 |
|
||||||||||||
|
Defining Health Literacy Our initiative uses Ratzan and Parker’s (2000) definition of health literacy as “the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions.” In our work with immigrants, we found that the Ratzan and Parker definition was somewhat narrow for our needs. Its focus on individual capacity to obtain and understand health information contrasted with responses from immigrant elders who told us of the importance of family and community connections in accessing healthcare. For many immigrant elders, health literacy was not an individual matter, but one which was intimately connected to family and community networks which provided resources such as cultural knowledge about the U.S. healthcare system and bilingual translation. Health literacy, from the standpoint of an immigrant elder, requires not only the ability to read and understand the literal text on a medicine bottle or a doctor’s spoken instructions, but the equally complicated tasks associated with accessing and navigating the healthcare system. These tasks include locating and accessing competent and affordable healthcare, finding transportation, understanding benefits, identifying translation resources, and interacting with doctors, nurses, medical technicians, billing clerks, appointment secretaries and others to advocate for oneself in order to receive quality care and make informed decisions about healthcare. Health literacy is a critical need for all segments of society. According the Journal of the American Medical Association, 46% of American adults lack the functional literacy to navigate the healthcare system in the United States. Functional health literacy levels are even lower among non-native speakers of English. A study of 2,659 low-income patients at two public hospitals found that 61.7% of non-native English speaking patients lack the literacy skills adequate to function in the healthcare settings. 42% of the patients in this study could not understand the instruction to “take medication on an empty stomach” and 60% were unable to read and understand a standard consent form (Williams, Parker and Baker et. al. 1998). Literacy levels directly affect patients’ ability to understand disease processes, to engage in disease prevention and early detection, and to comply with therapeutic routines. In order to successfully manage chronic diseases such as hypertension and diabetes, patients must be active participants in their care, making lifestyle modifications and taking medication consistently. Immigrant elders learning English through SHINE have already identified that their participation has improved their access to healthcare. A Hmong elder in Minneapolis commented, “…I go through my days better. The first time I used a translator and now I can go to see the doctor … by myself. And now I am a translator for others.” Effective, culturally appropriate health education materials, geared to the language and literacy abilities of immigrant elders, are essential for elders to acquire health literacy and to access health care resources. MetLife Foundation Health Literacy Initiative Objectives Project SHINE-MetLife Foundation Health Literacy Initiative builds partnerships among universities and community based-organizations nationally to address the health literacy needs of elderly immigrants and refugees. The project endeavors to: · Increase the ability of elder immigrants to communicate with health care providers and access health care; · Increase opportunities for college students from diverse backgrounds to learn about and address the health literacy needs of immigrant elders; · Increase the cultural competency of future health care professionals; · Develop culturally appropriate health literacy curriculum geared to the literacy abilities of elder immigrants and; · Build the capacity of university students, ESL instructors and adult education administrators serving immigrant elders to incorporate health literacy topics into their classes and educational programs. Needs Assessment of Health Literacy for Immigrant Elders Our investigation into the health literacy needs of older immigrants in Philadelphia, PA and San Jose, CA has confirmed that tremendous confusion and uncertainty exists among immigrant elders regarding their eligibility for health benefits and services, their ability to understand medical instructions, communicate with their doctors and other health professionals, and maintain their health and well-being. In the first year, ten focus group and seventeen in-depth individual interviews were conducted with elderly immigrants as part of the needs assessment in Philadelphia and San Jose. Information about immigrant and refugee elders’ views toward the health care system and their health literacy needs was solicited from 101 individuals representing seven major language groups: Cambodian, Chinese, South Asian (Hindi, Gujarati and Marathi), Korean, Russian, Spanish, and Vietnamese. In order to better understand the complexity of issues faced by this population, additional insights were collected from professionals in the fields of health care, senior services, immigration and English as a Second Language. Temple University nursing students and San Jose State University’s gerontology students assisted in the needs assessment. Students from these universities, with guidance from supervising faculty members, investigated demographic and health statistics of immigrant communities and conducted community needs analyses. Although elders expressed a strong desire to improve their language skills in order to communicate more effectively in medical settings, they recognized that effective communication is a shared responsibility. Recommendations from this needs assessment include training in intercultural communication for health professionals and interdisciplinary collaboration in the development and implementation of advocacy-oriented health literacy curricula. Curricula should include information about the healthcare system and patients’ rights as well as strategies for developing language, literacy and communication skills in healthcare settings. The report summarizing the findings from this needs assessment is currently being edited for publication and will be disseminated to ESL, immigration, health care and senior service providers through professional associations, state offices on aging, refugee and immigrant organizations and other appropriate venues. Preliminary findings of focus groups and interviews with immigrant elders are currently available. Health Literacy Curriculum Development In order to develop curriculum materials to meet the interests and needs identified through focus groups and interviews, health literacy ESL classes were organized in Philadelphia which have large populations of immigrant elders. Approximately 50 elders participated in these classes which were offered from April through June, 2004, providing a “laboratory” for curriculum development. To build the capacity of current and future ESL instructors and assist them in the process of creating lessons and thematic units for their classes, SHINE staff facilitated five curriculum development and planning meetings. Curriculum development meetings were attended by the health literacy ESL teachers, SHINE staff, and a professor of nursing from Temple’s School of Allied Health who provided content-specific expertise and helped determine what degree of health education was appropriate for an ESL classroom and what kind of information was best provided by specialists in a medical setting. Together with their elder immigrant learners, each teacher selected two main topics of greatest interest to their class from a list of health literacy topics, which was developed based on input from elders in the focus groups. Teachers used “Learners’ Lives as Curriculum” (Weinstein, 1999) as a point of departure, capturing stories about students’ experiences with healthcare in the United States to develop language and literacy skills and generate subsequent lessons. Teachers further developed their health literacy lessons into cohesive units organized thematically and structured around a matrix based on the sociolinguistic concept of communicative competence (Canale and Swain 1980; Hymes 1966; Hornberger 1989). Five of the thematic units entitled, The Doctor’s Office, The Hospital, Managing Illnesses, Healthy Aging, and Taking Medications were selected for revision. Each of these units is being adapted for use by teachers and tutors working with beginning and intermediate learners and were revised. Units are currently being field tested nationally. In the second year, SHINE sites in Northridge CA; San Francisco, CA; and Utica, NY have joined Philadelphia and San Jose in implementing this initiative. Replication sites are field-testing the health literacy units at various community organizations serving a wide range of immigrant groups. So far, approximately 400 immigrants and refugees have attended health literacy ESL classes offered by the initiative and learned communication skills needed for their healthcare encounters. Feedback from ESL instructors and students from these classes are gathered to inform further development of the units. SHINE replication sites have generated new health literacy projects that strengthen the partnerships between the universities and community organizations in the area. The project involves a wide range of allied-health departments such as Nursing, Gerontology, Occupational Therapy, Medical Interpreting, Health Science and Health Education. Participating allied-health students offer services for immigrant elders through various activities such as conducting health workshops, providing health screenings and exercise classes, planning and implementing community health fairs, developing health related materials, and tutoring in ESL classrooms utilizing our health literacy materials. The SHINE-MetLife Foundation Health Literacy Initiative began in 2003, with a generous grant from MetLife Foundation. For more information about the SHINE-MetLife Foundation Health Literacy Initiative or the Health Literacy Units, please contact: Hitomi Yoshida For more information about Project SHINE, please contact: |
||||||||||||
