How CHWs Improve Equity Through Health Literacy 

By Teresa Wagner, DrPH, MS, CPH, RD/LD, CPPS, CHWI, DipACLM, CHWC

Community health workers (CHWs) bridge gaps in healthcare that lead to health disparities and help people navigate disconnected healthcare systems that marginalize racial and other vulnerable populations. Recent research reveals that our country continues to be plagued by health disparities based on structural inequities such as residential segregation and other social determinants of health. These issues can be compounded by low health literacy as a social determinant and other communication barriers.


Low Health Literacy: What’s at Stake?

Personal health literacy is defined by Healthy People 2030, the nation’s public health agenda for the next decade, as “the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.” Two decades of research has shown that nearly 9 out of 10 United States adults struggle at one time or another to use the everyday health information that is available to them in their healthcare facilities and larger community. This impacts their ability to perform essential tasks, such as determining the right amount of medication to give a sick child, following preventive health guidelines, and responding to a warning about a public health outbreak in their area. Considering the challenges people face, like correctly following public health outbreak protocols, the consequences of low health literacy can be deadly.

How CHWs Improve Equity Through Health Literacy: A Case Study 

In Mount Pleasant, a rural town located in Titus County, Texas, these health inequities played out as the COVID-19 pandemic raged. Mount Pleasant became a hotspot for cases among Hispanics, who were predominantly employed by local agriculture and manufacturing industries that require working in close quarters. In June 2021, Stanford University’s Big Local News reported that Titus County had 815 cases of COVID-19 per 100,000 people. This was far above the state average of 58 cases per 100,000 people. Meanwhile, the county’s 24.8% vaccination rate lagged behind the state’s 40.8% rate.

Asked to examine potential barriers to proper precautions and suggest action steps to lessen COVID-19 spread, SaferCare Texas hired a CHW. The CHW led a project exploring factors that contributed to fractured communication between Titus Regional Medical Center (TRMC)—Mount Pleasant’s medical facility—and the Hispanic community of Mount Pleasant.

CHWs serve as frontline public health workers who are trusted members of and/or have an unusually close understanding of the community served. In the case of Mount Pleasant, the CHW grew up in the town, went to high school and community college there, and had family working in essential industry during the pandemic. Serving as a liaison between medical and social services and the community, she assisted with conducting focus groups and found that the Hispanic community was not receiving public health outbreak information due to language and digital barriers. In other words, TRMC was not practicing organizational health literacy, defined by Healthy People 2030 as “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.” As an advocate for change and supported by SaferCare Texas, she explored the ways TRMC could improve access to information and the overall cultural competency of its services.

TRMC began providing information in Spanish on its website, as well as through more traditional channels, such as storefront signage, front door flyers, and mailings. It also leveraged churches and businesses. As a result, Mount Pleasant’s vaccination rate rose above the state average for a period. Long term, TRMC opened a bilingual clinic and a community clinic that employs a CHW to serve the needs of Mount Pleasant’s 60% Hispanic population.

We can empower neighborhoods and build on community voices through CHWs armed with the knowledge and skills to address structural inequities. As in the case of Mount Pleasant, CHWs can empower communities by advocating for long-term solutions that build from communities, their contributions, and their wisdom. Since CHWs are from the communities they serve, they can act as a bridge between community members and health/social services, while providing culturally competent health education, counseling, and support. CHWs therefore represent a key piece of the National Action Plan to Improve Health Literacy.

To Learn More

If you have CHWs or other trusted messengers in your area who might benefit from learning more about how to decrease social inequities, please refer them to our 4.5-hour continuing education training “Empowering Community Health Workers and Trusted Messengers to Address Inequalities,” developed with and for CHWs by two faculty at the University of North Texas Health Science Center and SaferCare Texas.

About the Author

Teresa Wagner

Teresa Wagner serves as Interim Director for SaferCare Texas, the state patient safety institute. She also serves as Clinical Executive for Health Literacy. In addition, she is an assistant professor in the Department of Personalized Health & Well-Being in the UNTHSC School of Health Professions and oversees the community health worker training center. Her research focuses on abating health disparities through health literacy often leveraging community health workers.

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