How the Interaction of Residents and Community Institutions Impacts Health Literacy and How It Can Leveraged to Improve Health Care Access

Aims: While the volume of research on how the built and social environment impacts health continues to grow, our knowledge about the social mechanisms through which place or context-related effects manifest is still limited. The cross-pollination of public health and sociology-rooted research on the social determinants of health has been fruitful. Important gaps remain unaddressed, however. The primary objective of this project is to develop a communication-based model of neighborhood health effects, which can be applied to improve health care access and disease-specific health literacy in diverse ethnic communities. Methods: Data were collected from African Americans and Hispanics in South Los Angeles (N=607) via a telephone survey (RDD), as well as community-based organizations, health care providers, and media serving the area (N=80) collected through face-to-face interviews. Regression analyses and structural equation modeling were employed to explore relationships between residents and organizational actors' communication interaction patterns, socio-demographic factors, health literacy around diabetes and hypertension, and health care access. Results: Analyses indicate that the extent to which individuals are connected to neighbors, local/ethnically-targeted media, as well as community-based organizations is an important factor in building health literacy. Institutional community actors can amplify the positive effects of being part of such a neighborhood-wide communication network, even in circumstances where their independent influence may be small or negligible. The significance of the interaction effect between residents and institutional level actors is even larger in the case of predicting health care access, although certain environmental factors may strongly and negatively influence this relationship.