Community Participation Report

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Survey of Health Literacy in Bexar County San Antonio Health Literacy Initiative—Final Report^*

Introduction

In our daily lives, we are constantly bombarded with printed information. There are words on the foods we buy, words on the TV shows we watch, and even words on the roads we navigate. Imagine what it must be like to be unable to read these words or to be able to read them, but not understand what they mean. This is a reality for many people in the U.S. today in many settings, including the health setting. The Institute of Medicine reports that approximately one-half of American adults (about 90 million people) have difficulty understanding and acting on health information (Institute of Medicine, 2004). These are not just the people who have problems with literacy in general, but this also includes people who manage the rest of their lives very effectively. Problems with understanding and acting on health information transcend educational and socioeconomic boundaries. The result of this is that millions of people face serious challenges in maintaining or improving their health. Thus, the examination of health literacy issues is important for a variety of reasons.

Limited health literacy has been associated with a number of health issues, but one of the most pressing is that it impacts the quality of life. People with limited health literacy have been shown to have worse health outcomes than people with adequate health literacy (Baker, Schillinger, &, Gazmararian, 1996). They are also less likely to have knowledge about their disease and are less likely to seek preventive care and screening (Schillinger, et al., 2002; Williams, Baker, Parker, & Nurss, 1998). They are more likely to be hospitalized and more likely to misinterpret prescription drug information (Baker, et al., 2002; Williams, Baker, & Parker, 1995)

Limited health literacy has also been associated with higher health care costs. It is estimated that poor health literacy costs the health care system billions of dollars every year. In 2001, poor health literacy resulted in an estimated $32 to $58 billion in additional health costs (Center for Health Care Strategies, 2006). Another study estimates that it costs the health care system about $1,000 more to care for a person with inadequate health literacy during an inpatient hospital stay than it costs to care for a similar person with adequate health literacy (Institute of Medicine, 2004).

Recently, there is new interest among health professionals in the role that literacy skills play in people’s health in terms not only of outcomes, but also in decision-making processes. This has been marked by a remarkable increase in the number of research articles published in medical journals that are examining literacy issues in all areas of medicine including primary care, specialty care, and emergency care. However, these studies have relied primarily on convenience samples of patients who are accessing a health facility. They have not examined a general population and, further, have failed to examine specific cultural groups in any detail. The San Antonio Health Literacy Initiative (SAHLI) initiated a study to examine the health literacy of adults in Bexar County, Texas. The SAHLI is a collaboration of individuals who have organized to address the issue of health literacy in the San Antonio area. The vision of the SAHLI is that the people of San Antonio will develop skills and behaviors which achieve and maintain the best possible health for them, their families, and the community. The purpose of the Initiative is to bring together representatives from various entities, both public and private, to share their experiences and possible solutions in addressing low health literacy in San Antonio. A strategic planning session was conducted in November 2005. The major goals for the organization are to continue to host the health literacy conference and to become an official non-profit organization. The first San Antonio Health Literacy Conference was held October 8, 2005. As part of this project, the second San Antonio Health Literacy Conference was held October 13, 2006. The Initiative is actively pursuing becoming a non-profit organization. One future goal is to develop and implement a communication plan that includes having a cadre of speakers available to present information on health literacy along with prepared electronic presentations and fact sheets. The San Antonio Health Literacy Initiative believes it is important to have people available who can present information on this topic and highlight some of the same key points. Another long-term goal of the Initiative is to improve health literacy in San Antonio by developing and validating literacy interventions. The data that were collected for this study will be able to help with both of these future goals. It will help provide needed descriptive information about Bexar County that speakers can use when talking to others about health literacy and help point out some of the predictors of low health literacy in our area. Further, the data will help prioritize where interventions should be conducted by providing information on which groups and areas have the greatest need.

Goals for this project were as follows:

GOAL 1: To measure health literacy among adults in Bexar County, Texas.

GOAL 2: To disseminate results to community organizations and health associations in efforts to address interventions that will improve health outcomes in accordance with the guidelines set forth by the Health Collaborative.

Health literacy is a term that defines “the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions” (USDHHS, 2000). To successfully manage the health care system, a person must be able to access information, get health services, communicate with health care professionals about his/her illness, sign consent forms, understand treatment options, follow treatment plans, and deal with other concerns related to navigating healthcare settings. The problems compound for those people who do not speak English or who do not speak English fluently. With a large Hispanic and minority population in Bexar County, it is likely that language problems are a significant factor in health literacy. People who have limited literacy skills often have problems with the medical system, and this limitation frequently results in poorer health outcomes and increased medical care costs.

To examine the levels of health literacy in the San Antonio area, a cross-sectional survey of the population was conducted. At this time, there are no published data about health literacy in San Antonio or the surrounding areas. San Antonio is located within Bexar County and is the second largest city in the state. The American Community Survey (ACS) conducted by the U.S. Census Bureau estimates that, in 2004, the population of Bexar County was 1,493,965, up 7.3% from the official 2000 U.S. Census figure of 1,392,931. The 2000 Census reports that the racial composition of the county is 68.9% White, 7.2% Black, 0.8% Native American, 1.6% Asian, and 0.1% Pacific Islander. Nearly 18% of the population is “some other race” and 3.6% reported being of two or more races. Fifty-four percent of Bexar County residents are ethnically Hispanic or Latino. Eleven percent of residents report being born in a foreign country. Seventy-two percent of Bexar County residents are adults with a median age of 32.

The 2004 American Community Survey reports that 79.9% of Bexar County residents over age 25 are high school graduates, and 24.8% have earned a bachelors degree or higher. At home, 39% of residents speak a language other than English, which is twice the national the rate. Of these, 94% speak Spanish at home. The median family income of Bexar County is $46,193. Seventeen percent of residents and 14.6% of families live below the federal poverty level.