Population Considerations for Health Literacy Programs
When implementing a rural health literacy program, it is important to consider the unique characteristics of the populations being served. Specific population groups that rural health literacy programs may consider include:
- Youth and adolescents
- Older adults
- People with disabilities
- Tribal communities
- Racial and ethnic minority groups
- People with limited English proficiency
Youth and Adolescents
Teaching health literacy skills at a young age may improve cognitive, physical, and emotional development processes for youth and may help with health decision-making in the future. Health literacy programs implemented through early educational programs and school-based interventions can help improve health literacy skills including health decision-making. Programs working with youth to improve health literacy should consider ways to tailor messages and content for specific age groups and use a variety of methods to present the information to help comprehension. It is also important to incorporate approaches that empower youth and adolescents to fully engage with program materials and to encourage youth to speak up when they are presented with information they do not understand. Health literacy programs may wish to include family members and other peer community groups in youth-based interventions since they play a prominent role in shaping children and adolescents' attitudes, beliefs, knowledge, and health literacy skills.
Low health literacy is a contributing factor of morbidity and mortality among older adults in the U.S. Research has shown that cognitive aging may begin to influence health literacy skills among older adults with chronic disease, which ultimately affects healthcare decision-making. For example, older adults may have difficulty adhering to and administering medications. When implementing health literacy programs for older adults with chronic diseases, it is important to address medication adherence and administration. Examples of topics may include how to read medication labels and understand dosage and how to properly take the medication. These skills can improve older adults' health literacy levels and improve their knowledge about medication adherence and treatment regimens.
People with Disabilities
According to 2017-2021 data from the American Community Survey, the disability rate is 14.8% in rural communities, which is higher than the disability rate in urban areas. People with disabilities who live in rural areas may experience more challenges accessing health information and additional barriers related to understanding health information. Health literacy programs should ensure all information and materials are accessible to people with vision, hearing, and cognitive disabilities.
Several important considerations and strategies for communicating with people with a disability include:
- Use people-first language, which is respectful language that emphasizes the person first before their disability
- Highlight a person's abilities and not their limitations
- Emphasize the importance of accessibility
- Avoid using any language that could be hurtful or stigmatizing
- Always ask people about their preferences in terms of the most accessible and inclusive language and communication
Tribal communities are generally found in rural areas and affected by disproportionately high rates of chronic disease and morbidity and are less likely to be insured compared to their White counterparts. Additionally, American Indian and Alaska Native (AI/AN) populations are underrepresented in health research data as a result of historical misuse of AI/AN data and concerns over data governance. More research on the way tribal communities use and understand health information is needed. However, creating content that is culturally relevant is a critical first step when designing a health literacy program. It is important to note that this process may take time, as tribal customs and practices vary greatly from one tribe to another. Because of this, a one-size-fits-all approach should be avoided. One study suggests using methods such as storytelling and metaphors for sharing health information. An example of a tribal community working to improve health literacy is the Navajo Area Indian Health Service and its program described in Navajo Wellness Model: Keeping the Cultural Teachings Alive to Improve Health.
- For information on service integration for tribal populations, see Considerations for Services Integration Programs for Tribal Populations in the Rural Services Integration Toolkit.
- For information on AI/AN populations and the social determinants of health and health equity, see Population Considerations for Addressing the Social Determinants of Health.
Racial and Ethnic Minority Groups
Like tribal communities, communities of color or racial and ethnic minorities may be less inclined to trust medical professionals and the healthcare system. Black communities in particular have been the subject of numerous medical studies where unethical principles were practiced. Black communities continue to experience increased health literacy barriers. Today, more research is being done to identify effective practices for creating, implementing, and sharing health information. Materials created for health literacy should be community-driven efforts that are tailored to highlight the cultural and linguistic strengths of a community. Using real-life examples and stories has shown to be an effective method for communicating health information. Additionally, research shows that using community health workers and community leaders as an intermediary between healthcare providers and patients can improve health outcomes for racial and ethnic minority groups.
Doña Ana County and Washington County Health Departments are two examples of programs aiming to improve health literacy among racial and ethnic minorities.
People with Limited English Proficiency
According to 2017-2021 American Community Survey data, approximately 4.75 million rural residents 5 years or older speak a language other than English at home. Within this population, 31.1% report speaking English less than “very well.” People with limited English proficiency (LEP) have difficulty communicating in English and may need additional help understanding written and spoken resources. When implementing health literacy programs, it is important to be aware of community language needs and preferences and to understand how many different languages are spoken by patients in the community. Program materials should be developed with this in mind and translated into as many different languages as represent the community. In many healthcare settings, in-person and virtual translators may be available to help people with LEP interact with their providers. In resource-limited settings, these translators may be less available, and programs may need to figure out alternative options for translation services.
The National Culturally and Linguistically Appropriate Services (CLAS) Standards include 15 steps that people and organizations can use when designing and implementing programs and services. The standards focus on communication and ways to improve health equity and quality of care. The standards provide guidelines to facilitate implementation of practices related to culturally and linguistically appropriate services to meet the needs and preferences of each person. Examples of the National CLAS Standards include:
- Provide services that respect the cultural, language, and health literacy needs of each person
- Provide language assistance and translation services to people with limited English proficiency and other communication needs to ensure equitable access to healthcare services
- Provide written and media materials and signage that account for the cultural and linguistic preferences of the communities being served
Resources to Learn More
C.L.A.S. Cultural Competence Training
Training for healthcare providers about the CLAS Standards and ways to implement best practices for improving health literacy and reducing health disparities for their patients.
Organization(s): University of North Texas Health Sciences Center
Guide for Individuals with Disabilities
Outlines several communication strategies for people with a wide range of disabilities.
Organization(s): University of Alaska Anchorage Center for Human Development
Disability and Health
Provides information and resources — including national legislation — supporting practices and policies to ensure the inclusion of people with disabilities into everyday activities.
Organization(s): Centers for Disease Control and Prevention (CDC)
English Proficiency (LEP) Resources
Lists a variety of resources offering support and guidance to individuals with limited English proficiency (LEP).
Organization(s): U.S. Department of Health & Human Services (HHS)
Research & Training Center on Disability in Rural
A research center working with disability communities to identify needs and find solutions that promote better outcomes for individuals with disabilities living in rural communities.
Organization(s): University of Montana Research & Training Center on Disability in Rural Communities
Think Cultural Health: Resources
Offers a collection of resources including recorded presentations, videos, how-to guides, and tools related to the National CLAS Standards as well as other information about addressing cultural and linguistic competency and improving health equity.
Organization(s): U.S. Department of Health & Human Services, Office of Minority Health (OMH)