Eighty-seven million American adults have low health literacy (LHL), costing up to $238 billion annually in inefficiencies (Vernon, Trujillo, Rosenbaum, & DeBuono, 2007). Yet, the highly complex United States health care and health insurance systems require advanced health literacy for effective navigation (Kindig, Panzer, & Nielsen-Bohlman, 2004; Quincy, 2012; Somers & Mahadevan, 2010; Villaire & Mayer, 2009). For instance, health information is often written at or above a high school level; hence, inaccessible to people with LHL (Rudd, 2007). With respect to health insurance, consumers must navigate technical guides, understand cost-sharing terms, determine whether their provider is in- or out-of-network, and calculate co-pays, deductibles, and co-insurance (Quincy, 2012). Ultimately, LHL prevents optimal health system and insurance navigation, affecting health care access and health outcomes (Ingram, 2012; Long et al., 2014; Parker, 2012; Quincy, 2012; Volandes & Paasche-Orlow, 2007).
Older adults, adolescents, people with low income and educational levels, and racial and ethnic minorities are disproportionately affected by LHL (Ingram, 2012; Kutner, Greenburg, Jin, & Paulsen, 2006; Prins & Mooney, 2014; Rudd, 2007; Volandes & Paasche-Orlow, 2007). The 2003 National Assessment of Adult Literacy revealed that 58% of African Americans had basic or below basic health literacy, compared with 28% of non-Hispanic Whites (Kutner et al., 2006). LHL is an independent predictor of racial/ethnic disparities in health behaviors (e.g., smoking, adherence to HIV treatment), access to health care resources, and health outcomes (Al Sayah, Majumdar, Egede, & Johnson, 2015; Berkman et al., 2011; Hossain, Ehtesham, Salzman, Jenson, & Calkins, 2013; Lanning & Doyle, 2010; Mantwill, Monestel-Umaña, & Schulz, 2015; Sentell & Halpin, 2006; Stewart et al., 2015).
Despite the disproportionate LHL among African Americans, there is limited evidence on its determinants and on effective health literacy interventions in African-American populations (Weekes, 2012). This article explores health literacy barriers and strategies among African Americans, drawing from the literature and the authors' experiences with community-engaged research in African-American communities.
Health Literacy Barriers
The disproportionate LHL among African Americans is rooted in historically unjust power structures (Estacio, 2013; Gee & Ford, 2011; Noonan, Velasco-Mondragon, & Wagner, 2016; Volandes & Paasche-Orlow, 2007). Discriminatory policies and practices have systematically limited African Americans' access to the resources and skills needed to obtain, understand, and apply health information (Foulk, Carroll, & Wood, 2001; Prins & Mooney, 2014; Rajaram & Bockrath, 2014; Smith, 2003; Wallace, 2015). Systemic factors such as limited educational opportunities, racism, health system mistrust, and a lack of culturally tailored health information and services are health literacy barriers for this population (Bhattacharya, 2013; Goodman et al., 2012; Kutner et al., 2006; Ownby et al., 2014; Politi et al., 2014; Prins & Mooney, 2014).
Education is positively correlated with health literacy (Lee et al., 2014; Ownby et al., 2014; Rudd, 2007) and differences in educational opportunities mediate the relationship between race/ethnicity and health literacy (Ownby et al., 2014). Racial residential segregation and discrimination perpetuate inequities by limiting access to quality education among African Americans (Goodman et al., 2012; Kutner et al., 2006; Ownby et al., 2014; Prins & Mooney, 2014; Rudd, 2007; Wallace, 2015).
Additionally, African Americans are less likely than other racial/ethnic groups to trust the health care system due to negative past experiences including abuse by health researchers (Bhattacharya et al., 2013; Politi et al., 2014; Prins & Mooney, 2014). One of the most egregious examples was the Tuskegee Study of Untreated Syphilis in the Negro Male from 1932 to 1972, wherein a curative treatment (penicillin) was withheld from hundreds of Black men to examine the effects of untreated syphilis (Tuskegee University, n.d.). Mistrust interferes with health literacy development as it affects interactions with the health care system, access to health-related resources, and health-related decision-making (Bhattacharya, 2013; Politi et al., 2014). The health care system has played a role in creating disparities in health literacy by historically failing to accommodate racial and ethnic minority populations' needs and preferences in the delivery of services and health information (Saha, Beach, & Cooper, 2008).
