SPOTLIGHT

Teens Battle Low Health Literacy in Their Communities

As a member of the Institute of Medicine committee that wrote the report Health Literacy: A Prescription to End Confusion, Bill Smith learned firsthand that 90 million Americans from all walks of life suffer the consequences of low "health literacy," or difficulty understanding and acting on health information. He found the links between poor health literacy, high health care costs, and disparities in care sobering, but what galvanized him to action was the realization of how little attention the issue is getting at the community level.

Smith, the executive vice president of the Academy for Educational Development (AED), spurred his organization to partner with the IOM in coordinating a project to "map" the health resources in two model communities -- one urban, the other suburban -- and lay a foundation for improving health literacy in these and other communities. IOM's Kellogg Health of the Public Fund and AED provided financial support for the initiative.

The "Community YouthMapping" was carried out by two teams of high school students, one from the Harlem Children's Zone based in Harlem, N.Y., and the other from the Pinellas County 4-H Youth As Resources program, which covers St. Petersburg and Clearwater, Fla. AED staff trained teens in data-entry and communication skills as well as the challenges posed by lack of health literacy. But then it was up to the students to canvass pharmacies, clinics, and other health care organizations; collect written materials and analyze them for readability; and interview fellow citizens about their understanding of health information.

The teens' findings paint both a grim and encouraging picture of existing services and gaps. Anthony George, a member of the Harlem youth team reported counting zero physicians' offices along two 25-block stretches in Harlem as compared to 119 doctors' offices along a same-sized stretch in the Upper East Side. As a result, the relatively small number of clinics that are situated in the 7.5 square mile area of Harlem that the team surveyed were crowded and marked by long wait times.

Still, the team praised the staffs of the mobile health vans that serve the community, and Alexis Tripp and Artrese Reid pointed to two community outreach programs as role models. The teens visited a total of 46 health care organizations and analyzed the content of more than 300 print and online forms of health information. For low-income communities where people often rely on public transportation, outreach initiatives and the clustering of a range of health services near public transportation are particularly important actions, the teens concluded.

The Pinellas County youth team hit the streets to hear from fellow residents about how easy it is to comprehend health information. Of the 301 people they interviewed, 197 reported knowing someone who has experienced trouble reading or understanding information dispensed by their physician or pharmacist, team member Tyler Butler noted. More than two-thirds of the health care organizations they visited reported that low health literacy is a serious problem and almost one-third acknowledged that they haven't tested their written materials with audiences or made them available in multiple languages.

On the plus side, the Pinellas teens found that more than three-quarters of the 135 items of printed and online health information they analyzed were easy to read and understand, Takia West said. These materials could be further improved with larger print and greater brevity.

Though the teens must now turn their attention to schoolwork, their efforts on health literacy are not necessarily ended. They plan to present their findings to additional stakeholders in their communities and are finalizing video documentaries that can encourage other communities to begin similar projects to prevent problems that arise from trouble understanding health information -- something that Harlem team member Todd Holland says he is now personally prepared to handle. "I don't want it to happen to my family, but if it does, I'll be ready."   -- Christine Stencel