). Health literacy may also be affected by the lack of educational opportunity, learning disabilities, and reading abilities (NNLM, n.d.). Reading abilities are typically three to five grade levels below the last year of school completed. For example, individuals who graduated with a high school diploma usually read at a seventh or eighth grade level (NNLM, n.d.).
When it comes to the Latinx community, about 21 million (41%) of Latinx individuals lack basic health literacy levels whereas 4% are proficient in health literacy and have the necessary skills to make appropriate health decisions (NHCOA, 2015). Culture plays an important role in how the Latinx community communicates, understands, and responds to health information.
As a COVID-19 Case Investigator, I have seen how culture plays a role in my discussion with cases(positive COVID-19 individuals). I typically read a list of COVID-19 symptoms that the case is experiencing. There are situations where cases begin to tell me their symptoms once they discover why I am calling, giving me no opportunity to read off my list. Calling Spanish speaking cases has made me aware that some individuals do not use the medical terminology I have on my list to describe their symptoms. For example, some cases do not know what “escalofrios” (chills) or enfermedad de “células falciformes” (sickle cell disease) are. When a case doesn’t automatically respond to the symptom, I ask them if they need further explanation, and most of the time they do. They make it a point to tell me that they do not use the term and proceed to tell me what they usually call it. Although translated materials and interpreter services are great to help bridge communication gaps, we need to acknowledge that it can be a barrier to meaning, and that Spanish is not spoken the same across different cultures. Another case I spoke to once told me he had “pecho apretado”. Before selecting the symptom on my list, I clarified with the case if he meant he had chest pain. He said he did not. I asked the case if he had difficulty breathing, but the case kept repeating he had “pecho apretado.” I asked him to describe what he felt and after further discussion, I understood that for the case, “pecho apretado” meant he felt congested and had phlegm buildup. Clarifying what we both understood from the term helped me provide the case with the correct information needed.
With the constant new information we learn about COVID-19 and the vaccine, we need to make sure our community stays informed by tackling the issues presented with health literacy. It should be acknowledged that this is not the patient’s fault but rather an issue that reflects the presentation of information and navigation of the health system (Rudd, 2010). When I first began my Public Health journey, my professors always reminded us to focus on the individual’s strength rather than their deficits. Health information is delivered through multiple channels, such as family and friends, websites, social media, and community organizations. We need to provide health information in ways that capture the attention of our community. When we identify individuals in our communities with limited literacy, we can use shorter sentences, simpler language, and supplemental materials such as videos or pictures in Spanish (HRSSA, 2019). We can also test information on these same graphics with our intended audience and ask for feedback to provide more clarity before publishing (CDC, 2020). If you’re a health care provider, consider using the teach-back method and ask your patient to explain or demonstrate the procedure on the information you provided for their health plan(HRSA, 2019). It is up to us to make sure our community is aware and understands their health. Former U.S. Surgeon General Regina M. Benjamin said, “What we say does not matter unless our patients are able to understand the information we give them well enough to use it to make good health-care decisions. Otherwise, we didn’t reach them, and that is the same as if we didn’t treat them” (CDC, 2020).
By Clarissa Guzman, MPH, CHES®
For more information on health literacy in the Latinx community:
Bennett, I. M., Chen, J., Soroui, J. S., & White, S. (2009). The contribution of health
literacy to disparities in self-rated health status and preventive health behaviors in older adults. Annals of family medicine, 7(3), 204–211. https://doi.org/10.1370/afm.940
Centers for Disease Control and Prevention (CDC). (2020). Health Literacy.
Despres, C. (2020, December 23). Update: Coronavirus Case Rates and Death Rates
for Latinos in the United States.
Health Resources & Service Administration (HRSA). (2019, August). Health Literacy
Key, W. (2019). Understanding health literacy in the Latino population. Perspectives on
Social Work, 13(1). https://hdl.handle.net/10657/4380
National Hispanic Council on Aging (NHCOA). (2015, April 10). Health Literacy.
Network of the National Library of Medicine (NNLM). (n.d.). Health Literacy.
Rudd R. E. (2010). Improving Americans' health literacy. The New England journal of
medicine, 363(24), 2283–2285. https://doi.org/10.1056/NEJMp1008755