Moreover, health care providers may not recognize the extent of this health literacy gap. One study reported that physicians overestimated the health literacy scores of 54% of African-American patients, compared with 11% of non-Hispanic White and 36% of patients of another race/ethnicity (Kelly & Haidet, 2007). The failure to identify people with LHL is a missed opportunity to tailor patient-provider communications, thus affecting patients' understanding and application of recommendations (Kelly & Haidet, 2007).
Health Literacy Strategies
While adopting universal precautions of health literacy simplifies health communication and information processing for all consumers (DeWalt et al, 2010; 2011), studies suggest that reaching African Americans with LHL more effectively also relies on adopting culturally tailored, interactive, and community-engaged health literacy approaches (Bertera, 2014; Broussard, Radkins, & Compton, 2014; Rikard, Thompson, Head, McNeil, & White., 2012; Ross, Ashford, Bleechington, Dark, & Erwin, 2010). This is based on the premise that health information is processed through multiple lenses; thus, the interpretation of health-related concepts and images varies across cultures and other social markers (e.g., language, generations) (Kindig et al., 2004; Scrimshaw, 2019).
Culturally tailored and interactive approaches such as storytelling and culturally appropriate graphics have been reported to improve health literacy related to diverse health conditions in African-American samples (Bertera, 2014; Broussard et al., 2014; Rikard et al., 2012; Ross et al., 2010). For instance, oral storytelling slideshows on diabetes and hypertension that featured community members' voices and photographs were developed and administered to a group of predominantly older African-American women (Bertera, 2014). Exposure to these slideshows produced significant pre-post increases in diabetes (8.8%, p < .000) and hypertension (5.6 %, p < .001) knowledge and self-efficacy (11.3% and 13.2% respectively; p < .000) in the intervention group, with the greatest effects among those with LHL (measured by a Veteran's Administration instrument) (Bertera, 2014). Print materials containing real-life stories, culturally appropriate concepts and images, and practical, action-oriented steps have also been well received in African-American samples with LHL (Broussard et al., 2014; Rikard et al, 2012).
In addition, interactive and user-friendly digital platforms such as mobile health applications present considerable opportunities for reaching African Americans with LHL more effectively (Anderson, 2015; Fox and Duggan, 2012; Krebs & Duncan, 2015; Perrin, 2017; Pew Research Center, 2018). Although there is a dearth of literature on the use of digital health literacy interventions among African Americans with LHL, reports suggest that the ownership and use of mobile technology for accessing online health information has increased among racial/ethnic minorities, particularly African Americans (Anderson, 2015; Choi & Dinitto, 2013; Fox & Duggan, 2012; Krebs & Duncan, 2015; Perrin, 2017; Pew Research Center, 2018). However, these reports do not stratify mobile technology or internet use by health literacy levels, yet online health information is often written at higher reading levels and the ability to effectively process and use such information varies by health literacy levels (Meppelink, Smit, Diviani, & Van Weert, 2016). For instance, African Americans with LHL are less likely to use computers or the internet for health information (McCleary-Jones et al., 2013). Thus, to reach a large number of people with LHL, online or digital health literacy interventions should incorporate features that tailor health information to individuals' health literacy needs, technical skills, health needs, as well as personal and cultural values (Bickmore & Paasche-Orlow, 2012; Hur, Lee, & Schmidt, 2015).
On the other hand, some traditional health communication channels have received support in African-American samples of varying age groups (Ali, Combs, Muvuka, & Ayangeakaa, 2018; Lariscy, Reber, & Paek, 2010). For instance, along with the internet, television and radio were identified as preferred health communication channels in a sample of African-American youth (Lariscy et al., 2010). Furthermore, a qualitative study by our research team examined health insurance literacy among 87 residents (young, middle-aged, and senior adults) of a predominantly African-American community and found that participants preferred in-person health insurance navigation delivered by culturally competent community health workers who are from or familiar with the community, trustworthy, nonjudgmental, and knowledgeable about health insurance (Ali et al., 2018).
