Health Literacy and Systemic Racism—Using Clear Communication to Reduce Health Care Inequities

Coleman, Cliff; Birk, S.A.; DeVoe, Jennifer E.

doi:10.1001/jamainternmed.2023.2558

Cited by 11 publications

(5 citation statements)

References 7 publications

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“…Initial skepticism of Covid-19 vaccines related to historical medical mistrust was likely another factor; during the early vaccine rollout, receipt of vaccinations was lower among Black people 23 ; however, decreased disparities in all-cause mortality in Black people coincided with increased vaccine uptake later in 2021, suggesting successful messaging from trusted leaders. 24 To prepare for future pandemics, efforts to protect high-risk groups-utilizing evidence-based policy, equitable distribution of resources, and improving infrastructure-are essential. To achieve this level of preparation, systemic factors must be addressed.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Age-Specific All-Cause Mortality Disparities by Race and Ethnicity During the COVID-19 Pandemic

Faust,

Renton,

Bongiovanni

et al. 2024

Preprint

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BACKGROUNDThe end of the public health emergency provides an opportunity to fully describe disparities during the Covid-19 pandemic.METHODSIn this retrospective cohort analysis of US deaths during the Covid-19 public health emergency (March 2020-April 2023), all-cause excess mortality and years of potential life lost (YPLL) were calculated by race or ethnicity overall and by age groups (ages <25 years, 25-64 years, ≥65 years). Temporal correlations with Covid-19-specific mortality were measured.RESULTS>1.38 million all-cause excess deaths and ~23 million corresponding YPLL occurred during the pandemic. Had the rate of excess mortality observed among the White population been observed among the total population, >252,300 (18%) fewer excess deaths, and >5,192,000 fewer (22%) YPLL would have occurred. The highest excess mortality rates were among the American Indian/Alaska Native (AI/AN, 822 per 100,000; ~405,700 YPLL) and the Black (549 per 100,000; ~4,289,200 YPLL) populations. The highest relative increase in mortality was observed in the AI/AN population (1.34; 95% CI 1.31-1.37), followed by Hispanic (1.31; 95% CI 1.27-1.34), Native Hawaiian or Other Pacific Islander (1.24; 95% CI 1.21-1.27), Asian (1.20; 95% CI 1.18-1.20), Black (1.20; 95% CI 1.18-1.22) and White (1.12; 95% CI 1.09-1.15) populations. Greater disparities occurred among children and adults <65 years.CONCLUSIONSExcess mortality occurred in all groups during the Covid-19 pandemic, with disparities by race and ethnicity, especially in younger and middle-aged populations. >252,000 and 5.2 million fewer YPLL would have been observed had increases in mortality among the total population been similar to the White population.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Age-Specific All-Cause Mortality Disparities by Race and Ethnicity During the COVID-19 Pandemic

Faust,

Renton,

Bongiovanni

et al. 2024

Preprint

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“…Building trust is crucial to ensuring that families feel welcome and at ease [62]. Ensuring that systems are health literate is one piece of the puzzle, especially because health literacy is an interaction influenced by both individual and societal contexts [65]. When systems do not meet the needs of their users, distrust festers and barriers are erected.…”

Section: Discussionmentioning

confidence: 99%

Organizational Health Literacy as a Tool for Health Equity: Application in a High-Risk Infant Follow-Up Program

Rosenfeld,

McCullagh,

King

et al. 2023

Children

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Background: Healthy People 2030 emphasizes personal health literacy (individual skills) and organizational health literacy—the degree to which organizations equitably enable individuals to find, understand, and use information and services to inform health-related decisions and actions for themselves and others. However, research on the latter is in the early stages. Methods: This study describes an organizational health literacy assessment in a U.S. urban academic children’s hospital. A variety of evidence-based health literacy assessments were used to assess patient information materials and the environment, including institutional practices, navigation, culture and language, and communication. Trained interviewers and analysts reached consensus for all assessments. Results: Information Items: SMOG scores (n = 9) ranged from 7th- to 14th-grade reading level (average = 11.3). PEMAT-P scores (n = 9) ranged from 43.8% to 93.8% understandability and 0% to 80% actionability. CDC CCI scores (literacy demand) (n = 6) ranged from 18.2% to 58.8% (≥90% = excellent). SAM scores (suitability) (n = 6) fell in the “adequate” range (43.2–58.3%). The PMOSE/IKIRSCH scores (complexity) (n = 3) noted low-moderate difficulty. Apter’s Hierarchy (n = 4) revealed three numeracy domains (50% = descriptive purposes and decision-making, 100% = interpreting information). Organization-level: Walking interviews highlighted organizational facilitators and barriers related to the pre-visit and visit environments. HLE2 domain scores ranged from 52% to 68%. Conclusions: Organizational health literacy demands far outweigh the average literacy skills of adults in the U.S. (patients and staff). Findings can be used to hone quality improvement and other processes to focus on structural solutions to increase health equity.

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“…Without explicit health literacy training that alerts them to the use of jargon and helps them substitute more familiar words and phrases, physicians may be hampered in communicating clearly with their patients, especially as a number of national initiatives have highlighted the need for improving medical communication. 6 , 12 – 16 …”

Section: Introductionmentioning

confidence: 99%

A Game-Based Tool for Reducing Jargon Use by Medical Trainees

Burney,

Arora,

Gaillard

et al. 2024

MedEdPORTAL

Self Cite

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Introduction Physicians can be unaware that many US adults have intermediate or lower health literacy. Avoiding medical jargon in patient communication can improve poor outcomes associated with lower health literacy, but physicians may struggle to do so as health literacy education is neither standardized nor universal at US allopathic medical schools. As with other skills-based proficiencies in medical education, repeat exposure and active learning help build competency. Medical students developed the Patient Communication Challenge (PCC), an adaptation of the Hasbro game Taboo, to facilitate practice of patient-centered communication skills among medical trainees. Methods Hour-long workshops were held for groups of preclinical medical students. Students watched a communication exemplar video, played the PCC game, and completed a postworkshop survey. To play, two teams competed to earn points by identifying medical concepts as explained by a teammate who described the term without using medical jargon. Results Evaluations indicated that the game was enjoyable and reinforced didactic concepts through active learning, with self-reported participant satisfaction and competency gain. Overall, 59% of participants (53 of 90) completed postworkshop surveys; 91% (48 of 53) agreed they felt more proficient in avoiding jargon, 94% (50 of 53) would recommend the workshop to a classmate, and 100% (53 of 53) would play again. Discussion The PCC can help early medical trainees develop health communication skills through gamification with utilization of adult learning principles and adequate frequency for skill retention. Future applications include longitudinal assessment and expanding to later stages of medical training and other health professions.

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Health Literacy and Systemic Racism—Using Clear Communication to Reduce Health Care Inequities

Abstract: This Viewpoint describes why people need health information that is easy to understand to make informed decisions about health care and why this is necessary to avoid systemic racism.

Cited by 11 publications

References 7 publications

Age-Specific All-Cause Mortality Disparities by Race and Ethnicity During the COVID-19 Pandemic

Age-Specific All-Cause Mortality Disparities by Race and Ethnicity During the COVID-19 Pandemic

Organizational Health Literacy as a Tool for Health Equity: Application in a High-Risk Infant Follow-Up Program

A Game-Based Tool for Reducing Jargon Use by Medical Trainees

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