The statistics regarding health literacy are alarming. According to some surveys, nearly 90 percent of people in the United States have limited or low health literacy. In the face of such dire numbers, service providers began employing community health workers to reach out to people living in medically underserved areas.
For her scholarly project in the Doctor of Nursing Practice (DNP) program at Carlow University, Angela Simmons explored the health literacy of the community health workers.
“Community health workers are people who are trusted in their community to provide health information to residents of medically underserved communities,” said Simmons. “Community service providers would deploy community health workers to follow up with residents to see if they are taking their medications and see if they know the reason why they were prescribed the medication.”
During the pandemic, community health workers were relied on to distribute accurate, essential information to people in their area. There was mistrust about vaccines in many segments of society, but particularly in African American communities, where there are historical accounts of unethical practices by some healthcare providers.
“We relied on community health workers to go into the community with accurate information so people could make an educated choice about taking the vaccine or not,” said Simmons.
In her project, Simmons learned that community health workers were dedicated to improving their neighbors’ health, but often were unprepared for questions they received due to gaps in their own health literacy.
“They would say things like, ‘I’m frustrated going to work because I don’t know how to address these questions,’” said Simmons, who also learned through her research that the community health workers, while lacking health literacy, aren’t lacking in education.
“Going into this project, I thought that most of these community health workers would only have a high school diploma, but I found many people have a master’s prepared education,” she said. “There was an assumption made that because they were better educated, they would be prepared to answer all the questions they would get from residents. However, healthcare has its own language. Someone with a PhD in history isn’t prepared to answer questions about cancer treatment or high blood pressure.”
Simmons concluded that education and training for community health workers would be essential.
“By improving community health workers’ health literacy and teaching them techniques, they would have some knowledge about what they were being asked to talk to residents about,” she said. “By doing this, there is a potential to impact patient care in a much greater way.”
Community health workers need basic education about vaccines and chronic disease management like diabetes, hypertension, and congestive heart failure.
“They need to be able to not only tell people what they need to do but also be able to give the reason why they need to do it,” Simmons said. “For example, when they talk to a stroke patient, they need to be able to explain to them why it is important that they check their blood pressure regularly, or, if someone is diabetic, why they need to take their insulin as prescribed.”
Simmons says more training will also address the community health workers’ frustrations about feeling inadequate to answer questions. She also felt that the additional training shouldn’t stop there.
“Additional training should extend to all front-line healthcare workers,” she said. “There are people who won’t ask a question of the doctor or a nurse but may ask it of others. Nurses’ aides, escorts, even the van drivers may get questions or hear comments from patients about their health. They need to be prepared to provide an answer, even if it is encouragement to ask a doctor or nurse.”