Engaging African-American community members in developing health literacy interventions has shown promise in ensuring their cultural and linguistic suitability, acceptability, usability, and effectiveness (Bhattacharya et al., 2013; Mullen, 2013; Rikard et al., 2012; Smith, 2003). Participatory approaches help capture diverse and shared cultural values, beliefs, and experiences in African-American communities (Rikard et al., 2012). In addition, such approaches can mobilize collective action to improve health literacy policies and practices (Bhattacharya, 2013; Estacio, 2013; Freire, 1970; Gillis, 2004; Mullins, Blatt, Gbarayor, Yang, & Baquet, 2005; Rikard et al., 2012).
There are several promising examples of community-engaged health literacy interventions. A group comprising African-American community members, university researchers, and a community-based organization developed a culturally tailored HIV/AIDS toolkit with culturally appropriate images and skill-based information in plain language to improve HIV-related health literacy in an African-American community (Rikard et al., 2012). Community members perceived the toolkit as acceptable, easy to use, and effective in raising awareness and dialogue on HIV (Rikard et al., 2012). In another study, two interactive low-literacy educational workbooks were developed for African Americans with psychotic disorders in collaboration with service users, providers, and graphic designers (Broussard et al., 2014). These workbooks were written at the fifth-grade level and contained storylines with comic-strip illustrations featuring African-American characters, which service users and providers found useful and understandable (Broussard et al., 2014). Similarly, over a 2-year period, our team used Boot Camp Translation, a novel community-based participatory research (CBPR) tool, to engage community members, academics, and health professionals in a predominantly African-American community facing extensive health and social inequities. Through facilitated group discussions and consensus building, we developed and disseminated culturally targeted health communication campaigns to improve health literacy on depression (“Depression is Real”), HIV (“We're in Control Now!”), and childhood asthma (“Every Child with Asthma Needs an Asthma Action Plan”) (Community Research Louisville, n.d.; Muvuka, Combs, Ali, Scott, & Williams, 2020). The CBPR examples also highlight that health literacy needs can be more effectively addressed by multidisciplinary teams comprising community stake-holders, diverse health professionals, and academics, among several others.
In African-American communities, the Black church is a powerful resource for health literacy initiatives. Using CBPR, Tucker et al. (2019) trained church leaders and selected church goers from 21 Black churches to deliver a 6-week church-based health promotion intervention comprising individual coaching, group discussions, and physical activity. At post-test, this initiative significantly increased nutritional health literacy (measured using the Newest Vital Sign; mean difference = 1.20, p < .001) and health behaviors (e.g., nutrition and physical activity) in the intervention group (mean difference = 0.76, p < .001) (Tucker et al., 2019). Similarly, Dulchavsky, Riffin, Johnson, Cogan, and Joseph (2014) installed health information touchscreen kiosks in four Black churches to improve health literacy and found self-reported changes in at least one behavior in more than 85% of users 1 to 2 years later.
Conclusions
There are significant gaps in the literature concerning health literacy barriers and interventions in African-American communities. We conclude, as do D'Eath, Barry, and Sixsmith, (2012), that research on effective approaches for improving health literacy in populations that experience health disparities should be prioritized. Specifically, the health information delivery preferences of African Americans in diverse settings warrants further exploration (D'Eath et al., 2012; Spruill et al., 2015). Of particular interest would be examining the role of technology or digital platforms in reaching African Americans with LHL. Additionally, because many health literacy interventions are health system-focused, more research on community-based health literacy interventions is needed (Logan et al., 2015). Furthermore, we need to examine the determinants of LHL, particularly in racial/ethnic minority populations, and the mechanisms through which they interfere with health literacy development.
Given the multidimensional and multifactorial nature of health literacy, collaborative and multipronged solutions are necessary to ensure sustainable improvements. Health literacy barriers should be addressed on both supply (i.e., health system) and demand side (i.e., consumers). Examples of supply-side interventions include establishing user-friendly and culturally sensitive health system navigation processes, engaging consumers in developing interventions, and tailoring health communication approaches. In addition, health care providers and organizations should be trained to identify and accommodate consumers with unique health literacy, cultural, and linguistic needs.
