Barriers to Addressing Health Literacy in Rural Communities

When individuals have adequate levels of health literacy, it increases their ability to understand and use relevant health information to make informed decisions related to health and well-being. A more complex healthcare system demands higher levels of health literacy from people and organizations. Rural communities may have lower health literacy rates and experience limited resources. These factors can create inequities in health outcomes and can influence how community members interact with the healthcare system.

Many rural residents experience frequent challenges to accessing and navigating the healthcare system and, in some cases, obtaining health information. Rural communities often experience unique needs based on their geographic location and remoteness. Additional needs may include a lack of healthcare providers within certain regions or limited access to culturally and linguistically adapted materials that meet the needs of residents.

Improving health literacy can be challenging for reasons related to rural healthcare systems, community factors, and other non-healthcare-related reasons. The Patient Safety Network (PSN) identified important factors and considerations related to health literacy in healthcare settings that also pertain to rural patients, including:

• Most written health information materials use language that exceeds the reading level of the intended audience.
  • The receipt of the materials alone is not enough. Comprehension and understanding of health information is key to improving health outcomes.
  • Some patients may have disparities between written and verbal fluency, and stigma around low literacy levels may lead to exaggeration of reading ability.
• Communication barriers impact verbal interactions between patients and providers.
  • Conversations are often brief, involving complex medical jargon, and from a patient perspective can feel largely one-sided. Patients should be engaged in a way that makes them feel comfortable and able to listen and ask questions.
  • In rural areas with fewer healthcare providers overall, a lack of culturally and ethnically diverse healthcare providers that reflect the population can lead to distrust and ineffective communication.
  • Clear and open communication between patients and providers plays a major role in treatment adherence to help prevent serious health complications and hospitalizations.

The National Action Plan to Improve Health Literacy highlights other non-healthcare challenges and social determinants of health that impact levels of health literacy. Many rural communities continue to experience these disparities, including:

• Conditions associated with living in poverty, like health insurance status (being un- or under-insured can impact health literacy levels)
• Low educational attainment, which is often associated with more limited levels of health literacy
• Racial and ethnic minority groups with limited English proficiency who report having low health literacy levels
• A lack of resources and infrastructure to address limited health literacy
  • For example, approximately 22% of rural Americans and 28% of tribal communities lack access to broadband. Broadband has been shown to improve access to education and telehealth services.

For more examples of challenges and barriers to addressing health literacy and other social determinants of health in rural areas, see the Social Determinants of Health in Rural Communities Toolkit.

Resources to Learn More

Health Literacy: Hidden Barriers and Practical Strategies
Website
A PowerPoint presentation with speaker's notes for group dissemination or self-study that highlights the impact of health literacy on patient outcomes and identifies evidence-based approaches for achieving higher health literacy.
Organization(s): Agency for Healthcare Research and Quality (AHRQ)

Left Out: Barriers to Health Equity for Rural and Underserved Communities
Document
A report discussing the structural and root causes of inequity in health and the healthcare system. Emphasizes the role that racism and discrimination play in care delivery and provision, especially for communities of color and rural populations.
Organization(s): Committee on Ways and Means Majority U.S. House of Representatives
Date: 7/2020