"Health Information Accessibility and Availability and Its Impact on the Health Literacy of Hispanics"
Jennifer StoneJennifer Stone graduated from the University of Wisconsin-Madison in 2010 with a double major in Biology and Spanish. She is currently working as an associate research specialist in the Pathology Unit at the Wisconsin National Primate Research Center with the plan of applying to Medical School in the future. This research project was done as part of an English Composition course taught by Rebecca Lorimer who also advised Jennifer throughout the course of the project.
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DiscussionAfter surveying five healthcare provider locations in a mid-sized Midwestern city and their corresponding websites, several trends were noted. The findings of the survey of health information both in print and online as well as the entire information-gathering process was found to be quite surprising and frustrating as well. The first trend noted was the lack of actual printed materials available, which seemed quite unusual. Only a few years ago, health pamphlets were a very common commodity that could be found at a variety of locations, especially at healthcare provider locations. However after speaking to several employees at pharmacies and hospitals, the general feeling was that one of the reasons for a lack of printed health information had mainly to do with the constant changes and discoveries in this type of information. It appears that the economy has a part to play in this lack of printed health information as well. Many employees cited the lack of materials to the cost to print the materials (and re-print when a change needed to be made) and the manpower needed to distribute and change these materials. Rather than having printed health information materials available, the healthcare provider locations have moved their materials mostly onto the internet, an act which could be causing many people to be unable to access health information. Another trend noted was the lack of resources available in Spanish. Every healthcare provider and website visited had much less and less varied information available in Spanish. At the physical provider locations, the only information that was found was information about diabetes and smoking cessation, a very limited view of the possible health questions and problems that a Hispanic person could face. This type of information about lifestyle problems that was available in Spanish carries certain cultural assumptions with it that could be both damaging and offensive and which could lead to further implications and problems other than just poor health literacy. The Spanish-language information available online was much greater and more varied (which is not exactly saying much, in comparison to the sparsity of printed resources) but was often not accessible to Hispanic people due to the way the websites were designed and their use of English. Of the four health provider websites visited, only one, the UW Hospitals website, had health information available in Spanish. All of the other websites contained enormous amounts of health information in English, but none in Spanish. However, although the UW Hospital’s website did contain information in Spanish, most of it was completely inaccessible to Spanish-monolingual Hispanic people and was somewhat challenging to find for a bilingual or English-speaking person as well. While it originally seemed that the lack of availability of Spanish language resources would be the main contributor to the poor health literacy of Hispanics, several other interesting trends and possible contributors to the health literacy problem were discovered, including the lack of easily accessible health information and the shift of printed to online materials. The lack of easy access to health information creates a hurdle to the improvement of health literacy in Hispanics as well as other groups. Finding health information appears to be a much more arduous task than it once used to be. The entire process of trying to find health information seems to be an endless process of visiting locations (without actually having any success) and talking to multiple people unable to actually direct anyone to a definite location of health information. This process is overwhelming and confusing even to an English-speaking, college-educated researcher who knows exactly what she is looking to find and who would be assumed to have very high health literacy. Imagine how confusing and challenging this would be if a person did not know what she was looking for, spoke little to no English, or was assumed to have very low health literacy. The online search for health information is not much better for a predominantly Spanish speaker. On the only website that contained health information in Spanish (www.uwhealth.org), the majority of the available health information was hidden deep within the website in a location that would make no sense to the average person and that could, in general, only be found by accident while exploring the site. Hidden within a list of diseases and conditions were the Spanish translations (with English titles) of some health information sheets. A study looking at the Health Information National Trends Survey from 2005 demonstrated that 80% of Spanish-speaking Hispanics had never looked for cancer information, and compared to English-speaking people, Spanish-speaking Hispanics found their information search took a lot of effort, was hard to understand, and was frustrating (Vanderpool et al, 2009). It is sad and disconcerting that finding information about health and wellness is such an impossible act when a person can simply step outside of her house or visit the internet and be bombarded with copious amounts of advertisements about every other aspect of life. The observed trend of the shift of health information from printed materials to online materials has created yet another challenge for Spanish-monolingual Hispanics, Hispanics with low English proficiency, and people of other groups attempting to obtain health information. While the internet may technically be an easier and more comfortable place to obtain health information, the digital divide demonstrates that there is a split between those who have the ability to access the internet and those who do not. Studies have found that between 32 and 55 percent of Hispanic people use the internet (Schroeder et al, 2003). This leaves many Hispanic people unable to obtain written health information without having to go through the confusing process of accessing it at a healthcare provider location. Studies also have found that fewer Hispanics (28.9%) use the internet to search for health information compared to non-Hispanic whites (35.6%) (Peña-Purcell, 2008). These numbers are quite low for both Hispanics and non-Hispanic whites and demonstrate the impact that the shift from printed to online health resources has on a Hispanic person’s ability to access health information. While few Hispanics actually use the internet for health information, they do generally agree that online health information is useful in improving the understanding of medical conditions and treatments (Peña-Purcell, 2008). To further complicate the impact of health information availability and accessibility on the health literacy of Hispanic people, studies have shown that non-print materials are actually more important sources of health information than printed materials. Only 15 percent of those with below basic levels of health literacy said they used the internet for health information whereas 62 percent of those with proficient levels of health literacy admitted that they used the internet for health information. Also, those with below basic levels of health literacy were least likely to use written resources (43 percent indicated they used these resources infrequently) (America’s Health Literacy, 2008). These facts combined with the small area that was surveyed for health information indicate that more studies should be done to better understand the impact of written health information on the health literacy of Hispanics. While the city in which the research was conducted does have an estimated 12,649 Hispanic people, locations with higher concentrations of Hispanics should also be studied in the future (U.S. Census Bureau Detailed Table, 2008). Finally, while this study focused on websites associated with the physical locations surveyed, further studies should also take into account popular health information websites such as WebMD and the Mayo Clinic in order to better understand how these popular resources and their presentations of health information affect the health literacy of Hispanics.
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