Ultimately, achieving sustainable improvements in health literacy among African Americans requires tackling broader systemic barriers. This requires developing supportive institutions and policies to eliminate systemic racism and reduce inequities in access to quality education, employment, income, and health-related resources (Wallace, 2015). Considering that health literacy “crosses multiple boundaries, professions and jurisdictions” (Mitic & Rootman, 2012), there is a need for multisectoral and participatory health literacy approaches that engage diverse stakeholders such as community members, faith leaders, the health care sector, nonhealth sectors, policymakers, and academic institutions (Mitic & Rootman, 2012; US Department of Health and Human Services, 2010). Improving health literacy among African Americans should be a critical component of strategies to achieve health equity (Logan et al., 2015).
Ali N.M., Combs R.M., Muvuka B., Ayangeakaa S.D. (2018). Addressing health insurance literacy gaps in an urban African American population:Aqualitative study. American Journal of Community Health, 43, 1208–1216 10.1007/s10900-018-0541-x.
Al Sayah F., Majumdar S. R., Egede L. E., Johnson J. A. (2015). Associations between health literacy and health outcomes inapredominantly low-income African American population with type2diabetes. Journal of Health Communication, 20(5), 581–588 10.1080/10810730.2015.1012235 PMID: 25826448
Anderson M. (2015). Racial and ethnic differences in how people use mobile technology. Pew Internet and American Life Project. https://www.pewresearch.org/fact-tank/2015/04/30/racial-and-ethnic-differences-in-how-people-use-mobile-technology/
Berkman N. D., Sheridan S. L., Donahue K. E., Halpern D. J., Crotty K. (2011). Low health literacy and health outcomes: An updated systematic review. Annals of Internal Medicine, 155(2), 97–107 10.7326/0003-4819-155-2-201107190-00005 PMID: 21768583
Bertera E. M. (2014). Storytelling slide shows to improve diabetes and high blood pressure knowledge and self-efficacy: Three-year results among community dwelling older African Americans. Educational Gerontology, 40(11), 785–800 10.1080/03601277.2014.894381
Bhattacharya G. (2013). Contextualizing disparity reduction in rural health care:Acall to action. Journal of Family Social Work, 16(1), 86–100 10.1080/10522158.2012.736079
Bickmore T. W., Paasche-Orlow M. K. (2012). The role of information technology in health literacy research. Journal of Health Communication, 17(Suppl. 3), 23–29 10.1080/10810730.2012.712626 PMID: 23030559
Broussard B., Radkins J. B., Compton M. T. (2014). Developing visually based, low-literacy health education to ols for African Americans with psychotic disorders and their families. Community Mental Health Journal, 50(6), 629–636 10.1007/s10597-013-9666-7 PMID: 24633539
Community Research Louisville.(n.d.). About us. https://communityresearchlouisville.com
Choi N. G., Dinitto D. M. (2013). The digital divide among low-income homebound older adults: Internet use patterns, eHealth literacy, and attitudes toward computer/Internet use. Journal of Medical Internet Research, 15(5), e93 10.2196/jmir.2645 PMID: 23639979
D'Eath M., Barry M., Sixsmith J. (2012). Rapid evidence review of interventions for improving health literacy. European Centers for Disease Prevention and Control. https://ecdc.europa.eu/sites/portal/files/media/en/publications/Publications/1205-TER-Improving-Health-Literacy.pdf
DeWalt D. A., Callahan L. F., Hawk V. H., Broucksou K. A., Hink A., Rudd R., Brach C. (2010). Health literacy universal precautions toolkit. Agency for Healthcare Research and Quality. https://www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/quality-resources/tools/literacy-toolkit/healthliteracytoolkit.pdf
DeWalt D. A., Broucksou K. A., Hawk V., Brach C., Hink A., Rudd R., Callahan L. (2011). Developing and testing the health literacy universal precautions toolkit. Nursing Outlook, 59(2), 85–94 10.1016/j.outlook.2010.12.002 PMID: 21402204
Dulchavsky S. A., Ruffin W. J., Johnson D. A., Cogan C., Joseph C. L. (2014). Use of an interactive, faith-based kiosk by congregants of four predominantly, African-American churches inametropolitan area. Frontiers in Public Health, 2, 106 10.3389/fpubh.2014.00106 PMID: 25140296
Estacio E. V. (2013). Health literacy and community empowerment: It is more than just reading, writing and counting. Journal of Health Psychology, 18(8), 1056–1068 10.1177/1359105312470126 PMID: 23349398
Foulk D., Carroll P., Wood S. N. (2001). Addressing health literacy:Adescription of the intersection of functional literacy and health. American Journal of Health Studies, 17(1),7– 14 http://www.nald.ca/library/research/gillis/community/community.pdf
Fox S., Duggan M. (2012). Mobile health 2012. Pew Internet and American Life Project. http://www.pewinternet.org/2012/11/08/mobile-health-2012/
Freire P. (1970). Pedagogy of the oppressed. Herder and Herder.
