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
- 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 2016-2020 data from the American Community Survey, the
disability rate is 14.9% 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
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
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.
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 2016-2020 American Community Survey data, approximately
4.5 million rural residents 5 years or older speak a language other than English at home. Within this
population, 31.4% 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
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)