Innovations in Health Literacy Research Workshop Summary (2011) / Chapter Skim
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3 The Role of Health Literacy in Health Disparities Research
3 The Role of Health Literacy in Health Disparities Research
Pages 7-22
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From page 7... ...
The models do show, however, that health disparities are multifacto rial, resulting from the interaction of a variety of factors: socioeconomic and environmental (where people live, neighborhood conditions) , psycho social factors (stress, exposure to discrimination)
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It is interesting to note, Cooper said, that health disparities research has evolved in a manner similar to health literacy research. They both began by describing problems in different populations, then moved into
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In health disparities research, for example, better measures are needed for determining specific ethnic groups and language ability. The same is true for health literacy measures, Cooper said.
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How key is the integration of disciplinary perspectives in fashioning a more powerful explanation of the phenomenon in question? There are many disciplines that have potential contributions to make to health literacy and health disparities research, including experts from behav ioral science, sociology, social work, speech and language, organizational behavior, social psychology, health services research, epidemiology, cul tural anthropology, bioethics, biostatistics, economics, cognitive psychol ogy, neuropsychology, education and learning, psychometrics, health TABLE 3.1 Contrasting Themes Health Literacy Health Disparities Low health literacy is potentially Population assignment usually not modifiable modifiable Literacy status not readily apparent Disparity category (e.g., race, gender, age)
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From page 11... ...
It creates research consortia, estab lishes interdisciplinary training initiatives, promotes interdisciplinary technology methods, and has a multiple PI policy. Perhaps health literacy and health disparities could be the next topic for the NIH Common Fund program.
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WILL IMPROVING HEALTH LITERACY REDUCE HEALTH DISPARITIES FOR VULNERABLE POPULATIONS? Dean Schillinger, M.D.
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• What evidence exists that health literacy interventions improve health for vulnerable populations? • What is the need for a "vulnerable populations approach" to improving health literacy?
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found that health literacy mediated the relationship between race and selfrated health and flu vaccine receipt, but not mammography or dental care. In the Prudential study, Howard and colleagues (2006)
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What Are the Hypothesized Mechanisms by Which Better Health Literacy Can Improve Health for Vulnerable Populations? There are several hypothesized mechanisms that link health literacy, health disparities, and health outcomes.
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What Evidence Exists That Health Literacy Interventions Improve Health for Vulnerable Populations? Turning to the question of whether health literacy intervention reduces disparities, there is much less data.
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From page 17... ...
Given the cluster of risks that vulnerable populations face -- food insecurity, food access problems, unsafe neighborhoods, and so on -- that are determined by social context, it is important to be realistic regarding expectations of what improving health literacy can do. Another important issue is whether attempts to affect individual health literacy will be hampered by the nature of health systems that dispropor tionately care for vulnerable populations.
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If better health literacy is to reduce health disparities, interventions will need to target vulnerable populations where they live and where they receive services. DISCUSSION Cindy Brach, Agency for Healthcare Research and Quality, said it makes sense to concentrate resources on the needs of vulnerable popu lations, but, she asked, what about approaches that appeal to a wide spectrum since they have the potential to benefit everybody?
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Cooper noted the commonality of themes between health disparities and health literacy research. Health disparities share the same concern about using universal approaches and standard quality improvements that could improve the situation overall, but may exacerbate disparities.
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One of the keynote speakers for next year's HARC meeting is Nicole Lurie, who served as the chair of IOM's Roundtable on Health Disparities and is someone who interacts with both academia and the real world. Rima Rudd, from the Harvard School of Public Health, sees the need to bring new people to the table.
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From page 21... ...
The health disparities field, as Schillinger mentioned, has moved into a socioecological framework, bringing in communities and using participatory approaches in order to increase understanding of and benefit to the community populations. Involving those who under stand more about measuring environmental context and social environ ment as well as physical environment and social policies will enhance the quality of health literacy research.
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From page 22... ...
Would there be value in prioritizing areas and taking on some tough ques tions? It seems that the complexity of the health care interface is less well understood as a contextual factor, but it provides a real opportunity for some interventions, for example, mammography rates among vulnerable populations may go up by having sameday mammography available at the clinic.
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