Gee G. C., Ford C. L. (2011). Structural racism and health inequities: Old issues, new directions. Du Bois Review, 8(1), 115–132 10.1017/S1742058X11000130 PMID: 25632292
Gillis D. E. (2004).Acommunity-based approach to health literacy using participatory research. Adult Learning, 15(1–2), 14–17 10.1177/104515950401500104
Goodman M. S., Gaskin D. J., Si X., Stafford J. D., Lachance C., Kaphingst K. A. (2012). Self-reported segregation experience throughout the life course and its association with adequate health literacy. Health & Place, 18(5), 1115–1121 10.1016/j.healthplace.2012.04.010 PMID: 22658579
Hossain W. A., Ehtesham M. W., Salzman G. A., Jenson R., Calkins C. F. (2013). Healthcare access and disparities in chronic medical conditions in urban populations. Southern Medical Journal, 106(4), 246–254 10.1097/SMJ.0b013e31828aef37 PMID: 23558412
Hur I., Lee R., Schmidt J. J. (2015). How healthcare technology shapes health literacy?Asystematic review. 21st Americas Conference on Information Systems. https://pdfs.semanticscholar.org/0b8d/92a0b60e49157886384e07eccf4efe824b52.pdf
Ingram R.R. (2012). Using Campinha-Bacote's process of cultural competence model to examine the relationship between health literacy and cultural competence. Journal of Advanced Nursing, 68(3), 695–704. 10.1111/j.1365-2648.2011.05822.x
Kelly P. A., Haidet P. (2007). Physician overestimation of patient literacy:Apotential source of health care disparities. Patient Counselling and Health Education, 66(1), 119–122 10.1016/j.pec.2006.10.007 PMID: 17140758
Kindig D. A., Panzer A. M., Nielsen-Bohlman L(Eds.). (2004). Health literacy:Aprescription to end confusion. National Academies Press. https://www.nap.edu/catalog/10883/health-literacy-a-prescription-to-end-confusion
Krebs P., Duncan D. T. (2015). Health app use among US mobile phone owners:Anational survey. JMIR mHealth and uHealth, 3(4), e101 10.2196/mhealth.4924 PMID: 26537656
Kutner M., Greenburg E., Jin Y., Paulsen C. (2006). The health literacy of America's adults: Results from the 2003 National Assessment of Adult lLteracy. National Center for Education Statistics. http://nces.ed.gov/pubs2006/2006483.pdf
Lanning B. A., Doyle E. I. (2010). Health literacy: Developingapractical framework for effective health communication. American Medical Writers Association Journal. https://cdn.ymaws.com/www.amwa.org/resource/resmgr/journal/Issues/2010/2010v25n4_online.pdf
Lariscy R., Reber B., Paek H. (2010). Examination of media channels and types as health information sources for adolescents: Comparisons for black/white, male/female, urban/rural. Journal of Broadcasting & Electronic Media, 54(1), 102–120 10.1080/08838150903550444
Lee J. Y., Divaris K., DeWalt D. A., Baker A. D., Gizlice Z., Rozier R. G., Vann W. F. Jr. (2014). Caregivers' health literacy and gaps in children's Medicaid enrollment: Findings from the Carolina Oral Health Literacy Study. PLoS One, 9(10), e110178 10.1371/journal.pone.0110178 PMID: 25303271
Logan R. A., Wong W. F., Villaire M., Daus G., Parnell T. A., Willis E., Paasche-Orlow M. K. 2015. Health literacy:Anecessary element for achieving health equity. National Academy of Medicine Perspectives. https://nam.edu/perspectives-2015-health-literacy-a-necessary-element-for-achieving-health-equity/
Long S. K., Kenney G. M., Zuckerman S., Goin D. E., Wissoker D., Blavin F., Hempstead K. (2014). The health reform monitoring survey: Addressing data gaps to provide timely insights into the affordable care act. Health Affairs, 33(1), 161–167 10.1377/hlthaff.2013.0934 PMID: 24352654
