Health Care Providers and Health Literacy in Rural Populations: Bridging the Gap or Not?

Purpose: Health literacy affects health communication and health outcomes. Health care Providers are inherently responsible for the communication of health information. Millions of people in the United States lack the acceptable health literacy to manage their health care. Impaired understanding of health information, poor health status, limited understanding of preventive health services, including cancer screening decision making are a few of the issues resulting from poor health literacy. Low health literacy is prevalent among rural and minority populations. This study describes barriers and facilitators of addressing health literacy among a rural population.

Methods: A qualitative purposive sample of 12 health care providers with rural-dwelling patients and practicing in five counties in a Southeastern state were interviewed. Narratives were analyzed using the descriptive and thematic analysis approaches. A content analysis was completed and associated memos were created after the analysis. Each transcript was read, the text was searched for major themes, and subcategories by the individual researchers until all transcripts were completed. Throughout the coding process comparative methods were used to illuminate similarities and differences between data.  

Results: The average age of providers was 47 (SD = 13.67; Range 30 to 66). Seventy-five percent of the sample self-identified as African American (N = 9), 17% were Non-Hispanic white (N = 2), and one provider self-identified as Asian. Sixty-seven percent (N = 8) of the sample were physicians and the rest were nurse practitioners. Four were male and eight were female. There were no specific tools indicated by health care providers to measure health literacy. This was identified as a major barrier to addressing the health literacy. Two themes identified as perceived facilitators were “Trust and Rapport” and “Sitting and listening” a healthcare provider describes his way of addressing health literacy “I always take time out of the assessment to just sit with them and let them explain to me how they’re feeling, that builds a rapport with them, releases some of that feeling of anxiety, and then from there we talk about what’s going on and try to get an understanding of everything.” The use of simple terms were also identified by many health care providers a way to facilitate addressing health literacy. 

Conclusion: Bridging the health literacy gap is two-fold. A need for assess individual for health literacy was identified. Additionally, identifying barriers and facilitators in managing health literacy in the clinical setting is imperative. Trust and rapport, along with opportunities to openly talk and be listened to were identified by health care providers as facilitators to increasing communication, addressing health literacy issues. Taking time to explain, using simple easy to understand language were successful strategies used to reduce the health literacy barrier.