Creative Methods for Improving Health Literacy in Underserved Communities
In 2003, Recovery Café was founded with the goal of providing long-term recovery support to those in the margins, including those experiencing homelessness, addiction, and mental health challenges (Recovery Café, 2022). Recovery Café provides members with the support needed to gain and maintain access to housing, social and health services, healthy relationships, education, and employment (Recovery Café, 2022). Recovery Café provides this support by offering a safe space, with nutritious meals, fostering a loving community, and providing resources such as educational opportunities, 12-step meetings, and referral services (Recovery Café, 2022). In 2022, the Seattle Pacific University Lydia Green Nursing Program partnered with Recovery Café to determine and fulfill an unmet need of the organization and its members. After visiting Recovery Café and completing a windshield survey, the undergraduate nursing students determined a need for health information, presented in an appealing and accessible way. To address this need, a collection of double-sided educational sheets with a word search puzzle on the front and information on the back, were created on the following topics: COVID-19, drug overdose prevention, sexual health, Type 2 Diabetes, vaccinations, and Hepatitis. These sheets were designed to provide an educational resource about relevant health topics that is creative, fun, and utilizes easy readability and inclusive language.
Health literacy refers to the ability of people to access, understand, and use information to make decisions related to their health (Castro-Sanchez et al., 2016). It has been estimated that a third of adults in the United States are considered low level in terms of health literacy, with prevalence in the populations of older adults, those with low income, and those with low education level (Netemeyer et al., 2019). Consequently, low health literacy levels are associated with poorer health outcomes, including increased use of emergency services, lower adherence to health protocols, and inaccurate assessments of disease risk (Netemeyer et al., 2019). Unfortunately, public health entities do not always take health literacy levels into consideration when developing and dispersing complex public health information to communities. In the process of determining community health needs at Recovery Café, it was found that 69% of members at the café were experiencing homelessness in 2020, while 87% of members had experienced homelessness sometime in the past (“2019-20 Annual Report”, 2021). A vast majority of members also possessed education and reading levels lower than the high-school level. These demographic statistics speak to the income and education level of members at Recovery Café, demonstrating how health literacy levels may be low as well. Considering the health literacy level of this community and the subsequent need for improved accessibility to appropriate public health information, the nursing students created digestible health education fact sheets with activities to increase understanding.
Studies have shown that crossword and word search puzzles are effective self-learning tools that can reinforce previously acquired knowledge (Nirmal et al., 2020). Utilizing this study, the team developed six educational fact sheets focused on community health needs with corresponding word search puzzles. The primary goal of the word search puzzles was to increase engagement with health material and increase information retention. Community health needs were determined through interviewing Recovery Café members and staff, leading the students to focus on COVID-19, drug overdose prevention, sexual health, Type 2 Diabetes, vaccinations, and Hepatitis. Each fact sheet provides essential health information and resources for the Recovery Café members, while the corresponding word search reinforces the material. The primary nursing diagnosis associated with the Recovery Café population was deficient knowledge of health topics. The team utilized up-to-date and peer-reviewed information to create our health sheets to increase health literacy in this population. The educational level of Recovery Café members also led to the decision to refine our health information and present it so that any member, regardless of literacy level, could comprehend the information. The health education word searches were placed alongside the coloring sheets and community resources on the main activity table of Recovery Café. This puzzle-based learning engages the members of Recovery Café in the fact sheet's material, thereby increasing their competence with the topic and their ability to retain the material (Nirmal et al., 2020).
The project’s first outcome goal was to educate the members of Recovery Café about different health concerns (e.g., COVID-19, drug overdose prevention, sexual health, Type 2 Diabetes, vaccinations, and Hepatitis). A limitation was that there are many health concerns at Recovery Café that need to be addressed. To address this limitation, each group member focused on a specific health problem so that education could be provided on as many topics as possible. The next outcome goal was to create fact sheets that improve the health literacy among the members. A limitation to this goal was that most members at the Recovery Café read between 5th to 8th grade levels. To avoid these limitations, the students took medical terms and simplified them as much as possible and gave definitions within the word searches on words that might be harder to understand. The last outcome goal was to provide an incentive or an activity to keep the members engaged and want to learn more about these health concerns. A limitation was finding an activity that will encourage members to pick up the fact sheets and keep their interest. Avoiding this limitation was quite difficult, but since the Recovery Café has coloring nights, karaoke nights and other engaging activities available, the team decided that a word search with the fact sheets might be the best way to keep the members engaged. However, due to time constraints, these are the desired outcomes, and the team will not be able to evaluate whether they have been met.