Mantwill S., Monestel-Umaña S., Schulz P. J. (2015). The relationship between health literacy and health disparities:Asystematic review. PLoS One, 10(12), e0145455 10.1371/journal.pone.0145455 PMID: 26698310
McCleary-Jones V., Scheideman-Miller C., Rev Dorn J. A. Jr., Johnson B., Overall M., Dwyer K. (2013). Health information technology use and health literacy among community-dwelling African Americans. Association of Black Nursing Faculty Journal, 24(1), 10–16 PMID: 23589966
Meppelink C. S., Smit E. G., Diviani N., Van Weert J. C. (2016). Health literacy and online health information processing: unraveling the underlying mechanisms. Journal of Health Communication, 21(Suppl. 2), 109–120 10.1080/10810730.2016.1193920
Mitic W., Rootman I. (2012). An inter-sectoral approach for improving health literacy for Canadians:Adiscussion paper. Public Health Association of British Columbia. http://phabc.org/wp-content/uploads/2015/09/IntersectoralApproachforHealthLiteracy-FINAL.pdf
Mullen E. (2013). Health literacy challenges in the aging population. Nursing Forum, 48(4), 248–255 10.1111/nuf.12038 PMID: 24188436
Mullins C. D., Blatt L., Gbarayor C. M., Yang H.-W. K., Baquet C. (2005). Health disparities:Abarrier to high-quality care. American Journal of Health-System Pharmacy, 62(18), 1873–1882 10.2146/ajhp050064 PMID: 16141106
Muvuka B., Combs R.M., Ali N.M., Scott H., Williams M.T. (2020). Depression is real: Developingahealth communication campaign in an urban African American community. Progress in Community Health Partnerships: Research, Education, and Action, 14(2), 161–172 10.1353/cpr.2020.0029
Noonan A. S., Velasco-Mondragon H. E., Wagner F. A. (2016). Improving the health of African Americans in the USA: An overdue opportunity for social justice. Public Health Reviews, 37, 12 10.1186/s40985-016-0025-4 PMID: 29450054
Ownby R. L., Acevedo A., Waldrop-Valverde D., Jacobs R. J., Cabal-lero J. (2014). Abilities, skills and knowledge in measures of health literacy. Patient Education and Counseling, 95(2), 211–217 10.1016/j.pec.2014.02.002 PMID: 24637163
Parker R. M. (2012). Health literate practices can facilitate state health insurance exchange communication. Journal of Health Communication, 17(3), 372–375 10.1080/10810730.2012.670020 PMID: 22439691
Perrin A. (2017). Smartphones help blacks, Hispanics bridge some-but not all-digital gaps with whites. Pew Internet and American Life Project. https://www.pewresearch.org/fact-tank/2017/08/31/smart-phones-help-blacks-hispanics-bridge-some-but-not-all-digital-gaps-with-whites/
Pew Research Center. (2018). Mobile fact sheet. Pew Internet and American Life Project. http://www.pewinternet.org/fact-sheet/mobile/
Politi M. C., Kaphingst K. A., Kreuter M., Shacham E., Lovell M. C., McBride T. (2014). Knowledge of health insurance terminology and details among the uninsured. Medical Care Research and Review: MCRR, 71(1), 85–98 10.1177/1077558713505327 PMID: 24163306
Prins E., Mooney A. (2014). Literacy and health disparities. New Directions for Adult and Continuing Education, 2014(142), 25–35 10.1002/ace.20092
Quincy L. (2012). Measuring health insurance literacy:Acall to action. Consumers Union, University of Maryland, & American Institute of Research. http://consumersunion.org/pub/Health_Insurance_Literacy_Roundtable_rpt.pdf
Rajaram S. S., Bockrath S. (2014). Cultural competence: New conceptual insights into its limits and potential for addressing health disparities. Journal of Health Disparities Research and Practice, 7(5), 82–89.
