Health literacy and socio-cultural tailoring of health promotion education for public housing neighborhoods

A significant percentage of the US population has low literacy skills. Low literacy skills contribute to health disparities as it negatively impacts a person's response to health information, state of health and health management. Cultural preferences and health literacy impact comprehension and engagement in educational programs designed to improve health behaviors and outcomes. This project was an outgrowth of a partnership among academicians, health workers, and community members to promote smoking cessation. The purpose of the project was to identify and tailor the literacy, health literacy and socio-cultural preferences of intervention materials used in a smoking cessation study. Using Donabedian's structure-process-outcome model, multiple methods were used to evaluate the existing structures (i.e., literacy levels of participants, readability of the materials, and socio-culturally preferences). These methods included focus groups, quantitative and qualitative evaluations of literacy of the participants and the materials, personal interviews and field notes. Processes for revision of the materials included consultation with literacy and visual design experts and multiple field testing with neighborhood residents. The final smoking cessation materials, written at the 4th grade reading level, integrated tailored socio-cultural themes of spirituality, collectivism, and kinship. This project incorporated best practices for provision of health education to low literacy populations using written materials with visual graphics to explain major concepts and bulleted texts with large font, monosyllabic words and simple sentences. This project has enabled healthcare workers to serve individuals and the target population more effectively, and to employ strategies that reduce health disparities in this community.