In conclusion, the mission was to meet with the individuals at Recovery Café and discover what nursing students could do to provide them with the help that they might need. Learning about the history of this community center encouraged us to become more engaged in terms of figuring out some new methods to further provide for this community. The population at Recovery Café described a need for health education in a way that members can easily understand. This includes topics such as COVID-19, drug overdose prevention, sexual health, Type 2 Diabetes, vaccinations, and Hepatitis. Our idea of creating word search puzzles and fact sheets adequately demonstrates the main information these individuals need to know. Taking into consideration their education level and condition, the students made sure to create pieces of information that would make sense to them, is appealing to the eye, and would encourage them to become more engaged in learning more about these health topics. This method will further improve their knowledge deficit regarding topics that are important for them to be wary about and improve overall health literacy.
American Diabetes Association. (n.d.). Help with insulin is a phone call away. https://insulinhelp.org/
Banta-Green, C., Kuszler, P., Coffin, P., & Schoeppe, J. (2011). Washington’s 911 Good Samaritan Drug Overdose Law - Initial Evaluation Results. Alcohol & Drug Abuse Institute, University of Washington. http://adai.uw.edu/pubs/infobriefs/ADAI-IB-2011- 05.pdf
Carusone, S. C., Guta, A., Robinson, S., Tan, D. H., Cooper, C., O’Leary, B., Prinse, K. D., Cobb, G., Upshur, R., & Strike, C. (2019). Maybe if I stop the drugs, then maybe they’d care? —hospital care experiences of people who use drugs. Harm Reduction Journal, 16(1). https://harmreductionjournal.biomedcentral.com/articles/10.1186/s12954-019- 0285-7#citeas
Castro-Sánchez, E., Chang, P. W. S., Vila-Candel, R., Escobedo, A. A., & Holmes, A. H. (2016). Health Literacy and Infectious Diseases: Why does it matter? International Journal of Infectious Diseases, 43, 103–110. https://doi.org/10.1016/j.ijid.2015.12.019
Centers for Disease and Control Prevention. (March 25, 2022). COVID-19 information for specific groups of people. https://www.cdc.gov/coronavirus/2019-ncov/need-extra- precautions/index.html
Centers for Disease and Control Prevention. (April 15, 2022). Frequently asked questions about COVID-19 vaccination. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/faq.html
Centers for Disease and Control Prevention. (2020, September 9). Hepatitis B vaccines. https://www.cdc.gov/vaccinesafety/vaccines/hepatitis-b-vaccine.html
Centers for Disease and Control Prevention. (Feb 25, 2022). How to protect yourself & others. https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/prevention.html
Centers for Disease and Control Prevention. (July 14, 2021). How COVID-19 Spreads. https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/how-covid- spreads.html
Centers for Disease and Control Prevention. (2021, November 18). Key facts about seasonal flu vaccine.https://www.cdc.gov/flu/prevent/keyfacts.htm#:~:text=to%2060%20percent.- ,Flu%20vaccination%20has%20been%20shown%20in%20several%20studies%20to%20 reduce,to%20those%20who%20were%20unvaccinated
Centers for Disease Control and Prevention. (2022, April 12). STD Facts - HIV/AIDS & stds. Centers for Disease Control and Prevention. Retrieved May 4, 2022, from https://www.cdc.gov/std/hiv/stdfact-std-hiv.htm
Centers for Disease and Control Prevention. (March 22, 2022). Symptoms of COVID-19. https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html
Centers for Disease and Control Prevention. (2021, August 6). Tdap (Tetanus, Diphtheria, Pertussis) Vaccine: What You Need to Know. https://www.cdc.gov/vaccines/hcp/vis/vis- statements/tdap.pdf