Rikard R. V., Thompson M. S., Head R., McNeil C., White C. (2012). Problem posing and cultural tailoring: Developing an HIV/AIDS health literacy toolkit with the African American community. Health Promotion Practice, 13(5), 626–636 10.1177/1524839911416649 PMID: 22102601
Ross L., Ashford A. D., Bleechington S. J., Dark T., Erwin D. O. (2010). Applicability ofavideo intervention to increase informed decision making for prostate-specific antigen testing. Journal of the National Medical Association, 102(3), 228–236 10.1016/S0027-9684(15)30529-0 PMID: 20355352
Rudd R. E. (2007). Health literacy skills of U.S. adults. American Journal of Health Behavior, 31(1, Suppl. 1), S8–S18 10.5993/AJHB.31.s1.3 PMID: 17931141
Saha S., Beach M. C., Cooper L. A. (2008). Patient centeredness, cultural competence and healthcare quality. Journal of the National Medical Association, 100(11), 1275–1285 10.1016/S0027-9684(15)31505-4 PMID: 19024223
Scrimshaw S. C. (2019). Science, health, and cultural literacy inarapidly changing communications landscape. Proceedings of the National Academy of Sciences of the United States of America, 116(16), 7650–7655 10.1073/pnas.1807218116
Sentell T. L., Halpin H. A. (2006). Importance of adult literacy in understanding health disparities. Journal of General Internal Medicine, 21(8), 862–866 10.1111/j.1525-1497.2006.00538.x PMID: 16881948
Smith A. L. (2003). Health policy and the coloring of an American male crisis:Aperspective on community-based health services. American Journal of Public Health, 93(5), 749–752 10.2105/AJPH.93.5.749 PMID: 12721136
Somers S. A., Mahadevan R. (2010). Health literacy implications of the Affordable Care Act. http://www.chcs.org/media/Health_Literacy_Implications_of_the_Affordable_Care_Act.pdf
Spruill I., Pope C., Garrett-Mayer E., Zapka J., Davis B., Stubbs A., Freeman M. (2015, November 2). Ethno-cultural barriers to health literacy and Disease Management among African Americans in South Carolina[Paper presentation]. 7th Annual Health Literacy Research Conference, Bethesda, MD, United States. https://www.bumc.bu.edu/healthliteracyconference/files/2015/09/Spruill-health-literacy-oral-presentation3-r-final.pdf
Stewart D. W., Vidrine J. I., Shete S., Spears C. A., Cano M. A., Correa-Fernández V., McNeill L. H. (2015). Health literacy, smoking, and health indicators in African American adults. Journal of Health Communication, 20(02), 24–33. 10.1080/10810730.2015.1066465. PMID: 26513028
Tucker C. M., Kang S., Ukonu N. A., Linn G. S., DiSangro C. S., Arthur T. M., Ralston P. A. (2019).Aculturally sensitive church-based health-smart intervention for increasing health literacy and health-promoting behaviors among black adult churchgoers. Journal of Health Care for the Poor and Underserved, 30(1), 80–101 10.1353/hpu.2019.0009
Tuskegee University.(n.d.). USPHS syphilis study. https://www.tuskegee.edu/about-us/centers-of-excellence/bioethics-center/about-theusphs-syphilis-study
U.S. Department of Health and Human Services. (2010). National action plan to improve health literacy. https://health.gov/communication/HLActionPlan/pdf/Health_Literacy_Action_Plan.pdf
Vernon J. A., Trujillo A., Rosenbaum S., DeBuono B. (2007). Low health literacy: Implications for national health policy. Department of Health Policy, School of Public Health and Health Services, The George Washington University. https://publichealth.gwu.edu/departments/healthpolicy/CHPR/downloads/LowHealthLiteracyRe-port10_4_07.pdf
Villaire M., Mayer G. (2009). Health literacy: The low-hanging fruit in health care reform. Journal of Health Care Finance, 36(2), 55–59 https://www.ncbi.nlm.nih.gov/pubmed/20499721 PMID: 20499721
Volandes A. E., Paasche-Orlow M. K. (2007). Health literacy, health inequality andajust healthcare system. The American Journal of Bio-ethics, 7(11),5– 10 10.1080/15265160701638520 PMID: 18027287
Wallace S. P. (2015). Equity and social determinants of health among older adults. Generations, 38(4),6– 11 http://www.ingentaconnect.com/contentone/asag/gen/2014/00000038/00000004/art00002
Weekes C. V. (2012). African Americans and health literacy:Asystematic review. Association of Black Nursing Faculty Journal, 23(4), 76–80 PMID: 23311265
Baraka Muvuka, PhD, MPH, was a Graduate Research Assistant, School of Public Health and Information Sciences. Ryan M. Combs, PhD, MA, is an Assistant Professor, School of Public Health and Information Sciences. Suur D. Ayangeakaa, PhD, MPH, was a Graduate Research Assistant, School of Public Health and Information Sciences. Nida M. Ali, PhD, MPH, is a Postdoctoral Associate, School of Public Health and Information Sciences. Monica L. Wendel, DrPH, MA, is the Chair, Department of Health Promotion and Behavioral Sciences, and a Professor, School of Public Health and Information Sciences. Trinidad Jackson, MS, MPH, is a Senior Research Associate, Office of Public Health Practice, School of Public Health and Information Sciences. All authors are affiliated with the University of Louisville.
Grant: This study was supported by a grant from KentuckyOne Health.
Disclosure: The authors have no relevant financial relationships to disclose.
You have requested "on-the-fly" machine translation of selected content from our databases. This functionality is provided solely for your convenience and is in no way intended to replace human translation. Show full disclaimer
Neither ProQuest nor its licensors make any representations or warranties with respect to the translations. The translations are automatically generated "AS IS" and "AS AVAILABLE" and are not retained in our systems. PROQUEST AND ITS LICENSORS SPECIFICALLY DISCLAIM ANY AND ALL EXPRESS OR IMPLIED WARRANTIES, INCLUDING WITHOUT LIMITATION, ANY WARRANTIES FOR AVAILABILITY, ACCURACY, TIMELINESS, COMPLETENESS, NON-INFRINGMENT, MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. Your use of the translations is subject to all use restrictions contained in your Electronic Products License Agreement and by using the translation functionality you agree to forgo any and all claims against ProQuest or its licensors for your use of the translation functionality and any output derived there from. Hide full disclaimer
This work is published under https://creativecommons.org/licenses/by-nc/4.0 (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.
Abstract
LHL is an independent predictor of racial/ethnic disparities in health behaviors (e.g., smoking, adherence to HIV treatment), access to health care resources, and health outcomes (Al Sayah, Majumdar, Egede, & Johnson, 2015; Berkman et al., 2011; Hossain, Ehtesham, Salzman, Jenson, & Calkins, 2013; Lanning & Doyle, 2010; Mantwill, Monestel-Umaña, & Schulz, 2015; Sentell & Halpin, 2006; Stewart et al., 2015). The health care system has played a role in creating disparities in health literacy by historically failing to accommodate racial and ethnic minority populations' needs and preferences in the delivery of services and health information (Saha, Beach, & Cooper, 2008). [...]health care providers may not recognize the extent of this health literacy gap. [...]African Americans with LHL are less likely to use computers or the internet for health information (McCleary-Jones et al., 2013). [...]to reach a large number of people with LHL, online or digital health literacy interventions should incorporate features that tailor health information to individuals' health literacy needs, technical skills, health needs, as well as personal and cultural values (Bickmore & Paasche-Orlow, 2012; Hur, Lee, & Schmidt, 2015). Furthermore, a qualitative study by our research team examined health insurance literacy among 87 residents (young, middle-aged, and senior adults) of a predominantly African-American community and found that participants preferred in-person health insurance navigation delivered by culturally competent community health workers who are from or familiar with the community, trustworthy, nonjudgmental, and knowledgeable about health insurance (Ali et al., 2018).
You have requested "on-the-fly" machine translation of selected content from our databases. This functionality is provided solely for your convenience and is in no way intended to replace human translation. Show full disclaimer
Neither ProQuest nor its licensors make any representations or warranties with respect to the translations. The translations are automatically generated "AS IS" and "AS AVAILABLE" and are not retained in our systems. PROQUEST AND ITS LICENSORS SPECIFICALLY DISCLAIM ANY AND ALL EXPRESS OR IMPLIED WARRANTIES, INCLUDING WITHOUT LIMITATION, ANY WARRANTIES FOR AVAILABILITY, ACCURACY, TIMELINESS, COMPLETENESS, NON-INFRINGMENT, MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. Your use of the translations is subject to all use restrictions contained in your Electronic Products License Agreement and by using the translation functionality you agree to forgo any and all claims against ProQuest or its licensors for your use of the translation functionality and any output derived there from. Hide full disclaimer