Centers for Disease Control and Prevention. (2022, September 27). Viral Hepatitis. Centers for Disease Control and Prevention. Retrieved May 4, 2022, from https://www.cdc.gov/hepatitis/index.htm
Centers for Disease Control and Prevention. (2020, July 28). What is Viral Hepatitis? Centers for Disease Control and Prevention. Retrieved May 4, 2022, from https://www.cdc.gov/hepatitis/abc/index.htm
Centers for Disease and Control Prevention. (March 22, 2022). What to do if you are sick. https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/steps-when-sick.html
Centers for Disease and Control Prevention. (2022, April 27). Why get a covid-19 vaccine. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/vaccine-benefits.html
Country Doctor Community Health Centers. (2021). Country Doctor Community Clinic. https://cdchc.org/clinic/country-doctor/
Country Doctor Community Health Centers. (2021). After Hours Clinic. https://cdchc.org/clinic/after-hours-clinic/
Goyal, R., & Jialal, I. (2021, September 28). Diabetes Mellitus Type 2. National Library of Medicine: StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK513253/
Hawk, M., Coulter, R. W., Egan, J. E., Fisk, S., Reuel Friedman, M., Tula, M., & Kinsky, S. (2017). Harm reduction principles for healthcare settings. Harm Reduction Journal, 14(1). https://doi.org/10.1186/s12954-017-0196-4
HealthPoint. (2022). Evergreen. https://www.healthpointchc.org/find-clinics/evergreen-campus HealthPoint. (2022). Cynthia A. Green family center. https://www.healthpointchc.org/find-
Hinkle, J. L., Cheever, K. K. (2018). Assessment and management of patients with hepatic disorders. Lippincott’s CoursePoint for Hinkle & Cheever: Brunner & Suddarth’s Textbook of Medical-Surgical Nursing, 14, 1377-1426.
Koepsel, E. R. (2016). The power in pleasure: Practical implementation of pleasure in sex education classrooms. American Journal of Sexuality Education, 11(3), 205–265. https://doi.org/10.1080/15546128.2016.1209451
Naisteter, M. A., & Sitron, J. A. (2010). Minimizing harm and maximizing pleasure: Considering the harm reduction paradigm for sexuality education. American Journal of Sexuality Education, 5(2), 101–115. https://doi.org/10.1080/10627197.2010.491046
Netemeyer, R. G., Dobolyi, D. G., Abbasi, A., Clifford, G., & Taylor, H. (2019). Health Literacy, health numeracy, and trust in doctor: Effects on key patient health outcomes. Journal of Consumer Affairs, 54(1), 3–42. https://doi.org/10.1111/joca.12267
Nirmal, L., Muthu, M., & Prasad, M. (2020). Use of Puzzles as an Effective Teaching-Learning Method for Dental Undergraduates. International Journal of Clinical Pediatric Dentistry, 13(6), 606–10. https://dx.doi.org/10.5005%2Fjp-journals-10005-1834
Miller, L. (2022, April 19). Drug overdose symptoms: What happens when you overdose. American Addiction Centers. https://americanaddictioncenters.org/overdose
Our World In Data. (May 3, 2022). Cumulative confirmed COVID-19 cases and deaths. https://ourworldindata.org/explorers/coronavirus-data-explorer? facet=none&uniformYAxis=0&Metric=Confirmed+cases&Interval=Cumulative
Recovery Café. (2021, January 6). 2019-20 annual report. Recovery Café. Retrieved May 18, 2022, from https://recoverycafe.org/blog/rc_report/2019-20-annual-report/
Recovery Café. (2022). History/About. Recovery Café. Retrieved May 18, 2022, from https://recoverycafe.org/about/history/
Washington State Department of Health. (n.d.). Overdose education and Naloxone distribution. https://doh.wa.gov/you-and-your-family/drug-user-health/overdose-education-naloxone- distribution
Lance, Grace; Clark, Riley; Reid, Beth; McLauchlan, Makenzie; Nguyen, Jenny; and Maningat, Kiara, "Creative Methods for Improving Health Literacy in Underserved Communities" (2022). Nursing Leadership in Community Engagement Projects. 15.
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